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Abstract
The treatment of rheumatoid arthritis (RA) has changed dramatically over the past two decades. The combination of better insights into the pathophysiological and immunological mechanisms of RA and the possibilities offered by biotechnology led to the development and introduction into clinical practice of a new class of antirheumatic biologic therapies, which along with earlier and more aggressive treatment contributed to dramatically better outcomes for patients with RA. To date, nine biologic agents have been approved for the treatment for RA, and a first Janus kinase (JAK) inhibitor has also been approved in the United States and various other countries in the world (but not by the European Medicines Agency [EMA]). Many additional molecules with distinct mechanisms of action are currently being tested in laboratories and in clinical trials. In addition, considerable improvements have been made in the optimal use of all these agents through treatment strategies such as treating-to-target, induction-maintenance, and dose individualization.
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Affiliation(s)
- Ronald F van Vollenhoven
- Department of Medicine, Karolinska Institute, Unit for Clinical Research Therapy, Inflammatory Diseases (ClinTrid), D1:00, Karolinska Universitetssjukhustet 171 76, Stockholm, Sweden.
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Mir Viladrich I, Daudén Tello E, Solano-López G, López Longo FJ, Taxonera Samso C, Sánchez Martínez P, Martínez Lacasa X, García Gasalla M, Dorca Sargatal J, Arias-Guillén M, García García JM. Consensus Document on Prevention and Treatment of Tuberculosis in Patients for Biological Treatment. Arch Bronconeumol 2015; 52:36-45. [PMID: 26187708 DOI: 10.1016/j.arbres.2015.04.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/23/2015] [Accepted: 04/24/2015] [Indexed: 12/31/2022]
Abstract
Tuberculosis risk is increased in patients with chronic inflammatory diseases receiving any immunosuppressive treatment, notably tumor necrosis factor (TNF) antagonists therapy. Screening for the presence of latent infection with Mycobacterium tuberculosis and targeted preventive treatment to reduce the risk of progression to TB is mandatory in these patients. This Consensus Document summarizes the current knowledge and expert opinion of biologic therapies including TNF-blocking treatments. It provides recommendations for the use of interferon-gamma release assays (IGRA) and tuberculin skin test (TST) for the diagnosis of latent tuberculosis infection in these patients, and for the type and duration of preventive therapy.
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Affiliation(s)
| | | | | | | | - Carlos Taxonera Samso
- Servicio Aparato Digestivo, Hospital Clínico San Carlos e Instituto de Investigación del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | | | - Xavier Martínez Lacasa
- Unidad control de Tuberculosis, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España
| | - Mercedes García Gasalla
- Servicio de Medicina Interna, Unidad de Enfermedades Infecciosas, Hospital Son Llàtzer, Palma de Mallorca, España
| | - Jordi Dorca Sargatal
- Servicio de Neumología, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - Miguel Arias-Guillén
- Servicio de Neumología, Hospital Universitario Central de Asturias-Instituto Nacional de Silicosis, Oviedo, Asturias, España
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Michaud TL, Rho YH, Shamliyan T, Kuntz KM, Choi HK. The comparative safety of tumor necrosis factor inhibitors in rheumatoid arthritis: a meta-analysis update of 44 trials. Am J Med 2014; 127:1208-32. [PMID: 24950486 DOI: 10.1016/j.amjmed.2014.06.012] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 05/22/2014] [Accepted: 06/09/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The study objective was to evaluate and update the safety data from randomized controlled trials of tumor necrosis factor inhibitors in patients treated for rheumatoid arthritis. METHODS A systematic literature search was conducted from 1990 to May 2013. All studies included were randomized, double-blind, controlled trials of patients with rheumatoid arthritis that evaluated adalimumab, certolizumab pegol, etanercept, golimumab, or