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Rheumatology
Current Awareness Newsletter
September 2015
Outreach Your Outreach Librarian can help facilitate evidence-based practise for all Rheumatology staff, as well as assisting with academic study and research. We can help with literature searching, obtaining journal articles and books, and
setting up individual current awareness alerts.
Literature Searching We provide a literature searching service for any library member. For those embarking on their own research it is advisable to book some time with one of the librarians for a 1 to 1 session where we
can guide you through the process of creating a well-focused literature research and introduce you to the health databases
access via NHS Evidence.
Critical Appraisal Training We also offer one-to-one or small group training in
literature searching, accessing electronic journals, and critical appraisal/Statistics. These are essential courses that teach how to
interpret clinical papers.
For more information, email: [email protected]
Books Books can be searched for using SWIMS our online catalogue at
www.swims.nhs.uk. Books and journals that are not available on site or electronically may be requested from other locations.
Please email requests to: [email protected]
Contents
1: Tables of Contents from
September’s Rheumatology
journals
2: New NICE Guidance
3: Latest relevant Systematic
Reviews from the Cochrane
Library.
4: New activity in Uptodate
5: Current Awareness database
articles
Tables of Contents from Rheumatology journals
The links below will take you to the full Tables of Contents.
If you require full articles please email: [email protected]
Rheumatology September 2015, Volume 54, Issue 9
Annals of Rheumatic Disease October 2015, Volume 74, Issue 10
Arthritis & Rheumatology October 2015, Volume 67, Issue 10
Journal of Rheumatology September 2015, Volume 42, Issue 9
Osteoporosis International September 2015, Volume 26 Issue 9
New NICE Guidance
NG15 Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use
Latest relevant Systematic Reviews
from the Cochrane Library
Regional analgesia for improvement of long-term functional outcome after elective large joint
replacement
Alginate dressings for venous leg ulcers
New activity in Uptodate
www.uptodate.com
You will need your NHS Athens username/password (register through http://openathens.nice.org.uk/)
IDSA guidelines on vertebral osteomyelitis (August 2015)
Guidelines on diagnosis and treatment of vertebral osteomyelitis in adults have been issued by the
Infectious Disease Society of America (IDSA) [6]. These guidelines highlight the use of magnetic
resonance imaging as the diagnostic imaging method of choice, withholding empiric antibiotics in
patients without sepsis or progressive neurological complications until the microbiological etiology is
identified, and the importance of biopsy for microbiologic diagnosis when blood cultures and serology
are uninformative. In addition to prolonged antibiotic therapy, they recommend surgical intervention
for individuals with progressive neurologic deficits or deformity, spinal instability, or clinical
deterioration despite appropriate medical therapy. Our approach to vertebral osteomyelitis is generally
consistent with these guidelines. (See "Vertebral osteomyelitis and discitis in adults", section on
'Introduction'.)
Rehabilitation exercises for chronic tendinopathy (August 2015)
For a number of years, rehabilitation programs for the treatment of chronic, overuse tendinopathies
have emphasized the eccentric phase of resistance exercises. However, recent studies suggest that
resistance exercises involving the affected tendon may be effective regardless of what phase is
emphasized. In a single-blinded randomized trial involving 58 patients with chronic Achilles
tendinopathy, heavy slow resistance training emphasizing both the concentric and eccentric portions
of the exercises selected produced the same improvements in symptoms, function, and tissue
appearance on ultrasound achieved by patients following a training program that emphasized only the
eccentric portion of selected exercises [7]. The improvements were sustained at one-year follow-up in
each group. Of note, patient compliance was significantly better among patients following the heavy
slow resistance program (92 versus 78 percent in the eccentric training group). (See "Achilles
tendinopathy and tendon rupture", section on 'Heavy slow resistance training'.)
Antibiotic use and development of juvenile idiopathic arthritis (August 2015)
A few studies have found a link between antibiotic use and the development of juvenile idiopathic
arthritis (JIA). In one of these case-control studies, previous antibiotic prescriptions were compared in
152 children newly diagnosed with JIA and 1520 controls in the United Kingdom [11]. As with a
previous study, this study found that any use of antibiotics was associated with a twofold increased
risk of JIA. The risk was dose dependent and was greatest for antibiotic exposures that occurred
within one year of diagnosis. The potential underlying mechanism is unknown, but alteration of the
intestinal microbiome with subsequent immune dysregulation is postulated. Alternative explanations
include the possibility that these patients develop more frequent infections due to some intrinsic
abnormalities in the immune system that also predispose them to JIA. (See "Juvenile idiopathic
arthritis: Epidemiology and immunopathogenesis", section on 'Antibiotics'.)
