BackgroundRheumatoid arthritis (RA) may lasts for decades, so patient education is very important. There has been an increase in RA patients seeking information on the Internet during the last 15 years.Objectivesa) To assess the content, authorship, scope, readability and quality of the information currently available on the Internet in relation to RA; b) To compare it with a report published in 2001 [1] (2001-referent study); c) To assess the current positioning of websites posted by universities, hospitals, and medical associations.MethodsWe recreated the method used for the 2001-referent study assessing information on the Internet using the phrase “rheumatoid arthritis” in WebCrawler. All websites and pages were critically assessed for relevance, scope, authorship, type of publication, and financial objectives. Differences between studies were considered significant if 95% confidence intervals did not overlap. Additionally, we added a Google search following the same method, with a particular assessment of Internet pages posted by medical institutions regarding content quality (DISCERN instrument), readability (Flesch-Kincaid Grade Level test), and accessibility (the order of appearance).ResultsThe search returned 316 hits using WebCrawler (85% were considered relevant). There were significant differences between the current studies and the 2001-referent studies (WebCrawler). There were increases in information sites (82% vs. 36%) and RA-specific discussion pages (59% vs. 8%), and decreases in advertisements (2% vs. 48%) and alternative therapies (27% vs. 45%). Google searches had significantly lower relevance (58% vs. 85%), more news articles (18% vs. 7%), more “only RA discussed” pages (76% vs. 59%), and less “alternative therapy” pages (19% vs. 27%) when compared with WebCrawler. Concerning the content quality of Internet pages, 37% were rated as good and 36% unbiased. Among the first 300 hits, 30 (10%) were posted by medical institutions, 17 from the United States, five from the United Kingdom, four from Australia, and one each from Canada, Malaysia, Spain and the Netherlands. The Mayo Clinic appeared as the top result, the Arthritis Foundation (United States) 3rd, the National Institute of Arthritis and Musculoskeletal and Skin Diseases (United States) 7th, the American College of Rheumatology 8th, and the Arthritis Research (UK) in 14th position. Regarding readability, 7% of these Web pages required six years of schooling, 27% between seven and nine years, 27% between 10 and 12 years, and 40% 12 years of schooling or more.ConclusionsIt seems that information on the Internet has evolved in this fifteen-year period. Medical institutions are better positioned now. However, there are still areas for improvement, such as content quality, leadership from medical institutions, and readability of information.ReferencesSuarez-Almazor et al. Surfing the Net–information on the World Wide Web for persons with arthritis: patient empowerment or patient deceit? J Rheumatol 2001;28:185–91.Disclosure of InterestNone declared
The aim of this study was to assess the changes in the characteristics of rheumatoid arthritis information on the Internet over a 15-year period and the positioning of Web sites posted by universities, hospitals, and medical associations. We replicated the methods of a 2001 study assessing rheumatoid arthritis information on the Internet using WebCrawler. All Web sites and pages were critically assessed for relevance, scope, authorship, type of publication, and financial objectives. Differences between studies were considered significant if 95 % confidence intervals did not overlap. Additionally, we added a Google search with assessments of the quality of content of web pages and of the Web sites posted by medical institutions. There were significant differences between the present study's WebCrawler search and the 2001-referent study. There were increases in information sites (82 vs 36 %) and rheumatoid arthritis-specific discussion pages (59 vs 8 %), and decreases in advertisements (2 vs 48 %) and alternative therapies (27 vs 45 %). The quality of content of web pages is still dispersed; just 37 % were rated as good. Among the first 300 hits, 30 (10 %) were posted by medical institutions, 17 of them in the USA. Regarding readability, 7 % of these 30 web pages required 6 years, 27 % required 7-9 years, 27 % required 10-12 years, and 40 % required 12 or more years of schooling. The Internet has evolved in the last 15 years. Medical institutions are also better positioned. However, there are still areas for improvement, such as the quality of the content, leadership of medical institutions, and readability of information.
