Relationships between knowledge and experience in the use of disease-modifying antirheumatic agents: a study of primary care practitioners

Article Abstract:

Despite the extensive participation of physicians in continuing medical education (CME) programs, communication of important clinical developments to primary care physicians is inadequate in many respects. The authors studied primary care physicians' management of patients with rheumatoid arthritis (RA) to determine if they were prescribing the new disease-modifying antirheumatic drugs (DMARDs). Physicians who had admitted at least one patient with RA to the hospital in the past year were asked to participate. Of the 68 physicians contacted, 30 physicians completed the survey, which described the clinical history of a patient with RA and asked how they would treat the patient. Of the RA patients these physicians had admitted to the hospital, only 26 percent had ever been treated with DMARDs. In response to the clinical history in the survey, only 12 percent of the responding primary care physicians would begin treatment with DMARDs; the majority chose to refer the patient to a rheumatologist (physician specializing in rheumatology). Seventy-two percent of the physicians who responded were aware of the benefits of DMARDs, but only 14 percent had actually prescribed them within the last year. The authors concluded that, although information about DMARDs was being disseminated to primary care physicians, medical treatment of RA patients had changed very little. The results also confirm previous studies which reported that primary care physicians consider themselves competent to handle routine cases of RA, but not more complicated ones. Experience was an important factor in determining which physicians would initiate treatment with DMARDs. Physicians who had treated RA patients with similar symptoms were more likely to initiate DMARD therapy than to refer patients to rheumatologists.

Research, Dosage and administration, Graduate medical education, Postgraduate medical education

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Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies

Article Abstract:

Tumor necrosis factor (TNF) plays an important role in host defense and tumor growth control, therefore, anti-TNF antibody therapies may increase the risk of serious infections and malignancies. Two types of anti-TNF antibodies currently licensed for clinical use in rheumatoid arthritis are infliximab and adalimumab, the former being a partially and the latter a fully humanized monoclonal antibody specific for TNF.

Health aspects, Risk factors, Tumor necrosis factor, Viral antibodies, Antibodies, Tumour necrosis factor, Disease/Disorder overview

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Use of biologics for rheumatoid arthritis tempered by concerns over safety, cost

Article Abstract:

Five new drugs used to treat rheumatoid arthritis may be more effective than older drugs but are also more expensive and have serious side effects. The drugs are etanercept, infliximab, adalimumab, leflunomide, and anakinra. These drugs can cost $12,000 to $15,000 a year and can cause tuberculosis, fungal infections, pneumonia, and some types of cancer.

Complications and side effects

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