Secukinumab, an anti-IL17A antibody, for psoriatic arthritis (August 2015)
Secukinumab, an anti-interleukin (IL)-17A antibody, is available for the treatment of psoriasis in the
United States and other countries, and has been evaluated for psoriatic arthritis (PsA) using various
routes of administration and dosing regimens. In a multicenter randomized trial, involving almost
400 patients with active PsA, secukinumab (300, 150, or 75 mg administered aubcutaneously weekly
for four weeks and every four weeks thereafter, consistent with the regimen for psoriasis) was
superior to placebo in achieving significant improvement in joint and skin disease, and in physical
function and quality of life [17]. Responses by weeks 12 to 16 were similar to those at week 24
(ACR20 responses of 54, 51, and 29 versus 15 percent), and benefit was sustained at 52 weeks. The
drug was well-tolerated and may have a future role in the treatment of psoriatic arthritis. (See
"Treatment of psoriatic arthritis".)
Upcoming Lunchtime Drop-in Sessions
September (1pm)
Thurs 3rd Literature Searching
Fri 11th Understanding articles
Mon 14th Statistics
Tues 22nd Literature Searching
Weds 30th Understanding articles
October (12pm)
Thurs 8th Statistics
Fri 16th Literature Searching
Mon 19th Understanding articles
Tues 27th Statistics
The Library and Information Service provides free specialist information skills training for
all UHBristol staff and students.
To book a place, email: [email protected]
If you’re unable to attend we also provide one-to-one or small group sessions. Contact
[email protected] or [email protected] to arrange a session.
HDAS Literature Search guide http://www.library.nhs.uk/hdas
Forgotten how to conduct a search using the NHS Health Databases Advanced Search (HDAS)? Not
sure how to get the best out of your search strategy? This quick guide will help you fill in the blanks…
You will need to log in using your OpenAthens username and password. Register if needed here: https://openathens.nice.org.uk/
1) Choose your databases (or select all) 2) Enter in your search terms
Choose which fields to search (the default is title and abstract)
Break each concept down into all possible terms (British/American spellings, acronyms, alternative terms etc), then combine using ‘OR’
More useful database search tips:
* Truncation A substitute for any letters (or none) E.g. p*ediatric* = paediatric, pediatrics, paediatrician etc.
“ ” Inverted commas
Specifies that adjacent words should be searched as phrases
E.g. “noninvasive ventilation”
ADJ Adjacency Specifies the maximum number of words that can appear between two search terms
E.g. Random* ADJ1 trial
3) Combine the different search concepts using ‘AND’ 4) Apply limits e.g. publication date 5) Remove duplicates (this function can be slow) 6) Click on ‘unique results’ to see you results
But remember, the Library team can carry out searches on your behalf or provide you with assistance.
Email [email protected] for help with literature searches.
Current Awareness database articles
If you require full articles please email: [email protected]
Title: Randomized clinical trials as reflexive-interpretative process in patients with rheumatoid arthritis: a
qualitative study.
Citation: Rheumatology international, Aug 2015, vol. 35, no. 8, p. 1423-1430 (August 2015)
Author(s): de Jorge, Mercedes, Parra, Sonia, de la Torre-Aboki, Jenny, Herrero-Beaumont, Gabriel
Abstract: Patients in randomized clinical trials have to adapt themselves to a restricted language to capture the
necessary information to determine the safety and efficacy of a new treatment. The aim of this study was to
explore the experience of patients with rheumatoid arthritis after completing their participation in a biologic
therapy randomized clinical trial for a period of 3 years. A qualitative approach was used. The information was
collected using 15 semi-structured interviews of patients with rheumatoid arthritis. Data collection was guided
by the emergent analysis until no more relevant variations in the categories were found. The data were analysed
using the grounded theory method. The objective of the patients when entering the study was to improve their
quality of life by initiating the treatment. However, the experience changed the significance of the illness as they
acquired skills and practical knowledge related to the management of their disease. The category "Interactional
Empowerment" emerged as core category, as it represented the participative experience in a clinical trial. The process integrates the follow categories: "weight of systematisation", "working together", and the significance of
the experience: "the duties". Simultaneously these categories evolved. The clinical trial monitoring activities
enabled patients to engage in a reflexive-interpretative mechanism that transformed the emotional and symbolic
significance of their disease and improved the empowerment of the patient. A better communicative strategy
with the health professionals, the relatives of the patients, and the community was also achieved.
