ABSTRACT
Following the EULAR recommendations published in 2010 German guidelines for the medical treatment of rheumatoid arthritis were developed based on an update of the systematic literature search and expert consensus. Methotrexate is the standard treatment option at the time of diagnosis, preferably in combination with low dose glucocorticoids. Combined disease-modifying antirheumatic drugs (DMARD) therapy should be considered in patients not responding within 12 weeks. Treatment with biologicals should be initiated in patients with persistent high activity no later than 6 months after conventional treatment and in exceptional situations (e.g. early destruction or unfavorable prognosis) even earlier. If treatment with biologicals remains ineffective, changing to another biological is recommended after 3-6 months. In cases of long-standing remission a controlled reduction of medical treatment can be considered.
Subject(s)
Algorithms , Antirheumatic Agents/administration & dosage , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/drug therapy , Practice Guidelines as Topic , Rheumatology/standards , Antirheumatic Agents/adverse effects , Europe , HumansABSTRACT
OBJECTIVE: To compare the efficacy of a 10-day and a 4-month doxycylcine course for the treatment of Chlamydia trachomatis-reactive arthritis (Ct-ReA). METHODS: Patients with active Ct-ReA were enrolled in a prospective, multicentre, double-blind, controlled clinical trial and randomised to receive doxycycline 100 mg twice daily for 10 days followed either by placebo or by continued doxycycline 100 mg twice daily over 4 months. Various clinical and laboratory parameters referring to disease activity were recorded in the beginning and at the end of treatment. RESULTS: 32 of 37 patients included (15 men and 17 women; mean (standard deviation) disease duration 17 (13) months completed the study; 17 were randomised to short-term doxycycline and placebo (placebo group) and 15 to prolonged treatment with doxycycline (doxycycline group) over the 4-month study period. After this time, only two patients from each group went into remission. There were no drop-outs owing to adverse events or treatment failures. CONCLUSIONS: The results of this study suggest that prolonged treatment with a 4-month course of doxycycline is not superior to short-term treatment over 10 days in patients with Ct-ReA.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Arthritis, Reactive/drug therapy , Chlamydia Infections/drug therapy , Chlamydia trachomatis , Doxycycline/administration & dosage , Adult , Anti-Bacterial Agents/therapeutic use , Double-Blind Method , Doxycycline/therapeutic use , Drug Administration Schedule , Female , Humans , Male , Middle Aged , Prohibitins , Prospective Studies , Severity of Illness Index , Treatment OutcomeABSTRACT
The success of the treatment of rheumatoid arthritis depends primarily on early diagnosis. In most cases, basic therapy begins with methotrexate. Depending on the stage and course of the disease (radiographically detected early erosion and/or progression), basic immunosuppressive therapy can be combined or supplemented with cytokine antagonists. Furthermore, for specific indications, several alternative active substances (DMARD monotherapies) are available. Today the goal of therapy is always remission.
Subject(s)
Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/drug therapy , Immunosuppressive Agents/therapeutic use , Antirheumatic Agents/adverse effects , Arthritis, Rheumatoid/diagnosis , Combined Modality Therapy , Consensus Development Conferences as Topic , Cooperative Behavior , Drug Therapy, Combination , Early Diagnosis , Humans , Immunosuppressive Agents/adverse effects , Patient Care Team , Tumor Necrosis Factor-alpha/antagonists & inhibitorsABSTRACT
By application of a standardized core set of outcome measurement instruments, comparison between studies as well as meta-analyses in rehabilitation research can be facilitated. The German Society for Rheumatology has commissioned its working group on rehabilitation with the development of a proposal for such a core set of outcome measurement instruments. In a first step, dimensions for outcome measurement in rehabilitation were defined by a group of experts which represented rehabilitation hospitals, acute care hospitals, and research groups specialized in outcome measurement. The Delphi method was used in a multiple step consensus process. In a second step, instruments and procedures to operationalize the relevant dimensions were chosen. Reliability, validity, sensitivity to change, and practicability were used as criteria for selecting measurement instruments. The main intention of the proposed core set of outcome measurement instruments is to facilitate the processes of planning and carrying out rehabilitation research studies. Furthermore, the proposed instruments can be used for clinical documentation systems as well as for internal or external quality assurance programs.