infliximab treatment. The serious adverse events and discontinuation rates were abstracted, and risk estimates were calculated by Peto odds ratios (ORs). RESULTS Forty-four randomized controlled trials involving 11,700 subjects receiving tumor necrosis factor inhibitors and 5901 subjects receiving placebo or traditional disease-modifying antirheumatic drugs were included. Tumor necrosis factor inhibitor treatment as a group was associated with a higher risk of serious infection (OR, 1.42; 95% confidence interval [CI], 1.13-1.78) and treatment discontinuation due to adverse events (OR, 1.23; 95% CI, 1.06-1.43) compared with placebo and traditional disease-modifying antirheumatic drug treatments. Specifically, patients taking adalimumab, certolizumab pegol, and infliximab had an increased risk of serious infection (OR, 1.69, 1.98, and 1.63, respectively) and showed an increased risk of discontinuation due to adverse events (OR, 1.38, 1.67, and 2.04, respectively). In contrast, patients taking etanercept had a decreased risk of discontinuation due to adverse events (OR, 0.72; 95% CI, 0.55-0.93). Although ORs for malignancy varied across the different tumor necrosis factor inhibitors, none reached statistical significance. CONCLUSIONS These meta-analysis updates of the comparative safety of tumor necrosis factor inhibitors suggest a higher risk of serious infection associated with adalimumab, certolizumab pegol, and infliximab, which seems to contribute to higher rates of discontinuation. In contrast, etanercept use showed a lower rate of discontinuation. These data may help guide clinical comparative decision making in the management of rheumatoid arthritis.
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Affiliation(s)
- Tzeyu L Michaud
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis
| | - Young Hee Rho
- Section of Rheumatology and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Mass
| | - Tatyana Shamliyan
- Evidence-Based Medicine Quality Assurance Elsevier, Clinical Solutions, Philadelphia, PA
| | - Karen M Kuntz
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis
| | - Hyon K Choi
- Section of Rheumatology and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Mass.
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Zhou Q, Zhou Y, Chen H, Wang Z, Tang Z, Liu J. The efficacy and safety of certolizumab pegol (CZP) in the treatment of active rheumatoid arthritis (RA): a meta-analysis from nine randomized controlled trials. Int J Clin Exp Med 2014; 7:3870-3880. [PMID: 25550895 PMCID: PMC4276153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 11/08/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Certolizumab pegol (CZP) is a novel anti-TNF agent that is used for patients with moderate to severe active rheumatoid arthritis (RA). However, the efficacy of CZP in RA remains controversial. Thus, we performed this meta-analysis to assess the efficacy and safety of CZP in the treatment of RA patients. METHODS Eligible studies were randomized controlled trials (RCTs) that evaluated the efficacy and safe of CZP in the patients with active RA. The primary outcome was American College of Rheumatology 20% (ACR20), and secondary outcome were ACR50, ACR70, disease activity, patient-reported outcomes (PROs), and adverse events. A fixed-effect model or random-effect model was used to pool the estimates, depending on the absence or presence of heterogeneity among the included studies. RESULTS Nine RCTs with a total of 5228 patients were included in this meta-analysis, and all of the patients were administered CZP or placebo. The pooled results showed that CZP significantly improved the ACR20, ACR50, ACR70 response rates, and physical function. CZP was associated with a statistically significant reduction in Disease Activity Score in 28 joints-Erythrocyte sedimentation rate, arthritis pain, and fatigue. Patients who received CZP treatment did not have a higher incidence of treatment-related adverse events, no matter in any intensity. CONCLUSIONS CZP 200 or 400mg in the treatment of active RA significantly reduced the RA signs and symptoms, and improved physical function as compared with the placebo. More large-scale RCTs are needed to evaluate the long-term efficacy and safety of CZP in the treatment of active RA.