Title: Rheumatoid arthritis: Biological therapy other than anti-TNF.
Citation: International immunopharmacology, Aug 2015, vol. 27, no. 2, p. 185-188 (August 2015)
Author(s): Rossi, Daniela, Modena, Vittorio, Sciascia, Savino, Roccatello, Dario
Abstract: Rheumatoid arthritis (RA) is one of the most common autoimmune diseases and is characterized by
synovitis that causes joint damage. The introduction of biologic agents has made it possible to induce remission
in many patients and inhibit joint damage. Activated T cells in RA patients proliferate and stimulate the
production of pro-inflammatory cytokines including tumor necrosis factor (TNF) and interleukin 6 that play
important roles in RA pathogenesis. The most widely used biologic agents indicated for RA inhibit the activity
of TNF. However, newly developed biologic drugs targeting different pathways are now currently part of the
therapeutic options to induce remission in patients with RA. The present review focuses on biologic agents
directed at molecular targets different from TNF and addresses the possible advantages of these drugs.
Copyright © 2015 Elsevier B.V. All rights reserved.
Title: The assessment of lesions of the Achilles tendon by ultrasound imaging in inflammatory arthritis: A
systematic review and meta-analysis.
Citation: Seminars in arthritis and rheumatism, Aug 2015, vol. 45, no. 1, p. 103-114 (August 2015)
Author(s): Carroll, Matthew, Dalbeth, Nicola, Boocock, Mark, Rome, Keith
Abstract: Ultrasound (US) is a highly sensitive, reliable and non-invasive tool, which allows for the assessment
of lesions of tendons and entheseal sites. The aim of this systematic review and meta-analysis is to identify
differences in US lesions of the Achilles tendon (AT) between people with inflammatory arthritis (IA) and healthy controls. An electronic literature search was performed on Medline, CINAHL, SportDiscus and The
Cochrane Library. Methodological quality was assessed using a modified Quality Index. Odds ratios with 95%
confidence intervals (CI) were determined. Meta-analysis was conducted on those studies that were considered
to be homogenous. A total of 13 high-to-medium quality studies met the inclusion criteria. The majority of
studies reported US lesions in spondyloarthropathy (SpA), with limited evidence for other forms of IA. US
lesions were not consistently defined with regard to Outcome Measures in Rheumatology Clinical Trials
(OMERACT) definitions, and numerous scoring systems were used across the majority of studies. The mean AT
thickness at the enthesis in people with SpA was 0.54mm thicker (95% CI: 0.10-0.97mm) with more frequent
erosions in people with SpA (odds ratio = 7.43, 95% CI: 1.99-27.77, P = 0.003) and rheumatoid arthritis (RA) (odds ratio = 9.60, 95% CI: 1.23-74.94, P = 0.03), compared to controls. There was no significant difference in
the frequency of enthesophyte formation in people with SpA compared to the controls (odds ratio = 2.48, 95%
CI: 0.64-9.70, P = 0.19). The systematic review identified that a majority of studies reporting US lesions were in
SpA, but limited evidence relating to other forms of IA. Consistent application of the OMERACT US
definitions and scoring of US lesions is required in future studies of AT disease in IA. Further work is also
required to distinguish between US lesions reflective of inflammation and structural damage. Copyright © 2015
Elsevier Inc. All rights reserved.
Title: Prevention of Knee Osteoarthritis in Overweight Females: The First Preventive Randomized Controlled
Trial in Osteoarthritis.
