Disease-modifying anti-rheumatic drug usage, prescribing patterns and disease activity in rheumatoid arthritis patients in community-based practice.

AIMS: Our aim was to examine the spectrum of disease activity and usage of disease-modifying anti-rheumatic drugs (DMARD) in rheumatoid arthritis (RA) patients seen over a period of 12 months in community-based rheumatology practice. METHODS: Data were prospectively collected on 1059 consecutive RA patients who attended two private, community-based rheumatology clinics from 1 May 2007 to 1 May 2008. Information on patient demographics, medication history and disease activity was collected. Life table graphs were developed to track medication retention over time. Statistical significance was determined by log-rank tests. RESULTS: One thousand and fifty-nine patients with RA were entered into the database over a 12-month period. Eight hundred and twenty-six patients (85%) were treated with single or combination conventional DMARD compared with 159 patients (15%) on a biologic DMARD either alone or in combination. Methotrexate monotherapy was the most commonly prescribed DMARD, used in 41% of patients studied. Almost half (47%) were on combination DMARD therapy. Methotrexate and tumour necrosis factor inhibitors had the highest retention rate over 12 and 30 months since first prescription. A large proportion of patients (47%) had moderate disease activity. CONCLUSION: Rates of biologic DMARD usage were similar to other studies and the predominance of methotrexate use was also in keeping with current recommendations for management of RA. There appears to be a significant unmet need for improved disease control among RA patients with moderate disease activity, which requires further investigation.

The use of databases for quality assessment in rheumatoid arthritis.

As resources in health care systems become increasingly scarce, rheumatologists may need to provide evidence that their quality of care uses the allocated resources effectively by achieving a good outcome for patients with rheumatoid arthritis (RA). In order to assess quality, it has been recommended in other areas of medicine to gather data according to appropriate outcome measures, preferably in electronic databases, enabling identification of benchmarks to compare the outcome quality of different clinical settings. Available electronic applications commonly comprise a database for data processing and storage, as well as a tool for regularly measuring and following disease activity in individual patients. Access to aggregated data makes it possible to monitor disease activity in individual patients over time in relation to treatment. In addition, electronic applications should allow the extraction of patient data according to special characteristics for analysis. In this way, such electronic applications can provide a central database that can be used for monitoring patients in routine care, case studies or general research, as well as facilitating comparisons of quality of care in different centres or in different countries for reference purposes.

A metaanalysis of chondroitin sulfate in the treatment of osteoarthritis.

OBJECTIVE: To examine the efficacy of chondroitin sulfate (CS) in the treatment of osteoarthritis (OA) on the basis of a metaanalysis of controlled clinical trials. METHODS: After personal, Medline, and Embase searches, a decision tree analysis of the available publications was performed, with respect to types of joint involvement studied, study designs, numbers of patients enrolled, and variables analyzed. The Lequesne index and pain rating on visual analog scale (VAS) were considered the main variables. Of a total of 16 publications found, 7 trials of 372 patients taking CS could be enrolled into the metaanalysis. Although all selected studies claimed to be randomized, double blind designs in parallel groups, it should be noted that CS was given along with analgesics or nonsteroidal antiiflammatory drugs, making required dosage of comedication an important factor. RESULTS: Following patients to 120 or more days, CS was shown to be significantly superior to placebo with respect to the Lequesne index and pain VAS. Pooled data confirmed these results and showed at least 50% improvement in the study variables in the CS group compared to placebo. CONCLUSION: CS may be useful in OA, but further investigations in larger cohorts of patients for longer time periods are needed to prove its usefulness as a symptom modifying drug in OA.

ZEMa, a member of a novel group of MADS box genes, is alternatively spliced in maize endosperm.

The identification of a number of cis-elements which direct gene expression in maize endosperm, and the characterization of corresponding DNA binding proteins, point to the interaction of different classes of transcription factors in this tissue. To assess whether MADS box genes are also involved in maize endosperm development, cDNA and genomic MADS box clones have been isolated. The three cDNA clones ZEM1, ZEM2 and ZEM3 were cloned from a maize endosperm cDNA library using a probe based on sequences conserved in plant MADS box genes. Further transcripts were cloned by RT-PCR experiments and designated ZEM4 and ZEM5. Analysis of the corresponding genomic clones led to the identification of the ZEM2 MADS box gene family, three members of which were characterized sharing 97% sequence identity in corresponding domains. 100% sequence identities between cDNA and one of the genomic clones, conserved exon-intron boundaries and the demonstration of in vivo splicing in a maize endosperm transient expression system, show that the transcripts ZEM1-5 are derived by alternative splicing of ZEMa, one ZEM2 member. The ZEMa transcripts are present in almost all maize tissues, but specific differentially spliced forms accumulate preferentially in maturing endosperm and leaf. The function of the ZEMa gene is discussed in the light of similarities in the expression pattern with members of the human MEF2/RSRF gene family.

An empirical evaluation of behavioral and cognitive-behavioral group marital treatments with discordant couples.

Previous research has revealed that group behavioral therapy for distressed couples provides an effective and efficient form of marital treatment. However, research comparing alternative group approaches is lacking. The current investigation evaluated group behavioral and cognitive-behavioral marital treatments across a variety of relationship dimensions and measures of individual functioning. Dysfunctional couples were randomly assigned to experimental conditions and demonstrated statistically and clinically significant improvement as contrasted with the waiting list control group. These results are discussed in terms of the differences between treatment conditions, potential advances in the field of marital therapy, and recommendations for further inquiry.