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Affiliation(s)
- Qing Zhou
- Department of Orthopaedics, Suzhou Kowloon Hospital Affiliated to Shanghai Jiaotong University School of Medicine Jiangsu 215021, China
| | - Yaodong Zhou
- Department of Orthopaedics, Suzhou Kowloon Hospital Affiliated to Shanghai Jiaotong University School of Medicine Jiangsu 215021, China
| | - Hao Chen
- Department of Orthopaedics, Suzhou Kowloon Hospital Affiliated to Shanghai Jiaotong University School of Medicine Jiangsu 215021, China
| | - Zhen Wang
- Department of Orthopaedics, Suzhou Kowloon Hospital Affiliated to Shanghai Jiaotong University School of Medicine Jiangsu 215021, China
| | - Zhibing Tang
- Department of Orthopaedics, Suzhou Kowloon Hospital Affiliated to Shanghai Jiaotong University School of Medicine Jiangsu 215021, China
| | - Jinlian Liu
- Department of Orthopaedics, Suzhou Kowloon Hospital Affiliated to Shanghai Jiaotong University School of Medicine Jiangsu 215021, China
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Ward MM, Guthrie LC, Alba MI. Brief report: rheumatoid arthritis response criteria and patient-reported improvement in arthritis activity: is an American College of Rheumatology twenty percent response meaningful to patients? Arthritis Rheumatol 2014; 66:2339-43. [PMID: 24838475 DOI: 10.1002/art.38705] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 05/08/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine the association of the American College of Rheumatology (ACR) response criteria (20% improvement [ACR20], ACR50, and ACR70) and the European League Against Rheumatism (EULAR) response criteria with patient-reported improvement in rheumatoid arthritis (RA) activity. METHODS Two hundred fifty patients with active RA were studied prospectively, before and after escalation of antirheumatic treatment. Patients were asked to report if they subjectively judged that they had experienced important improvement with treatment, and the proportion of patients who reported improvement was compared with the proportion who met the ACR20, ACR50, ACR70, and EULAR response criteria. RESULTS Improvement in overall arthritis status was reported by 167 patients (66.8%), while 107 patients (42.8%) had an ACR20 response, 52 (20.8%) had an ACR50 response, 24 (9.6%) had an ACR70 response, and 136 (54.4%) had a EULAR moderate/good response. ACR20 response had a sensitivity of 0.57 and a specificity of 0.85 for clinically important improvement as judged by patients. Sensitivities of the ACR50, ACR70, and EULAR moderate/good responses were 0.30, 0.14, and 0.68, respectively, while their specificities were 0.97, 0.99, and 0.73, respectively. The ACR hybrid score with the highest sensitivity and specificity for important improvement was 19.99. CONCLUSION Among patients with active RA, ACR20 responses are highly specific measures of improvement as judged by patients, but exclude a substantial proportion of patients who consider themselves improved. Response criteria are associated with, but not equivalent to, patient-perceived improvement.
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Affiliation(s)
- Michael M Ward
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
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Felson DT, LaValley MP. The ACR20 and defining a threshold for response in rheumatic diseases: too much of a good thing. Arthritis Res Ther 2014; 16:101. [PMID: 24387346 PMCID: PMC3978644 DOI: 10.1186/ar4428] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In the past 20 years great progress has been made in the development of multidimensional outcome measures (such as the Disease Activity Score and ACR20) to evaluate treatments in rheumatoid arthritis, a process disseminated throughout rheumatic diseases. These outcome measures have standardized the assessment of outcomes in trials, making it possible to evaluate and compare the efficacy of treatments. The methodologic advances have included the selection of pre-existing outcome measures that detected change in a sensitive fashion (in rheumatoid arthritis, this was the Core Set Measures). These measures were then combined into a single multidimensional outcome measure and such outcome measures have been widely adopted in trials and endorsed by the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) and regulatory agencies. The secular improvement in treatment for patients with rheumatoid arthritis has been facilitated in part by these major methodologic advancements. The one element of this effort that has not optimized measurement of outcomes nor made it easier to detect the effect of treatments is the dichotomization of continuous measures of response, creating responders and non-responder definitions (for example, ACR20 responders; EULAR good responders). Dichotomizing response sacrifices statistical power and eliminates variability in response. Future methodologic work will need to focus on improving multidimensional outcome measurement without arbitrarily characterizing some patients as responders while labeling others as non-responders.