Citation: The American journal of medicine, Aug 2015, vol. 128, no. 8, p. 888 (August 2015)
Author(s): Runhaar, Jos, van Middelkoop, Marienke, Reijman, Max, Willemsen, Sten, Oei, Edwin H,
Vroegindeweij, Dammis, van Osch, Gerjo, Koes, Bart, Bierma-Zeinstra, Sita M A
Abstract: With accumulating knowledge on osteoarthritis development, the next step is to focus on possibilities
for primary prevention. In a 2 × 2 factorial design, the effects of a diet-and-exercise program and of oral
glucosamine sulfate (double blind and placebo-controlled) on the incidence of knee osteoarthritis were evaluated
in a high-risk group of 407 middle-aged women with a body mass index ≥ 27 kg/m(2) without clinical signs of
knee osteoarthritis at baseline (ISRCTN 42823086). Primary outcome was the incidence of knee osteoarthritis,
defined as Kellgren & Lawrence grade ≥ 2, joint space narrowing of ≥ 1.0 mm, or clinical knee osteoarthritis (clinical and radiographic American College of Rheumatology criteria) after 2.5 years. After 2.5 years, only
10% of all subjects were lost to follow-up, and 17% of all knees showed incident knee osteoarthritis.
Accounting for the significant interaction between the interventions, no significant main effect of either
intervention was found. Independently, both interventions alone showed indications of reduced knee
osteoarthritis incidence (odds ratio [OR] 0.69; 95% CI, 0.39-1.21 for the diet-and-exercise program and OR
0.60; 95% CI, 0.31-1.12 for the glucosamine intervention). These effects were neutralized in subjects receiving
both interventions (OR 0.97; 95% CI, 0.55-1.71). No significant main effects of the diet-and-exercise program
and of glucosamine sulfate were found on incident knee osteoarthritis. Nevertheless, this trial provides valuable
insights for future trial design for preventive osteoarthritis studies. Copyright © 2015 Elsevier Inc. All rights
reserved.
Title: Predictive value of Doppler ultrasound-detected synovitis in relation to failed tapering of biologic therapy
in patients with rheumatoid arthritis.
Citation: Rheumatology (Oxford, England), Aug 2015, vol. 54, no. 8, p. 1408-1414 (August 2015)
Author(s): Naredo, Esperanza, Valor, Lara, De la Torre, Inmaculada, Montoro, María, Bello, Natalia, Martínez-
Barrio, Julia, Martínez-Estupiñán, Lina, Nieto, Juan Carlos, Ovalles-Bonilla, Juan Gabriel, Hernández-Flórez,
Diana, González, Carlos M, López-Longo, Francisco Javier, Monteagudo, Indalecio, Carreño, Luis
Abstract: To investigate the predictive value of synovitis detected by Doppler US in relation to failed tapering
of biologic therapy (BT) in RA patients in sustained clinical remission. A total of 77 RA patients (52 women, 25 men) in sustained clinical remission, treated with a stable dosage of BT were prospectively recruited. BT was
tapered according to an agreed strategy implemented in clinical practice (i.e. increasing the interval between
doses for s.c. BT and reducing the dose for i.v. BT). BT tapering failure was assessed at 6 and 12 months.
Doppler US investigation of 42 joints for the presence and grade (0-3) of B-mode synovial hypertrophy and
synovial power Doppler signal (i.e. Doppler synovitis) was performed at baseline by a rheumatologist blinded to
clinical and laboratory data. Hand and foot radiographs were obtained at baseline and at 12-month follow-up. Of
the 77 patients, 46 (59.7%) were on s.c. BT and 31 (40.3%) on i.v. BT. At 12 months, 35 patients (45.5%)
presented BT tapering failure, 23 of them (29.9% of all patients) in the first 6 months of BT tapering. In logistic
regression analysis, the baseline DAS28 and the global score of Doppler synovitis were identified as
independent predictors of BT tapering failure at 12 and 6 months. The presence of Doppler synovitis was the
strongest predictor for BT tapering failure. No patient showed radiographic progression. Our results suggest that
the presence of Doppler-detected synovitis may predict BT tapering failure in RA patients in sustained clinical
remission. © The Author 2015. Published by Oxford University Press on behalf of the British Society for
Rheumatology. All rights reserved. For Permissions, please email: [email protected].
Title: Does disease activity at the start of biologic therapy influence health care costs in patients with RA?