This study aims to explore the different connotations and potential offensiveness of ten mechanistic labels in newly referred Mexican patients with rheumatic symptoms as well as in Mexican and Canadian rheumatologists. Patients with musculoskeletal complaints newly referred for a rheumatology assessment were interviewed consecutively before they saw the rheumatologist. Patients were asked to choose one of nine feelings provoked by ten different illness mechanism labels. Rheumatologists gave a medical diagnosis after seeing the patients. Mexican and Canadian rheumatologists were invited to answer a structured questionnaire about their feelings at the moment they identified each of the ten different provided scenarios. Patients' and rheumatologists' feelings were classified as "offended" or "nonoffended." The "offensive score" was used to calculate a "number needed to offend" (NNO). One hundred and fifty patients were included. Inherited, immunological, and inflammatory labels had the fewest negative connotations (NNOs 17, 12, and 14, respectively), and psychological, functional, idiopathic, and sleep disturbance labels had the most (NNO 2 and 3, respectively). Functional labels were almost four times more offensive than organic labels. Stratified by rheumatologist diagnosis, patients with functional disorders were more accepting of organic-based mechanistic labels. A higher potential to offend was observed when patients with functional somatic conditions were given functional mechanistic labels (NNOs 1 to 4). The survey was completed by 186 Mexican rheumatologists and 71 Canadian rheumatologists. Primarily functional disorders such as somatization and anxiety had a high potential to evoke offensive feelings (NNOs 3 to 7). No significant differences in the NNO were found between Mexican and Canadian rheumatologists. Getting or giving mechanistic/explanatory labels is emotional. Both patients and rheumatologists experienced offended feelings with functional or idiopathic labels.
Introduction Musculoskeletal concerns are common, yet residents at our institution lacked arthrocentesis training. We created a workshop to teach residents knee and shoulder arthrocentesis, developed simulated assessment scenarios (SASs) with tools to measure procedural proficiency, and collected validity evidence. Methods A multidisciplinary group conducted a modified Delphi to define content for the workshop, SASs, and assessment tools. We defined minimum thresholds for competence in knee and shoulder arthrocentesis using the modified borderline-group method. We implemented the workshop and SASs in 2020 and 2021 and analyzed assessment tool scoring for statistical reliability and validity. Our program evaluation included SAS performance, participants’ survey responses, and change in the number of arthrocenteses performed in the internal medicine (IM) resident primary care clinic. Results Sixty-one residents (53 IM, eight physical medicine and rehabilitation [PM&R]) participated. Fifty-two (85%; 46 IM, six PM&R) completed the evaluation survey. We procured data from 48 knee and 65 shoulder SASs for validity evidence. All arthrocentesis SAS performances met the proficiency standard except one resident's shoulder SAS. Validity evidence revealed strong interrater reliability (α = .82 and .77 for knee and shoulder, respectively) and strong relational validity ( p < .001 for both procedures). All participants rated workshop quality and usefulness as good or very good. The number of arthrocenteses performed at our institution's primary care clinic increased. Discussion We created a workshop to teach residents arthrocentesis and assessment tools with strong validity and reliability evidence. The workshop was well regarded by residents, who applied their arthrocentesis skills during patient care.