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Cardiel MH, Díaz-Borjón A, Vázquez del Mercado Espinosa M, Gámez-Nava JI, Barile Fabris LA, Pacheco Tena C, Silveira Torre LH, Pascual Ramos V, Goycochea Robles MV, Aguilar Arreola JE, González Díaz V, Alvarez Nemegyei J, González-López LDC, Salazar Páramo M, Portela Hernández M, Castro Colín Z, Xibillé Friedman DX, Alvarez Hernández E, Casasola Vargas J, Cortés Hernández M, Flores-Alvarado DE, Martínez Martínez LA, Vega-Morales D, Flores-Suárez LF, Medrano Ramírez G, Barrera Cruz A, García González A, López López SM, Rosete Reyes A, Espinosa Morales R. Update of the Mexican College of Rheumatology guidelines for the pharmacologic treatment of rheumatoid arthritis. ACTA ACUST UNITED AC 2013; 10:227-40. [PMID: 24333119 DOI: 10.1016/j.reuma.2013.10.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 09/30/2013] [Accepted: 10/02/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND The pharmacologic management of rheumatoid arthritis has progressed substantially over the past years. It is therefore desirable that existing information be periodically updated. There are several published international guidelines for the treatment of rheumatoid arthritis that hardly adapt to the Mexican health system because of its limited healthcare resources. Hence, it is imperative to unify the existing recommendations and to incorporate them to a set of clinical, updated recommendations; the Mexican College of Rheumatology developed these recommendations in order to offer an integral management approach of rheumatoid arthritis according to the resources of the Mexican health system. OBJECTIVE To review, update and improve the available evidence within clinical practice guidelines on the pharmacological management of rheumatoid arthritis and produce a set of recommendations adapted to the Mexican health system, according to evidence available through December 2012. METHODS The working group was composed of 30 trained and experienced rheumatologists with a high quality of clinical knowledge and judgment. Recommendations were based on the highest quality evidence from the previously established treatment guidelines, meta-analysis and controlled clinical trials for the adult population with rheumatoid arthritis. RESULTS During the conformation of this document, each working group settled the existing evidence from the different topics according to their experience. Finally, all the evidence and decisions were unified into a single document, treatment algorithm and drug standardization tables. CONCLUSIONS This update of the Mexican Guidelines for the Pharmacologic Treatment of Rheumatoid Arthritis provides the highest quality information available at the time the working group undertook this review and contextualizes its use for the complex Mexican health system.
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Affiliation(s)
- Mario H Cardiel
- Jefe de la Unidad de Investigación «Dr. Mario Alvizouri Muñoz», Hospital General «Dr. Miguel Silva», Secretaría de Salud de Michoacán, Morelia, Michoacán, México
| | - Alejandro Díaz-Borjón
- Profesor Titular del Curso de Especialización en Medicina Interna, Hospital Ángeles Lomas/UNAM, Huixquilucan, Estado de México, México
| | - Mónica Vázquez del Mercado Espinosa
- Reumatólogo del Nuevo Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Profesor del Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara. Jefa del Instituto de Investigación en Reumatología y del Sistema Músculo Esquelético, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Jorge Iván Gámez-Nava
- Investigador de UMAE, Hospital de Especialidades Centro Médico Nacional de Occidente, IMSS. Profesor del Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Leonor A Barile Fabris
- Reumatóloga y Doctora en Ciencias de la Salud, Jefa del departamento de Reumatología HE CMNSXXI IMSS, Profesora titular del curso de especialización en Reumatología, miembro titular del Sistema Nacional de Investigadores, México Distrito Federal, México
| | - César Pacheco Tena
- Reumatólogo, Profesor-investigador de la Facultad de Medicina de la Universidad Autónoma de Chihuahua, Chihuahua, México
| | - Luis H Silveira Torre
- Médico adjunto, Profesor adjunto Curso de Reumatología, Departamento de Reumatología, Instituto Nacional de Cardiología Ignacio Chávez, México Distrito Federal, México