Citation: Rheumatology (Oxford, England), Aug 2015, vol. 54, no. 8, p. 1472-1477 (August 2015)
Author(s): Johansson, Kari, Eriksson, Jonas K, Vollenhoven, Ronald van, Miller, Heather, Askling, Johan,
Neovius, Martin, ARTIS Study Group
Abstract: To investigate whether disease activity at baseline influences health care costs in patients with RA
initiating biologic treatment. In the Swedish Biologics Register, we identified patients with RA with baseline
28-joint DAS (DAS28) recorded and starting their first biologic in 2007-11 [n = 1638 with moderate disease activity (DAS28 3.2-5.1) and n = 1870 with high disease activity (DAS28 > 5.1)]. Data on inpatient and
outpatient care and prescription drugs were retrieved from nationwide registers. Mean cost differences were
estimated adjusted for age, sex and costs the year before treatment start. Patients with high (vs moderate) disease
activity were older (60 vs 56 years; P < 0.001), but did not differ in sex distribution (75 vs 74% women; P =
0.99) or disease duration (10 vs 10 years; P = 0.13). The year after initiation of biologics, patients with high (vs
moderate) baseline disease activity accumulated 9% higher health care costs, but the difference was not
statistically significant after adjustment [€19 333 vs €17 810; adjusted difference €870 (95% CI -2, 1742)]. In
the subgroup of patients with up to 4 years of follow-up data, decreasing costs were observed over the follow-up
time, but no difference was found between patients with high compared with moderate baseline disease activity
[€13 704 vs €12 349; adjusted difference 878 (95% CI -364, 2120)]. Irrespective of baseline disease activity,
health care costs were approximately three times higher the year after initiation of biologics than the year before due to increased drug costs. Over up to 4 years of follow-up, no difference in health care costs was found after
adjustment in patients starting their first biologic treatment with high vs moderate baseline disease activity. ©
The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All
rights reserved. For Permissions, please email: [email protected].
Title: Effect of Aerobic Exercise Training on Fatigue in Rheumatoid Arthritis: A Meta-Analysis.
Citation: Arthritis care & research, Aug 2015, vol. 67, no. 8, p. 1054-1062 (August 2015)
Author(s): Rongen-van Dartel, S A A, Repping-Wuts, H, Flendrie, M, Bleijenberg, G, Metsios, G S, van den
Hout, W B, van den Ende, C H M, Neuberger, G, Reid, A, van Riel, P L C M, Fransen, J
Abstract: Rheumatoid arthritis (RA) fatigue is not being well-managed currently, and evidence of effective
interventions is limited. Aerobic exercise may provide benefit to treat fatigue in RA. Therefore, the purpose of
this meta-analysis is to analyze the effect of aerobic land-based exercise on fatigue in RA. A literature search
was conducted using PubMed, Cochrane Library, Embase, and trial registers to identify randomized controlled
trials (RCTs) with a supervised land-based aerobic exercise program performed with an intensity between 50%
and 90% of maximal heart rate, of at least 15 minutes' duration, performed at least 2 times a week, and lasting
for a time period of at least 4 consecutive weeks. Risk of bias was assessed using the Cochrane tool. A meta-
analysis of fatigue outcomes was performed by calculating the standardized mean difference (SMD) using a
random-effects model. Five RCTs were included. None of the trials selected patients with RA for having
fatigue. Risk of bias was low in 3 RCTs and unclear in 2. Land-based aerobic exercise programs had a positive effect on fatigue in RA compared to no exercise at 12 weeks, SMD -0.31 (95% confidence interval [95% CI] -
0.55, -0.06). At 24 weeks, the effect of aerobic land-based exercise was smaller and not statistically significant:
SMD -0.15 (95% CI -0.33, 0.02). There is evidence with low risk of bias that an aerobic exercise program is
effective in reducing fatigue among patients with RA, especially in the short term; however, effects are small.
To substantiate the evidence, RCTs should be performed in patients with RA selected for having fatigue. ©
2015, American College of Rheumatology.
Title: Biosimilar vs biological agents in rheumatology: When are biosimilar agents similar enough?