BackgroundRheumatoid arthritis (RA) treatment has changed considerably over the last decade with the introduction of biologics and target synthetic non-conventional DMARDs. In spite of algorithms about when to begin using these drugs, data about when to stop them are scant.ObjectivesTo assess the length of remission in patients with RA who had to discontinue a biological or a non-conventional DMARD because a clinical trial ended, and to compare survival remission curves.MethodsA prospective cohort study of RA patients assembled at the time of their last dose of any of the following drugs: tocilizumab subcutaneous (TCZ-SC), TCZ intravenous (TCZ-IV), or targeted synthetic oral drugs (tsDMARDs) tofacitnib or baricitinib p.o. All patients were in RA remission (DAS-28 <2.6 and absence of swollen joints). Patients were followed at our clinic in the following way: 1) each patient had a structured telephone interview based on the COPCORD questionnaire every eight weeks by a senior medical student; 2) each patient was instructed to communicate with our center immediately if they were experiencing swollen joints, and 3) All patients had in-office assessments with the same rheumatologists every four months. The primary outcome was RA relapse, defined as the time (months) when the patient presented at least one swollen joint. Survival remission curves were calculated per type of drug (TCZ vs. tsDMARDs) and per route of administration (PO, SC or IV). A Long Rank Test was used to assess differences among survival curves and p<0.05 was considered significant. A Cox analysis was used to assess baseline predictors for relapse times.Results99 patients were included, 88% female, with a mean age of 47±13 years. Sixty patients were treated with TCZ-IV, 18 with TCZ-SC and 21 with tsDMARDs-PO. Over the following 165 person-years, 27 (27%) remained in RA remission and 73% developed flare-ups (9 months was the median period for a flare-up). There were no significant differences among the three types of administration (IV, SC, and PO) or between the two classes of drugs (biological vs. tsDMARD). None of the baseline variables were significant as predictors of flare-ups.ConclusionsLong-term clinical remission is possible in a number of patients with RA after suspending a biological or non-conventional DMARD. This feature has also been reported with other biological agents, but not with tsDMARDs. Additional data are required to support recommendations for discontinuing a biological agent after achieving remission.Disclosure of InterestNone declared
BackgroundThe effects of latitude gradients on diseases serve as surrogates for environmental factors to generate hypotheses for further testing. The age of onset in rheumatoid arthritis (ao-RA) is one important outcome predictor. Some reports suggest that ao-RA may be different depending on latitude gradients.ObjectivesTo assess the ao-RA at preselected cities worldwide.MethodsA proof-of-concept, worldwide survey. We selected major cities in each 15° quadrant (latitude and longitude) worldwide and found rheumatologists' contact information through rheumatology associations (e.g. ACR, PANLAR). An invitation e-mail was sent to rheumatologists requesting to directly interview 20 consecutive RA patients (ACR criteria) who attended their clinics about ao-RA. A second e-mail with instructions and a data-log sheet was sent to those who accepted. The information was limited to patient ID (initials or consecutive numbers), date of birth (month and year), date of RA diagnosis and date of RA onset (when the patient first noted a swollen joint). This data was considered nonsensitive, so no informed consent was required as per local regulations. Our goal was to have 3 participating rheumatologists in each selected city from 40 countries around the world. Statistical analysis: intra-city consistency was considered if no significant differences in ao-RA among rheumatologists' data were found (non-parametric tests). Then the ao-RA was compared per latitudes (each 10°) and longitudes by continents, and worldwide (one-way ANOVA with post-hoc Scheffé for multiple comparisons). Frequency distribution per ao-RA etary groups (10 year intervals) was also analyzed by country and quadrant. Significant differences were set at p<0.05.ResultsData from 2,481 patients were obtained from 126 rheumatologists in 78 cities in 42 countries. Intra-city variability could be assessed in 29 (37%) cities, and consistency was ascertained in 72.5% of these. The overall frequency distribution by age group showed that in 28% of patients the disease started before 35 yrs of age, 23% between 36 and 45, 26% between 46 and 55, 15% between 56 and 65, and 8% after 65 yrs of age; the mean ao-RA was 44±14 years (95% CI 44 to 45) and 84% were women. The linear chart of the mean ao-RA by worldwide latitudes showed a U shape, with the first peak in southern latitudes (>30°), the second peak in northern latitudes (>41°) and the base at the Tropic of Cancer. The ao-RA was 9 years older in northern latitudes when compared to the Tropic of Cancer (48 ± 15 vs. 39 ± 12 years, p<0.001), and the proportion of patients with ao-RA after the age of 55 was also higher (38% vs. 20%, p<0.001); these figures were consistent when analyzing data by continent.ConclusionsRA should be considered a disease mainly affecting young people, with almost one-third beginning before age 36 and half before the age of 45 worldwide. ao-RA appears to be influenced in some way by latitudes, mainly in the Tropic of Cancer (younger) and northern latitudes (older). Studies to assess environmental factor...
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