Objective. To compare the benefits of initiating treatment with methotrexate (MTX) and infliximab (anti-tumor necrosis factor ␣ [anti-TNF␣] monoclonalantibody) with those of MTX treatment alone in patients with rheumatoid arthritis (RA) of <3 years' duration.Methods. RA patients were eligible if they had active disease and no prior treatment with MTX or a TNF␣ inhibitor. One thousand forty-nine patients were randomly assigned in a 4:5:5 ratio to 3 treatment groups: MTX-placebo, MTX-3 mg/kg infliximab, and MTX-6 mg/kg infliximab. MTX dosages were rapidly escalated to 20 mg/week, and infliximab or placebo infusions were given at weeks 0, 2, and 6, and every 8 weeks thereafter through week 46.Results. At week 54, the median percentage of American College of Rheumatology improvement (ACR-N) was higher for the MTX-3 mg/kg infliximab and MTX-6 mg/kg infliximab groups than for the MTX-placebo group (38.9% and 46.7% versus 26.4%, respectively; P < 0.001 for both comparisons). Patients in the MTX-3 mg/kg infliximab and MTX-6 mg/kg infliximab groups also showed less radiographic progression than those receiving MTX alone (mean ؎ SD changes in van der Heijde modification of the total Sharp score at week 54: 0.4 ؎ 5.8 and 0.5 ؎ 5.6 versus 3.7 ؎ 9.6, respectively; P < 0.001 for each comparison). In addition, physical function improved significantly more in the MTX-3 mg/kg infliximab and MTX-6 mg/kg infliximab groups than in the MTX-placebo group. Infliximab therapy was associated with a significantly higher incidence of serious infections, especially pneumonia.Conclusion. For patients with active RA in its early stages, combination therapy with MTX and infliximab provides greater clinical, radiographic, and functional benefits than treatment with MTX alone.

Cut-off values for disease activity states and improvement using the ASDAS have been developed. They proved to have external validity and a good performance compared to existing criteria.

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Objective. To identify disease characteristics leading to progression of joint damage in patients with early rheumatoid arthritis (RA) treated with methotrexate (MTX) versus those treated with infliximab plus MTX.Methods. Patients who had not previously been treated with MTX with active RA were randomly assigned to receive escalating doses of MTX up to 20 mg/week plus placebo or infliximab at weeks 0, 2, and 6, and every 8 weeks thereafter through week 46. Radiographic joint damage was assessed using the modified Sharp/van der Heijde score (SHS). The relationship between disease activity measures at baseline and week 14, as well as those averaged over time, were examined in relation to the change in SHS from baseline through week 54.Results. C-reactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), and swollen joint count were associated with greater joint damage progression in the MTX-only group, while none of these parameters was associated with progression in the infliximab plus MTX group. Mean changes in SHS among patients in the highest CRP (>3 mg/dl) and ESR (>52 mm/hour) tertiles in the MTX-only group were 5.62 and 5.89, respectively, compared with 0.73 and 1.12 in the infliximab plus MTX group (P < 0.001). Patients with greater joint damage at baseline (SHS >10.5) showed less progression with infliximab plus MTX compared with MTX alone (؊0.39 versus 4.11; P < 0.001). Patients receiving MTX alone who had persistently active disease at week 14 showed greater radiographic progression of joint damage than those taking MTX plus infliximab.Conclusion. High CRP level, high ESR, or persistent disease activity was associated with greater radiographic progression in the group taking MTX alone, while little radiographic progression was seen in patients receiv-

Success in rugby league football seems heavily reliant on players possessing an adequate degree of various physical fitness qualities, such as strength, power, speed, agility, and endurance, as well as the individual skills and team tactical abilities. The purpose of this study was to describe and compare the lower body strength, power, acceleration, maximal speed, agility, and sprint momentum of elite first-division national rugby league (NRL) players (n = 20) to second-division state league (SRL) players (n = 20) players from the same club. Strength and maximal power were the best discriminators of which players were in the NRL or SRL squads. None of the sprinting tests, such as acceleration (10-m sprint), maximal speed (40-m sprint), or a unique 40-m agility test, could distinguish between the NRL or SRL squads. However, sprint momentum, which was a product of 10-m velocity and body mass, was better for discriminating between NRL and SRL players as heavier, faster players would possess better drive forward and conversely be better able to repel their opponents' drive forward. Strength and conditioning specialists should therefore pay particular attention to increasing lower body strength and power and total body mass through appropriate resistance training while maintaining or improving 10-m sprint speed to provide their players with the underlying performance characteristics of play at the elite level in rugby leagues.

The analyses of this study provide evidence of the utility and validity of the DAREA for PsA disease activity assessment. A second name should therefore be assigned to this score: DAPSA (for 'Disease Activity index for PSoriatic Arthritis').

With methotrexate, joint damage progresses even at low and moderate disease activity levels, whereas methotrexate plus infliximab inhibits radiographic progression across all disease activity states.

Objective To study the relationship between spinal mobility, radiographic damage of the spine and spinal infl ammation as assessed by MRI in patients with ankylosing spondylitis (AS). Methods In this subanalysis of the Ankylosing Spondylitis Study for the Evaluation of Recombinant Infl iximab Therapy cohort, 214 patients, representing an 80% random sample, were investigated. Only baseline data were used. MRI infl ammation was assessed by the AS spinal MRI activity (ASspiMRI-a) score, structural damage by the modifi ed Stoke AS Spine Score (mSASSS) and spinal mobility by the linear defi nition of the Bath Ankylosing Spondylitis Metrology Index (BASMI). Univariate correlations were calculated on baseline values using Spearman rank correlation. Independent associations between the variables of interest were investigated by multivariate linear regression analysis. Associations with clinical disease activity, C-reactive protein, disease duration, age, gender, body mass index and HLA-B27 status were also investigated. Subanalyses were performed according to disease duration. Results BASMI correlated moderately well with mSASSS (Spearman's ρ=0.6) and weakly with ASspiMRI-a (ρ=0.3). A best-fi t model for BASMI included both mSASSS (regression coeffi cient (B)=0.865, p<0.001) and p=0.018). In patients with a disease duration ≤3 years, B was greater for ASspiMRI-a than for mSASSS (0.595 vs 0.380), while in patients with a disease duration >3 years B was greater for mSASSS than for ASspiMRI-a (0.924 vs 0.156). Conclusion Spinal mobility impairment in AS is independently determined both by irreversible spinal damage and by reversible spinal infl ammation. Spinal mobility impairment is more infl uenced by spinal infl ammation in early disease, and by structural damage in later disease.