I’ve just written on the 12th
TNF-alpha-Forum in Munich. Prof. Schulze-Koops talked about patient related
outcomes. The gist is: PROs are indispensable tools to capture the functional
experience of the patient. PROs capture parameters that are not directly
related to inflammation. The scores recorded in disease activity scores with
visual analogue scales are not suitable for sensitively and adequately
providing information about functionality limitations. PROs are not sufficient
to escalate immune-suppressive therapy.
SA Provan and colleagues just published: “Fibromyalgia
in patients with rheumatoid arthritis. A 10-year follow-up study, results from
the Oslo Rheumatoid Arthritis Register.” The authors concluded: “RA-FM was
associated with significantly higher levels of cross-sectional and longitudinal
RA disease activity. FM should be considered in patients with RA not reaching
remission.”
On the same TNF-alpha-Forum
the CAPEA study has been quoted, which shows a constant DAS28 above 3.2 in a
little less than 40% of RA patients. After six months nothing changes for the
next 18 months.
It means that we have to find
tools besides the current disease activity scores to monitor activity, which
means to separate pain, inflammation, immunologic parameters, disability and
more to come to safer conclusions concerning the escalation or de-escalation of
immune-suppressive therapies. The fibromyalgia group could easily receive a
more intensive immune-suppression, which would result in a higher risk for
infections for instance. By the way, obese women share also this risk as they
have elevated inflammation markers.
Links:
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