| | - Virginia Pascual Ramos
- Médico adscrito del Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México Distrito Federal, México
| | - María Victoria Goycochea Robles
- Reumatóloga, investigadora titular A, adscrita a la Unidad de Investigación en Epidemiología Clínica del Hospital General Regional Núm. 1. «Dr. Carlos McGregor Sánchez Navarro», IMSS, México Distrito Federal, México
| | - Jorge Enrique Aguilar Arreola
- Reumatólogo del Nuevo Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Profesor del Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Verónica González Díaz
- Reumatóloga del Antiguo Hospital Civil de Guadalajara «Fray Antonio Alcalde», Guadalajara, México
| | - José Alvarez Nemegyei
- Profesor Investigador de la escuela de Medicina de la Universidad Anáhuac-Mayab, Mérida, Yucatán, México
| | - Laura del Carmen González-López
- Reumatólogo del Hospital General Regional 110 del IMSS, Profesor del Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Mario Salazar Páramo
- Jefe de la División de Investigación de la UMAE, Hospital de Especialidades Centro Médico Nacional de Occidente, IMSS. Profesor del Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Margarita Portela Hernández
- Adscrita al Departamento de Reumatología del Hospital de Especialidades del CMN SXXI, México Distrito Federal, México
| | - Zully Castro Colín
- Adscrita al Departamento de Reumatología de HGZ 27 IMSS, México Distrito Federal, México
| | | | | | | | - Miguel Cortés Hernández
- Medicina Interna-Reumatología, Profesor de Fisiología Humana, Facultad de Medicina, Universidad Autónoma de Estado de Morelos, Morelos, México
| | - Diana E Flores-Alvarado
- Profesora de Medicina Interna y Reumatología, Hospital Universitario «José E. González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Laura A Martínez Martínez
- Investigadora titular, Departamento de Reumatología, Instituto Nacional de Cardiología Ignacio Chávez, México Distrito Federal, México
| | - David Vega-Morales
- Hospital Universitario «José E. González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Luis Felipe Flores-Suárez
- Reumatólogo, Jefe de la Clínica de Vasculitis Sistémicas Primarias, Instituto Nacional de Enfermedades Respiratorias, Investigador en Ciencias Médicas «D», México Distrito Federal, México
| | - Gabriel Medrano Ramírez
- Médico internista y reumatólogo, Adscrito al Servicio de Reumatología, Hospital General de México. Presidente del Consejo Mexicano de Reumatología, México Distrito Federal, México
| | - Antonio Barrera Cruz
- Reumatólogo, Maestro en Ciencias Médicas, Coordinador de Programas Médicos, adscrito a la División de Excelencia Clínica, área de Desarrollo de Guías de Práctica Clínica de la Coordinación de Unidades Médicas de Alta Especialidad del IMSS , México Distrito Federal, México
| | - Adolfo García González
- Reumatólogo, Doctor en Ciencias Médicas, Hospital General de Zona IMSS, La Paz, Baja California Sur, México
| | | | - Alejandra Rosete Reyes
- Reumatóloga especializada en Fármaco-vigilancia, Jefe de operaciones Centro de Investigación en Farmacología y Biotecnología, Médica Sur, México Distrito Federal, México
| | - Rolando Espinosa Morales
- Profesor titular de Reumatología, UNAM, Jefe del Departamento de Reumatología, Instituto Nacional de Rehabilitación, México Distrito Federal, México.
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Henrique da Mota LM, Afonso Cruz B, Viegas Brenol C, Alves Pereira I, Rezende-Fronza LS, Barros Bertolo M, Carioca Freitas MV, da Silva NA, Louzada-Junior P, Neubarth Giorgio RD, Corrêa Lima RA, Marques Bernardo W, Castelar Pinheiro GDR. Diretrizes para o tratamento da artrite reumatoide. REVISTA BRASILEIRA DE REUMATOLOGIA 2013. [DOI: 10.1590/s0482-50042013000200004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Zidi I, Mnif W, Bouaziz A, Amor NB. Certolizumab pegol therapy of rheumatoid arthritis: Overview. Drug Dev Res 2011. [DOI: 10.1002/ddr.20470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Felson DT. American College of Rheumatology hybrid measure for assessing efficacy of treatment in patients with refractory rheumatoid arthritis: comment on the article by Genovese et al. ARTHRITIS AND RHEUMATISM 2011; 63:3181-3182. [PMID: 21769845 DOI: 10.1002/art.30544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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