Citation: International immunopharmacology, Aug 2015, vol. 27, no. 2, p. 220-223 (August 2015)
Author(s): Lie, G, Sciascia, S, Cuadrado, M J
Abstract: With the introduction of biological agents, over the last two decades treatment prospects in many
medical fields including Rheumatology have experienced an exciting revolution. The advent of biological
therapy for specifically rheumatic diseases has provided more effective control of both the underlying disease,
and sustained amelioration of disease activity, compared to the pre-biological era when only anti-inflammatory
and immunosuppressant drugs were available. Although the importance of potential improved clinical outcome
cannot be overstated, these efficacious treatments for rheumatic diseases are not without a high cost. Biological
agents are expensive and rheumatological diseases are common. The patent and regulatory data protection
periods for the first and second waves of biological agents based on recombinant proteins have begun to expire,
leaving open the potential for development and regulatory approval of one or more "generic" versions of these
biological therapies, termed "biosimilars" or "BSs" in Europe (the term we shall use from henceforth),
"subsequent entry biologics" in Canada, or "follow-on-biologics" in US. We aimed to review the critical topics
of efficacy, safety and regulatory approach of upcoming biosimilars. Copyright © 2015 Elsevier B.V. All rights reserved.
Title: Menaquinone-7 as a novel pharmacological therapy in the treatment of rheumatoid arthritis: A clinical
study.
Citation: European journal of pharmacology, Aug 2015, vol. 761, p. 273-278 (August 15, 2015)
Author(s): Abdel-Rahman, Mahran S, Alkady, Eman A M, Ahmed, Sameh
Abstract: Menaquinones (MKs) have been reported to induce apoptosis in rheumatoid arthritis (RA) synovial cells. Recently, menaquinone-4 (MK-4) was proven as a new potential agent for the treatment of RA. However,
menaquinone-7 (MK-7) has greater bioavailability and efficacy than MK-4 after oral administration. Yet, the
therapeutic benefits of MK-7 in the management of patients with RA have never been addressed. This study was
designed to clarify the therapeutic role of MK-7 added to normal therapeutic regimen of RA in patients with
different stages of the disease with a clinical follow up through a randomized clinical trial. In a cross sectional
study, 84 RA patients (24 male, 60 female) (average age=47.2 years) were enrolled in this study. The patients
were divided into MK-7 treated group (n=42) and MK-7 naïve group (n=42). MK-7 capsules were administered
in a dose of 100μg/day for three months in the first group without changing in other medications. The clinical
and biochemical markers on RA patients treated with MK-7 and naïve group were assessed. In MK-7 treated
group, serum concentrations of MK-7 were monitored before and after three months of MK-7 administration. In
the cross sectional study, a significant decrease in MK-7 treated group for the levels of undercarboxylated
osteocalcin (ucOC), erythrocyte sedimentation rate (ESR), disease activity score assessing 28 joints with ESR (DAS28-ESR), C-reactive protein (CRP) and matrix metalloproteinase (MMP-3) was found. In MK-7 treated
group, a marked decrease in RA clinical and biochemical markers for moderate and good response compared to
non-responders was observed in ucOC, ESR and DAS28-ESR. A marked increase in the levels of MK-7 for the
moderate and good responders compared to non-responders was observed. The results suggest that MK-7
improves disease activity in RA patients. Therefore, MK-7 represents a new promising agent for RA in
combination therapy with other disease modifying antirheumatic drugs. Copyright © 2015 Elsevier B.V. All
rights reserved.
Title: Characterizing Pain Flares From the Perspective of Individuals With Symptomatic Knee Osteoarthritis.
