Rheumatoid Arthritis: Goldman JA

Goldman JA, Xia HA, White B, Paulus H. · Division of Rheumatology, Emory University School of Medicine, Medical Quarters 5555 Peachtree-Dunwoody Road, Atlanta, GA 30342-1711, USA. · Ann Rheum Dis. · Pubmed #17105853 No free full text.

Abstract: OBJECTIVE: To evaluate a modified American College of Rheumatology 20 (mACR20) scoring system for patients with rheumatoid arthritis. METHODS: The data were evaluated from one study on patients with methotrexate (MTX)-naive early rheumatoid arthritis (ERA) and another study on patients with DMARD-refractory late rheumatoid arthritis (LRA). For mACR20 scoring, acute-phase reactant measurements were excluded, and 20% improvement from baseline was determined by 2 or 3 of the 4 remaining ACR components. RESULTS: For full joint counts with data from patients with ERA, marked differences favoured 25 mg etanercept (ETN) over 10 mg ETN by using the unmodified ACR20 (69% v 55%), the mACR20(3 of 4) (63% v 49%) and the mACR20(2 of 4) (72% v 58%). An assessment of 28 joints showed similar findings. In the trial on patients with LRA, considerably more patients in both ETN groups achieved a clinical response compared with placebo by using the ACR20, the mACR20(3 of 4) and the mACR20(2 of 4), whether using full or 28 joint counts. The mACR20(3 of 4) and full joint counts with data on patients with ERA showed a marked difference between the MTX and 10 mg ETN groups (63% v 49%), which was not observed with the ACR20. CONCLUSION: Patterns of improvement indicated by mACR20 scores were consistent with standard ACR20 scores.

Gibofsky A, Palmer WR, Goldman JA, Lautzenheiser RL, Markenson JA, Weaver A, Schiff MH, Keystone EC, Paulus HE, Harrison MJ, Whitmore JB, Leff JA. · Department of Rheumatology, Hospital for Special Surgery, New York, NY, USA. · Curr Med Res Opin. · Pubmed #16393443 No free full text.

Abstract: OBJECTIVE: Rheumatoid Arthritis (RA) Disease-Modifying Anti-Rheumatic Drug (DMARD) Intervention and Utilization Study (RADIUS) is a unique, real-world, prospective, 5-year, observational study of over 10 000 patients with RA. RADIUS provides a snapshot of use patterns, effectiveness, and safety of DMARDs, biologics, and combination therapies used to manage RA in clinical practice. RESEARCH DESIGN AND METHODS: Patients with RA requiring a new DMARD or biologic (addition or switch) were eligible for the RADIUS study. Two separate patient cohorts were enrolled; RADIUS 1 patients initiated any new therapy at entry, and RADIUS 2 patients initiated etanercept at entry. Patient demographics and disease activity measures were collected at study entry, and baseline characteristics were summarized for various subgroups. Effectiveness, safety, and patterns of use will be tracked for therapies utilized during the 5-year study. RESULTS: RADIUS 1 enrolled 4959 patients, and RADIUS 2 enrolled 5102 patients, mostly at community private practices (88%). In RADIUS 1, most patients initiated methotrexate (MTX) monotherapy, followed by MTX in combination with a biologic (e.g. infliximab plus MTX) or other DMARD. In RADIUS 2, most patients initiated etanercept in combination with MTX, followed by etanercept monotherapy. When a new therapy was required, physicians tended to add another therapy versus switching therapies. Patients initiating a biologic had a longer duration of RA and more severe disease compared with patients initiating non-biologic therapy. CONCLUSIONS: These real-world data provide evidence of the prescribing practices of rheumatologists in 2001-2003. Future analyses will allow evidence-based comparisons of the long-term safety and effectiveness of DMARDs, biologics, and combination therapies to assist physicians in clinical decision-making.

Goldman JA, Hartman SS. · Department of Medicine, Division of Rheumatology and Immunology, Emory University School of Medicine, Atlanta, Georgia, USA. · MedGenMed. · Pubmed #16369392 links to  free full text

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Lai S, Goldman JA, Child AH, Engel A, Lamm SH. · Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD, USA. · J Rheumatol. · Pubmed #10990240 No free full text.

Abstract: OBJECTIVE: To examine possible relationships among fibromyalgia (FM, American College of Rheumatology 1990 criteria), hypermobility, and breast implants. METHODS: The medical records of 2,500 female patients (ages 25-65) who had been seen for the first time in a rheumatology practice in Atlanta, GA, during 1986-92 were abstracted and analyzed. In each analysis, patients whose records indicated that the patient met the full case criteria were compared with patients whose records had no indication of the disease. Patients whose medical records indicated the clinical onset of FM prior to breast implantation were identified. RESULTS: Univariate and multivariate regression analyses were performed, adjusting for age, income, and the presence of connective tissue disease or rheumatoid arthritis. Significant associations were found between hypermobility and FM (adjusted OR 2.20, 95% CI 1.73, 2.80) and between hypermobility and breast implantation (adjusted OR 1.80, 95% CI 1.19, 2.69). No association was found between breast implantation and subsequent FM (adjusted OR 0.74, 95% CI 0.42, 1.32). CONCLUSION: Hypermobility was found to be independently associated with both FM and with breast implantation, but FM and breast implantation were not found to be independently associated with each other.