The Journal of rheumatology. Supplement
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Review
The efficacy and safety of antidepressants in inflammatory arthritis: a Cochrane systematic review.
To determine the efficacy and safety of antidepressants in pain management in patients with inflammatory arthritis (IA). ⋯ Based upon 9 trials of high or unclear risk of bias, it is not possible to draw firm conclusions about the efficacy of TCA as analgesics for patients with IA. The use of these agents may be associated with adverse events that are generally mild and do not lead to cessation of treatment. High-quality trials are needed in this area.
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To systematically review the available literature on measuring pain and the efficacy of pain treatment in inflammatory arthritis (IA), as an evidence base for generating clinical practice recommendations. ⋯ A variety of pain measures are available to cover different aspects of pain such as intensity, frequency, or location. Single-item tools such as VAS, NRS, or VRS can be recommended to measure overall pain in clinical practice. If more specific issues need to be addressed, more sophisticated tools should be taken into account.
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The goal of treatment for patients with rheumatoid arthritis (RA) is to achieve remission, or at least a low disease activity state. A variety of useful and practical tools are available to rheumatologists to assess patient prognosis and evaluate response to treatment in clinical practice. Frequent assessments, ideally every 1 to 3 months, allow rheumatologists to adjust therapy according to patient outcomes. For patients who fail to respond to treatment with classic disease modifying antirheumatic drugs, combination therapies with biologic agents offer improved outcomes.
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Clinical trials evaluating therapies for the management of rheumatoid arthritis (RA) typically report disease activity using measures such as the American College of Rheumatology response criteria and Disease Activity Scores. Additional outcomes, such as feeling well and feeling less fatigue, appear to be more important to patients than traditional disease activity outcomes such as joint tenderness and stiffness. As a result, patient-driven outcomes are increasingly used in clinical trials of RA, and have been shown to provide useful information. It is proposed that factors such as Health Assessment Questionnaire scores, fatigue, sleep, and physical and mental function become part of a patient's core set of outcomes when assessing patients with RA.
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The appropriateness and utility of considering fibromyalgia syndrome (FM) and other syndromes without anatomically localized pathology of the nervous system as neuropathic pain syndromes is uncertain. In this afterword, a synthesis of the information presented in these proceedings and opinion as to how FM relates to classical neuropathic pain syndromes is provided.