IntroductionAppropriate medical treatment can reduce the morbidity and mortality associated with rheumatoid arthritis (RA). Studies have shown that older patients with RA may be treated less aggressively than their younger counterparts, despite evidence suggesting that biologic treatments may be safe and efficacious in older age groups. The aim of this study was to assess whether patient age was associated with biologic treatment for RA in a single center in the United Kingdom.MethodsThis was a retrospective cross-sectional analysis of clinic records for all patients with RA reviewed over 1 year in our center. Data were also collected on healthcare use in patients aged 65 years and older as a surrogate marker of comorbidity.ResultsIn total, 856 patients with RA were identified, of which 22.8% were on biologic treatment. Patients on biologics were younger (mean age 58.9 years) compared to the mean age of all patients (61.4 years). Of patients aged less than 65 years, 27.2% were receiving biologic treatment, while only 15.2% of patients aged 65 years or older were on biologics. Increasing age was significantly associated with a lower likelihood of receiving biologic treatment. However, in patients 65 years or older, there was no significant difference in overall healthcare use between those on biologic treatment and those not. Patients treated with prednisolone were found to have a greater number of admissions.ConclusionIn our center, older patients are less likely to receive biologic treatment than younger patients. Among older patients we found no difference in healthcare use between those treated with biologics and those not, suggesting similar levels of comorbidity. Potential contributors are discussed, but further assessment is required to determine the reasons for this observation.Electronic supplementary materialThe online version of this article (doi:10.1007/s40744-015-0021-z) contains supplementary material, which is available to authorized users.
Patients with early and established inflammatory arthritis alike benefited from a 6-week PRT programme provided within a National Health Service setting. Although further work is needed to look at long-term effects, we suggest that this intervention should be more widely available.
Objective: To highlight the importance of taking the psychological, social and biological aspects into consideration when dealing with somatic complaints of spinal cord injured patients. Setting: Supra-regional Spinal Injury Unit in the UK. Study design: Case study series. Material and methods: The somatic complaints of four patients with spinal cord injury were assessed and their relationship to psychological and social issues were correlated. Two patients su ered unexplained pain, another excessive spasm uncontrolled with intrathecal Baclofen pump and the fourth with several pressure sores, constipation and other physical problems. The impact of psychosocial issues on the somatic complaints were analysed. Results: In all four patients the resolution of their psychosocial issues resulted in signi®cant gains vis-aÁ-vis their somatic complaints. Conclusion: Psychological and social issues of spinal injury patients could have a serious impact on the resolution of somatic complaints. It is important to take these into consideration in their treatment. Spinal Cord (2001) 39, 644 ± 649
Objective: Rheumatoid factor (RF) testing is used in primary care in the diagnosis of rheumatoid arthritis (RA); however a positive RF may occur without RA. Incorrect use of RF testing may lead to increased costs and delayed diagnoses. The aim was to assess the performance of RF as a test for RA and to estimate the costs associated with its use in a primary care setting. Material and methods: A retrospective cohort study using the Information System for the Development of Research in Primary Care database (contains primary care records and laboratory results of >80% of the Catalonian population, Spain). Participants were patients ≥18 years with ≥1 RF test performed between 01/01/2006 and 31/12/2011, without a pre-existing diagnosis of RA. Outcome measures were an incident diagnosis of RA within 1 year of testing, and the cost of testing per case of RA. Results: 495,434/4,796,498 (10.3%) patients were tested at least once. 107,362 (21.7%) of those tested were sero-positive of which 2,768 (2.6%) were diagnosed with RA within 1 year as were 1,141/388,072 (0.3%) seronegative participants. The sensitivity of RF was 70.8% (95% CI 69.4 to 72.2), specificity 78.7% (78.6 to 78.8), and positive and negative predictive values 2.6% (2.5 to 2.7) and 99.7% (99.6 to 99.7) respectively. Approximately €3,963,472 was spent, with a cost of €1,432 per true positive case. Conclusions: Although 10% of patients were tested for RF, most did not have RA. Limiting testing to patients with a higher pre-test probability would significantly reduce the cost of testing. Ethical disclosures Protection of human and animal subjects. The authors declare that no experiments were performed on humans or animals for this study. Confidentiality of data. The authors declare that they have followed the protocols of their work center on the publication of patient data. Right to privacy and informed consent. The authors declare that no patient data appear in this article. *Responsabilidades eticas TITLE (in English): "Rheumatoid factor testing in Spanish primary care: a populationbased cohort study including 4.8 million subjects and almost half a million measurements." Title in Spanish: "Uso del factor reumatoide en atención primaria en España: estudio de cohortes poblacional incluyendo 4.8 millones de participantes y casi medio millón de mediciones."
Although 10% of patients were tested for RF, most did not have RA. Limiting testing to patients with a higher pre-test probability would significantly reduce the cost of testing.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.