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A call for pragmatic treatment trials in rheumatoid arthritis

Nature Clinical Practice Rheumatology volume 4, pages 292–293 (2008)Cite this article

“Is that all there is?” I wondered after reading a recent exhaustive review of therapy for rheumatoid arthritis (RA).1 It felt like watching a soufflé that had been slowly rising in the oven suddenly collapse when the door was opened. Why was I so profoundly disappointed? What follows is a personal reflection and a call for pragmatic trials in RA.

In my career as a rheumatologist, I have been fortunate to experience first-hand rheumatology's unbelievable progress. As a PhD candidate in 1989, I studied 132 patients with RA who were autopsied during the period 1958 to 1978 in Leiden, The Netherlands. I learned about RA by reading the clinical charts going back to the 1930s. I read about high-dose salicylates and months of bed rest in splints. The mystery code 'TE' was shorthand for 'total extraction'—all the patient's teeth were pulled out routinely as foci of chronic infection and a putative cause of RA. I saw the introduction of gold, cortisone, D-penicillamine, chloroquine and sulfasalazine. However, my chief, Professor Cats, threatened to fire anyone caught administering prednisone. In 1988, we started using methotrexate for cases of RA resistant to other drugs, at low doses and with careful documentation of the cumulative dose.

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  1. Department of Clinical Epidemiology and Biostatistics, PK 6Z 185, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands keb.info@vumc.nl

Authors and Affiliations

  1. M Boers is Professor of Clinical Epidemiology in the Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.,

    Maarten Boers

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Boers, M. A call for pragmatic treatment trials in rheumatoid arthritis. Nat Rev Rheumatol 4, 292–293 (2008). https://doi.org/10.1038/ncprheum0811

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