Intended for healthcare professionals

Rapid response to:

Views & Reviews From the Frontline

Bad medicine: rheumatoid arthritis

BMJ 2011; 343 doi: (Published 05 October 2011) Cite this as: BMJ 2011;343:d6357

Rapid Response:

Re:Re:Authors Response to Bad medicine : rheumatoid arthritis

I for one am grateful to Des Spence for raising such a challenge. I
am persuaded that a perceived diminishing frequency of severe RA is very
possibly due to improved treatment. In my own GP practice, like Des, we
are now detecting more RA than ever, and are racing to get them onto
multiple drug regimes.

Our supportive and dedicated local Rheumatologist visited recently to
encourage us to re-double our efforts, and not stop drugs too soon. The
implication being, I felt, that we GPs were stuck in the past, with
ungrounded fears of overprescribed toxic treatments. The controlled trials
and NICE guidance ought to reassure me that the drugs do work. But not in
everybody, and not without some harmed. What is the NNT, and NNH ?

I therefore asked for evidence-based "stopping rules"

- How will we know if improvement or resolution of signs and symptoms
is due to an effective "cure", or a misdiagnosed non-rheumatoid condition
? Anti-CCP serology might be a sufficiently specific test, I thought, but
my consultant disagreed.

So I am grateful for Gough and Foo's considered response to Des..
They go some way to answer my concern that I MAY be overtreating patients
- too many for too long. I will now more often do the 'Kenalog' test at
onset, and I will stop treatment to 'wait-and-see' in all those whose
clinical features resolve..

Many thanks for the enlightenment.

Competing interests: No competing interests

17 October 2011
L Sam Lewis
GP Trainer
Surgery, Newport, Pembrokeshire, SA42 oTJ