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Exercise in Rheumatoid Arthritis
- John F Searle (22 January 2006)
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Is there not a role for primary care?
- john sharvill (25 January 2006)
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Serious infections are also assoc iated with the use of tumor necrosis alpha blockade
- Robert Eli (3 December 2007)
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John F Searle, Personal Trainer Exeter EX2 4RY
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As a former medical practitioner, current personal trainer and sufferer from RA I am grateful to Dr Emery for this informative article. However, he makes no mention of exercise in the treatment of RA. There is now a substantial body of controlled evidence to show that structured, progressive, supervised aerobic and resistance exercise programmes confer considerable benefit on patients with RA. My own disease was only partly controlled with DMRDs including methotrexate 20mg weekly. Regular, demanding exercise produced a huge improvement such that I was able to reach the summit of Kilimanjaro (5895m) in July 2005 Competing interests: Practising personal trainer |
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john sharvill, GP Deal Kent CT14 7AU
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It is great to see such an enthusiastic article. As a GP I do though find it irritating to be regarded merely as the person who referrs the patient. Until the enthusiasm for methotrexate took off a few years ago we had as GPs a fair degree of personal contact with our patients with rheumatoid. At that stage there was also I believe a fair scepticism about the value of rheumatoid factor and the other 'disease modifying' drugs in primary care. Now our patients are protocol managed by the rheumatology nurses with us just printing the scripts. If there is a test such as anticyclic citrullinated peptide that is of value should this not be rolled out to those of us who see people with joint pains daily and have to decide who may need agressive treatment? It cannot be too hard to envisage interested sub sets of GPs to learning how to use the new drugs in conjunction with our consultant colleagues? Competing interests: None declared |
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Robert Eli, semi-retired 332 Adams Street, Nevada City, CA 95959
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The clinical review "Treatment of rheumatoid arthritis" 1 seems to suggest that all possible adverse effects of tumour necrosis factor alpha blockade (anti-TNF therapy) can be detected and possibly even prevented before treatment begins. Treatment with anti-TNF blockade, as compared with treatment with traditional DMARDS is associated with a doubling of the risk of serious infections such as pneumonia, lower respiratory infections and viral infections and a roughly 37% increase in infections requiring hospitalization. 2 Additionally, neurological adverse events such as demylelinating-like syndrome, optic neuritis, multiple sclerosis and even Parkinson's disease have been associated with anti-TNF therapy. 3 Finally, the United States FDA has determined that there is a significant risk of tuberculosis associated with anti-TNF treatment and required three anti-TNF products, infliximab, etanercept and adalimumab to be labeled accordingly.4 1. Emery, P, Treatment of rheumatoid arthritis. British Medical Journal. 2006, January 21; 332:152-155. 2. Ianac N, Direskeneli H. Serious infections under treatment with TNF- alpha antagonists compared with traditional DMARDS in patients with rheumatoid arthritis. Rheumatol Int. 2006;27:67-71. 3. Park, KS and Park, SW. Adverse effects of tumour necrosis-alpha blocking agents. APLAR Journal of Rheumatology 2006; 9:165-169. 4. "Tuberculosis associated with Blocking Agents Against Tumor Necrosis Factor-Alpha---California 2002-2003" http://www.cdc.gov/MMWR/preview/mmwrhtml/mm5330a4.htm. Competing interests: None declared |
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