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Genes controlling the production and activity of the glutathione S-transferase (GST) enzyme may have some influence on the risk or outcome of rheumatoid arthritis. GST enzymes use byproducts of oxidation that can damage cells and cause inflammation. Researchers compared the genes of 277 patients with rheumatoid arthritis and 577 healthy people. Particular genetic types were more common in patients with arthritis, and gene type appeared to influence the severity of disease and the functional abilities of patients.

Objective structured clinical examination (OSCE) is a key part of medical student assessment. Currently, assessment is performed by medical examiners in situ. Our objective was to determine whether assessment by videotaped OSCE is as reliable as live OSCE assessment.Participants were 95 undergraduate medical students attending their musculoskeletal week at Freeman Hospital, Newcastle (UK). Student performance on OSCE stations for shoulder or knee examinations was assessed by experienced rheumatologists. The stations were also videotaped and scored by a rheumatologist independently. The examinations consisted of a 14‐item checklist and a global rating scale (GRS).Mean values for the shoulder OSCE checklist were 17.9 by live assessment and 17.4 by video (n = 50), and 20.9 and 20.0 for live and video knee assessment, respectively (n = 45). Intraclass correlation coefficients for shoulder and knee checklists were 0.55 and 0.58, respectively, indicating moderate reliability between live and video scores for the OSCE checklists. GRS scores were less reliable than checklist scores. There was 84% agreement in the classification of examination grades between live and video checklist scores for the shoulder and 87% agreement for the knee (κ = 0.43 and 0.51, respectively; P < 0.001).Video OSCE has the potential to be reliable and offers some advantages over live OSCE including more efficient use of examiners' time, increased fairness, and better monitoring of standards across various schools/sites. However, further work is needed to support our findings and to implement and evaluate the quality assurance issues identified in this work before justifiable recommendations can be made.

To identify whether there was measurable impact of a specific computer‐assisted learning (CAL) package, “Virtual Rheumatology,” on the learning of musculoskeletal examination skills by medical students.We conducted 2 parallel, cluster‐randomized controlled trials using undergraduate curricula at 2 locations: Newcastle and London, UK. Medical students attending a musculoskeletal rotation were allocated to the intervention (Virtual Rheumatology CD) or the control arm of the study by placement group. A formative 14‐item objective structured clinical examination (OSCE) assessment on the examination of shoulder and/or knee joints was the main outcome measure at Newcastle. At London, a 17‐item knee station formed part of the summative OSCE. We also used a questionnaire including a 15‐item confidence log (C‐Log) for self assessment of musculoskeletal examination skills and knowledge. Analysis was by intention to teach.At Newcastle, there were 112 students in the CD allocated group and 129 in the non‐CD group. The CD allocated group performed significantly better on the OSCE (P = 0.002) and C‐Log (P = 0.005) than the non‐CD group. At London, there were 48 students in the CD allocated group and 65 in the non‐CD group. The CD allocated group performed better on the knee OSCE than the non‐CD group (adjusted P = 0.040), but there was little difference in the change in C‐Log scores from baseline to followup between the 2 groups (P = 0.582).The Virtual Rheumatology CD has a positive impact on the acquisition of musculoskeletal examination skills in medical students. Further study is needed to see if similar advantages could be gained in other clinical specialities and how CAL resources could be effectively integrated into the medical curriculum.

Findings of a recent study suggested that HLA–DRB1 alleles encoding the rheumatoid arthritis (RA) “shared epitope” (SE) were not predictive of erosive damage at 2 years in patients with early inflammatory arthritis who were rheumatoid factor (RF) positive, but were predictive in those who were RF negative. The present study was undertaken to determine whether RF status was also important in the association between the SE and radiographic outcome in patients with longstanding RA. The association between radiographic outcome, HLA–DRB1, and RF status was examined in 299 RA patients with established disease (5–30 years). Radiographic outcome was measured by scoring radiographs of the hands and feet using the standard radiographs of Larsen. HLA–DRB1 typing was performed using polymerase chain reaction methodology. Results were stratified by RF status and analyzed by multiple regression. An association between radiographic severity and the SE was found in RF−, but not RF+, patients. RF− patients carrying an SE allele had higher Larsen scores than RF− patients lacking the SE, although there was no association with SE dosage. The mean Larsen score was significantly higher in RF+ patients than in RF− patients, but there were no differences between RF+ patients with 0, 1, or 2 SE alleles. Multiple regression analysis confirmed independent associations of RF and SE positivity with radiographic outcome. No significant associations were found between RF and the SE, or RF and individual SE alleles. Our data indicate that RF and the SE are independently associated with radiographic outcome in RA. In RF+ patients with longstanding RA, there is no apparent association between the presence of the SE and radiographic damage. However, in RF− patients, although radiographic outcome is generally less severe, there is an association between severity and presence of the SE.

To investigate whether interactions between tumor necrosis factor (TNF) microsatellite polymorphisms and the HLA–DRB1 shared epitope (SE) are associated with disease severity in rheumatoid arthritis (RA), and to determine if such associations are the same in male and female patients. Genotyping for the TNFa microsatellite and HLA–DRB1 was carried out on 157 RA patients with established disease (duration >5 years). Disease severity measures included radiographic damage (the Larsen method), functional assessment by the Health Assessment Questionnaire, history of joint surgery, and global appraisal of outcome by means of a visual analog scale score. The association of severity measures with TNFa microsatellite polymorphisms stratified by SE status, and the interaction between TNFa and the SE, were investigated using stratified analyses and multiple or logistic regression analyses. No significant associations were observed between any single TNFa microsatellite polymorphism and disease severity, although preliminary evidence for an interaction between TNFa6 and TNFa11 was obtained. In the presence of the SE, a significantly worse outcome was associated with individuals carrying TNFa6, and a significant interaction (P = 0.04–0.006) was found between these alleles for all the outcome measures examined except history of joint surgery. In the absence of the SE, the TNFa6 allele was associated with significantly better outcome scores. When examined by sex, significant associations between the TNFa6/SE haplotype and disease outcome measures were found only in females. No statistically significant interactions were found in males, although the TNFa6/SE haplotype was still associated with the worst outcome scores. The association of the SE with disease severity in RA is influenced by an interaction with the TNFa6 microsatellite polymorphism. This interaction appears to be acting predominantly in female patients, although the trend is similar in the smaller percentage of males carrying the TNFa6/SE haplotype.