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By the early 2000s, disease remission had become a realistic goal, although the definition of remission varied widely, making it hard to compare treatment strategies and gauge how often remission occurred. Conclusion With remission achievable in RA, making the definition of remission stringent will ensure that patients benefit from comprehensive control of their disease. Lee et al (5) reported that joint pain was present and persisted in patients with RA in DAS28 remission but was absent if patients were in Boolean remission. Reexamining Remission Definitions in Rheumatoid Arthritis: Considering Disease Activity Score in 28 Joints, C-Reactive Protein, and Patient Global Assessment. [Extracted from the article]

The editors address concerns regarding the provisional remission criteria in rheumatoid arthritis (RA). The issues include the use in trials of the 28-joint Disease Activity Score thresholds to define remission, the use of C-reactive protein as an element of remission definitions, as well as the appropriateness of including patient global assessment in defining RA remission. They also discuss the history of the development of remission definitions in RA.

Objective: Studies suggest that parenteral MTX may be more efficacious than the oral form at equivalent doses for the treatment of rheumatoid arthritis. We carried out a meta-analysis to compare the efficacy of oral versus parenteral MTX in RA. Methods: PubMed, Web of Science and Embase were systematically searched from inception to June 8th 2017 and reviewed following PRISMA 2009 guidelines, by two independent reviewers. To be included, trials had to study adults with RA randomized to the same dose of either oral or parenteral MTX. The primary endpoint was ACR20 at 6 months. Intention-to-treat analysis results were used when possible. Data from direct comparisons between oral and parenteral methotrexate quantitatively analyzed using maximum likelihood random effects meta-analysis. Relative treatment effects were generated as an odds ratio [OR] (OR>1 indicated a benefit for parenteral therapy). Results: The search yielded 357 papers or abstracts. After review of titles or abstracts and full text papers, we found 4 that met inclusion criteria with 703 patients randomized. Dose of MTX started at 15mg/week and increased up to 25mg/week. The summary OR for achieving ACR20 using parenteral vs. oral MTX was 3.02 (95% CI 1.41, 6.46), with no significant difference in the risk for all adverse events. Conclusion: Parenteral MTX therapy had significantly higher odds than oral MTX of achieving reduction in disease activity. We propose that parenteral MTX is more effective than weekly oral MTX; its widespread use may lead to better control of disease and a decrease in demand for biologic agents. [ABSTRACT FROM AUTHOR]

The article presents a cohort study which examined whether and how risk factors for rheumatoid arthritis (RA) work disability may differ from previous studies in the U.S. Discussions on the methods used as well as the results of the said study are provided. The study found that older age, lower income, fewer working hours, and preference not to work were the risk factors for work disability. It adds that the impact of disease factors was limited to subjects ages 56 years old.

The article reports on a study on the association of contemporary prevalence and incidence of work disability with rheumatoid arthritis (RA) in the U.S. The study was done on 5,384 patients with average age of 52 years, 82 percent of which were female and all had arthritis for an average of 14 years. It was found that work disability affected 35 percent of the patients averaging 10 years of having the disease.

Many people with arthritis become work disabled, but little is known about (a) the types of work barriers they experience and (b) their use of job accommodations. Our objectives were to describe work barriers and use of accommodations and to examine factors associated with accommodation use in persons with arthritis at risk for work disability. Barrier assessment was conducted using the Work Experience Survey. Factors associated with accommodation use were analyzed by logistic regression. The overwhelming majority of the 121 participants (98%) reported having one or more barriers, and 68% reported 10 or more barriers; 38% used an accommodation. Greater functional limitations and self-efficacy for accommodation request were each associated with accommodation use. Even though these employed persons with arthritis faced multiple barriers at work, only a small number used any form of job accommodation. [ABSTRACT FROM AUTHOR]