J Rheumatol
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Editorial Comment Review
How do I know thee...? Let me count the ways. The varieties of medical evidence.
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A proposed standard "core set" of outcome measures for low back pain includes 5 domains: back-specific function, generic health status, pain, work disability, and patient satisfaction. This paper focuses on the 2 recommended back-specific measures of function: the Roland-Morris Disability Questionnaire (RDQ) and the Oswestry Disability Index (ODI). We specifically address their ability to measure change. ⋯ The responsiveness of the RDQ found in the literature ranges from 2 to 8 points on its 0 to 24 scale depending on what change is being measured. As a rough guide, Roland recommends that a change in 2-3 points on the RDQ should be considered the minimum clinically important change. Choosing any value larger than 5 in designing a clinical trial would risk underpowering the trial, since fewer patients are needed if a trial is designed on the basis of a large change score.
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Review Case Reports
Reversible methotrexate associated lymphoproliferative disease evolving into Hodgkin's disease.
We describe a case of nodular sclerosing Hodgkin's disease (NSHD) developing in a 61-year-old woman with seropositive rheumatoid arthritis treated with oral methotrexate (MTX) 5 to 15 mg/week for 5 years. Computed tomography (CT) of the abdomen revealed splenomegaly and marked abdominal and retroperitoneal lymphadenopathy. ⋯ However, CT studies at 10 months showed asymptomatic progression of lymphadenopathy, which on biopsy revealed NSHD. Patients with apparently reversible MTX associated lymphoproliferative disorder require periodic monitoring for asymptomatic development of malignant lymphoma.
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Review Comparative Study
Validity aspects of erythrocyte sedimentation rate and C-reactive protein in ankylosing spondylitis: a literature review.
The preliminary core set for endpoints in disease controlling antirheumatic therapy includes acute phase reactants. The objective of this clinically oriented literature review was to examine and compare the validity of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in ankylosing spondylitis (AS) clinical trials. A MEDLINE search was performed covering the years 1967 through April 1998. ⋯ Their worth in AS clinical trials is limited. Based on the currently existing data neither measure is clearly superior in terms of validity. When selecting an acute phase reactant, feasibility aspects may be most relevant in choice of measure.