Citation: Arthritis care & research, Aug 2015, vol. 67, no. 8, p. 1103-1111 (August 2015)
Author(s): Murphy, Susan L, Lyden, Angela K, Kratz, Anna L, Fritz, Heather, Williams, David A, Clauw,
Daniel J, Gammaitoni, Arnold R, Phillips, Kristine
Abstract: Although pain in knee osteoarthritis (OA) commonly affects activity engagement, the daily pain
experience has not been fully characterized. Specifically, the nature and impact of pain flares is not well
understood. This study characterized pain flares as defined by participants with knee OA. Pain flare occurrence
and experience were measured over 7 days. This was a multiple methods study; qualitative methods were
dominant. Data were collected during the baseline portion of a randomized controlled trial. Participants met
criteria for knee OA and had moderate to severe pain. They completed questionnaires and a 7-day home
monitoring period that captured momentary symptom reports simultaneously with physical activity via
accelerometry (n = 45). Participants also provided individual definitions of pain flare that were used throughout
the home monitoring period to indicate whether a pain flare occurred. Pain flares were described most often by quality (often sharp), followed by timing (seconds, minutes) and by antecedents and consequences. When asked
if their definition of a flare agreed with a supplied definition, 49% of the sample reported only "somewhat," "a
little," or "not at all." Using individual definitions, 78% experienced at least 1 daily pain flare over the home
monitoring period; 24% had a flare on more than 50% of the monitored days. Pain flares were common,
fleeting, and often experienced in the context of activity engagement. Participants' views on what constitutes a
pain flare differ from commonly accepted definitions. Pain flares are an understudied aspect of the knee OA
pain experience and require further characterization. © 2015, American College of Rheumatology.
Title: Comparable effect of partly supervised and self-administered exercise programme in early rheumatoid
arthritis - a randomised, controlled trial.
Citation: Danish medical journal, Aug 2015, vol. 62, no. 8 (August 2015)
Author(s): Seneca, Trine, Hauge, Ellen Margrethe, Maribo, Thomas
Abstract: There is a need to establish a framework and exercise level for patients with early rheumatoid arthritis
(RA). The aim of this study was to compare the effect of a partly supervised and a self-administered exercise
programme for patients with early RA. A total of 51 patients with early (≤ 5 years) RA were randomised to
either a six-week supervised, progressive, high-intensity exercise programme followed by a six-week self-
administered exercise programme or a 12-week self-administered exercise programme. A total of 36 patients
completed the study. Following the 12 weeks of exercises, patients in the two groups had improved both their
muscle strength and their physical fitness. There was a significant difference in Disease Activity Score in 28 joints calculated with C-reactive protein between the two exercise groups, but no significant differences in
physical fitness, pain perception, Health Assessment Questionnaire, Short Form 36 health survey questionnaire,
Fear-Avoidance Beliefs Questionnaire, or in muscle strength, except from a significant difference in trunk
extensors. The dropout was 40% in the supervised group versus 20% in the self-administered group. A
progressive, high-intensity exercise programme is feasible for patients with early RA, although we observed an
elevated number of dropouts for reasons not related to the intervention. The partly supervised exercise
programme with follow-up after 12 weeks does not seem to be more effective than the self-administered
exercise programme. none. The trial was registered with www.clinicaltrials.gov (NCT015553305).
Title: Attitudes towards subsequent entry biologics/biosimilars: A survey of Canadian rheumatologists.
Citation: Clinical rheumatology, Aug 2015, vol. 34, no. 8, p. 1427-1433 (August 2015)
Author(s): Grabowski, David, Henderson, Bradley, Lam, Dennis, Keystone, Edward C, Thorne, Carter, Jamal,
Shahin, Pope, Janet, Haraoui, Boulos, Lin, Daming, Revers, Leigh
Abstract: Globally, patents on several well established biologic agents used to treat rheumatic diseases have
already or will expire over the next few years, allowing for the availability of subsequent entry biologics (SEBs
or biosimilars). The objective of this study was to identify gaps in knowledge and attitudes towards SEBs
among Canadian rheumatologists. Eighty-one rheumatologists completed the survey and were included in the
analysis (22 % of the 369 who were contacted). We found that one third of physicians (31 %) were familiar with
SEBs and that physicians with greater than 20 years of practice were significantly more likely to be familiar or very familiar with SEBs compared to respondents with less than 10 years or 10-20 years of experience (OR
11.1, 95 % CI: 2.1-55.5, p = 0.004 and OR 4.5, 95 % CI: 1.2-16.2, p = 0.023, respectively). A third (32 %) of
physicians agreed or strongly agreed that they would be comfortable with indication extrapolation. Most
respondents (88 %) would feel concerned or very concerned if a pharmacist had the ability to substitute a
biologic drug for an SEB without the physician's approval. This survey was the first study that evaluated the
position of rheumatologists on key areas surrounding SEBs from a nationwide Canadian perspective. Current
physician attitudes and perceptions of SEBs can inform future educational initiatives and highlight important
issues for payers, policy makers, and other stakeholders.
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