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Reports a study that compared the combination of sulphasalazine, methotrexate and prednisolone with sulphasalazine alone in the treatment of rheumatoid arthritis. Background; Methods; Findings; Interpretation; Discussion; References.

The authors analyze a study which showed that it is possible to stop a risky and expensive treatment for patients with rheumatoid arthritis once an initial response has been obtained. They think that the study raises three questions, including the need for patients to take biological therapy, another treatment effect hidden within the trial results and the cost effectiveness of biological therapy. They also mention other treatments used in the study, such as glucocorticoids and methotrexate.

Presents a letter to the editor in response to the article "Risk of cardiovascular events and rofecoxib: cumulative meta-analysis," by Peter J¨ni and colleagues in the December 4, 2004 issue.

Comments on pharmaceutical clinical research. Evidence of bias in some trials due to pressure from sponsors; Efforts of editors of medical journals to make requirements for study authors more stringent; Suggestion that masked analyses should be used.

Discusses two studies that describe how selective cyclo-oxygenase-2 (COX-2) inhibition can reduce the incidence of major gastrointestinal complications caused by non-steroidal anti-inflammatory drugs (NSAID). Findings of the CLASS study of celecoxib versus ibuprofen or diclofenac in osteoarthritis and rheumatoid arthritis, and the VIGOR study of rofecoxib versus naproxen in rheumatoid arthritis; Finding that the prevention of cardiovascular events is at the cost of significant gastrointestinal toxicity; Indications for the clinician.

Comments on the value of magnetic resonance imaging (MRI) in the management of rheumatoid arthritis. Reference to research by Mette Klarlund and colleagues comparing MRI with conventional radiography, technetium scintigraphy, and clinical assessment of inflammation; Discussion of whether MRI satisfies the criteria for a useful clinical measurement; View that MRI has a limited role in the assessment of arthritis.

Comments on the prognosis of rheumatoid arthritis (RA). Antirheumatic agents and the length of time needed for follow up studies; The phenotype of RA differing between men and women; Association of RA and its manifestations with sex and related factors, such as pregnancy; The traditional therapeutic approach being challenged by early intervention strategy.

Reflects on medical error and a situation in which a young patient had myocardial infarction. Way that the physician refused to look at an electrocardiogram because he had assumed it would be normal; View that pattern recognition must be balanced by a strong reflex of self-doubt and appraisal of all evidence.

Summary: Background: Up to 50% of curative surgery for suspected non-small-cell lung cancer is unsuccessful. Accuracy of positron emission tomography (PET) with 18-fluorodeoxyglucose ([18]FDG) is thought to be better than conventional staging for diagnosis of this malignancy. Up to now however, there has been no evidence that PET leads to improved management of patients in routine clinical practice. We did a randomised controlled trial in patients with suspected non-small-cell lung cancer, who were scheduled for surgery after conventional workup, to test whether PET with [18]FDG reduces number of futile thoracotomies. Methods: Before surgery (mediastinoscopy or thoracotomy), 188 patients from nine hospitals were randomly assigned to either conventional workup (CWU) or conventional workup and PET (CWU+PET). Patients were followed up for 1 year. Thoracotomy was regarded as futile if the patient had benign disease, explorative thoracotomy, pathological stage IIIA-N2/IIIB, or postoperative relapse or death within 12 months of randomisation. The primary outcome measure was futile thoracotomy. Analysis was by intention to treat. Findings: 96 patients were randomly assigned CWU and 92 CWU+PET. Two patients in the CWU+PET group did not undergo PET. 18 patients in the CWU group and 32 in the CWU+PET group did not have thoracotomy. In the CWU group, 39 (41%) patients had a futile thoracotomy, compared with 19 (21%) in the CWU+PET group (relative reduction 51%, 95% CI 32-80%; p=0.003). Interpretation: Addition of PET to conventional workup prevented unnecessary surgery in one out of five patients with suspected non-small-cell lung cancer. [ABSTRACT FROM AUTHOR]

Every year, 3000 women in the Netherlands are treated with in-vitro fertilisation (IVF), and results from studies suggest that the offspring of these women do not have a heightened risk of cancer. Between November, 2000, and February, 2002, we diagnosed retinoblastoma in five patients born after IVF. To calculate the relative risk of the disease, we assumed that the proportion of children conceived by IVF in the Netherlands is between 1.0 and 1.5%, and that the five patients who we diagnosed with the disease represent all new cases in the Netherlands during that period. Relative risks for retinoblastoma were significantly raised (7.2 [95% CI 2.4-17.0], and 4.9 [1.6-11.3], for 1% and 1.5% rates, respectively). This possible association of an increased risk of retinoblastoma in a population-based study needs to be established. [ABSTRACT FROM AUTHOR]