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Treatment of rheumatoid arthritis (RA) was boosted in the 1950s by the discovery that injectable gold and antimalarial drugs were effective therapies. The effects of these medications were established by comparing them to placebo (inert) treatment, and they became the standard second-line therapy and were used after nonsteroidal anti-inflammatory drugs such as aspirin, until penicillamine was introduced in the 1970s. Other second-line agents have since become available, including methotrexate, sulfasalazine, and azathioprine. Their effects have been established using placebo controls and also in comparisons with the gold and antimalarial drugs, the ''old standards''. Other changes in the testing of antirheumatic drugs have occurred, including rising costs, which increased support from grant agencies or pharmaceutical companies, publication of standards, and the use of more complex methods in these studies. The changes that have occurred in 105 clinical trials of antirheumatic drugs, from 1945 to 1989, were evaluated. The use of placebos to evaluate drug effects decreased by 75 percent during this time period. The incidence of full funding of drug trials by drug companies increased from zero, in the initial time period, to 61 percent in the most recent decade. The average age of patients was significantly older in the later studies, and patients tended to have less severe disease in these later studies. The use of statistical methods changed somewhat during the study period, but most studies still fail to indicate the statistical power of their study design and type of analysis. This review indicates that the trends in studies of antirheumatic drugs should be considered when comparing results from research performed at different times. (Consumer Summary produced by Reliance Medical Information, Inc.)

In 1980, a national study designed to analyze future requirements for medical care and the supply of physicians in all specialties estimated that there would be an oversupply of rheumatologists; 3,000 rheumatologists were estimated to be available, while a need of only 1,900 was projected for 1990. The projection of available rheumatologists was accurate, as 3,200 currently exist, but they are not a surplus, as shown by the numbers of advertisements for the physicians and by long waiting lists of new patients. New estimates of the supply of and demand for rheumatologists were sought in a study commissioned by the American College of Rheumatology; this study was coordinated with a national study of supply of physicians in the primary care specialties. The new study estimates that 6,000 rheumatologists will be needed in 1990, while a supply of 3,055 is projected. The large increase in estimated demand for these specialists is caused by several factors. Some disorders that are often managed by rheumatologists were not included in the earlier study or were severely underestimated. A low rate of referral to rheumatologists for certain disorders was another problem in the first study. Compounding this, rheumatologists have provided more care for patients with chronic illnesses such as rheumatoid arthritis during the past decade. The age distribution of the US population is strongly anticipated to shift upward in coming years, and this is a major source of growth in the need for rheumatologists. Given these results, it is important for the American College of Rheumatology to develop programs that will narrow the gap between estimated future supply and demand for rheumatologists. (Consumer Summary produced by Reliance Medical Information, Inc.)

Rheumatoid arthritis (RA) is an inflammatory joint disease with immune system components which destroys joint structure and function over a long time period. Studies of physical function and health status suggest that joint destruction and disability is fairly rapid in the first five years and then slows. This tendency has been cited in support of arguments that rheumatoid arthritis should be aggressively treated in the early stages. To better understand the early process of the disease, joint changes and health status in patients with early (313 subjects) and established (108 subjects) RA were studied and compared with those in 188 healthy control subjects. Patients in the established RA group had the disease for an average of eight years and were more likely to be nonwhite and less educated. Patients with established disease had greater joint involvement, but both RA groups were almost identical in their overall medical status, as assessed by a physician. Health status assessed by patients or subjects was significantly poorer in RA groups. Physical function and impact of arthritis were reported as significantly poorer in the established than in the recent-onset RA group. Analysis of the data showed that the impact of recently-diagnosed RA on measures of health was at least three-fourths that on the group with established RA. In measures such as psychological status, pain, and arthritis impact, the effects were about 90 percent of that in the group with established RA. The results support the idea that RA causes severe medical and health status abnormalities early in its course, and early aggressive therapy is justified by this finding. (Consumer Summary produced by Reliance Medical Information, Inc.)

Although rheumatoid arthritis (RA) affects women more than men, and women do most household work, studies of the impact of RA have tended to ignore effects on household work and have instead focused on income losses related to employment disability and costs of health care. Household work is a valuable commodity because of its importance for the economic and social well-being of families. Inability to perform household work due to disability can cause personal, family, and economic problems for affected women. To better understand these issues, 142 women with RA and 58 healthy control subjects were questioned about household work in their families. Women with RA were divided into two groups, those with mild disease (84 subjects) and those with more severe disease (58 subjects). The average age of control subjects was 43 years, those with mild RA 49 years, and those with severe RA 53 years. Women with RA reported poorer functional status, more pain, and poorer general health. Those with severe RA reported more depression, lower family income, and a lower employment rate. Although total amount of time spent in household work was similar among subjects' families, the amount done on five of six tasks by women with more severe RA was significantly less than that done by women with mild RA or no disease. However, all women spent a similar amount of time when it came to taking care of others. Women with mild RA spent less time than healthy subjects in shopping and doing errands. Family members of women with more severe RA spent significantly more time on four of the six tasks and on total housework than families of other subjects. Family members of women with mild RA spent more time on general cleaning than families of women with no disease. The use of paid household employees was not related to severity of RA. Decreased functional status was significantly associated with household disability, while increased depression was associated with increased time spent in household work. The presence of children at home was associated with increased time in household work, while outside employment or a college education was associated with less household work done. (Consumer Summary produced by Reliance Medical Information, Inc.)

Rheumatoid arthritis is a joint disease characterized by inflammation of the joints, stiffness, swelling, overgrowth of cartilage tissue, and pain. The effectiveness and toxicity of second-line drugs used to treat rheumatoid arthritis, including methotrexate (MTX), injectable gold, D-penicillamine (DP), sulfasalazine (SSZ), auranofin (AUR), and antimalarial drugs were assessed. Analysis of 66 clinical trials involving 117 treatment groups showed that AUR was less effective than MTX, injectable gold, DP, SSZ, and the antimalarial drugs. There was a lack of uniformity in effectiveness among antimalarial agents. For example, chloroquine was shown to be more effective than hydroxychloroquine. MTX, injectable gold, DP, and SSZ were similar in effectiveness. Analysis of 71 clinical trials involving 129 treatment groups showed that about 30 percent of patients withdrew from the study, and half of these subjects dropped out because of drug toxicity. Injectable gold was the most toxic drug and was associated with the highest dropout rates. Thirty percent of patients treated with gold withdrew from studies compared with a 15 percent dropout rate associated with the other drug treatments. The antimalarial drugs were the least toxic agents. These findings show that AUR is the least effective and injectable gold is the most toxic of the second-line drugs used to treat rheumatoid arthritis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Over one million Americans reside in nursing homes, and 24 percent of these people have joint diseases, such as arthritis and rheumatism. Arthritis, the inflammation of joints associated with pain, swelling and changes in joint structure, is the primary diagnosis in five percent of these patients, and its prevalence among nursing home residents increases with age. The incidence of arthritis and its effect on continued resident institutionalization and function was examined in five nursing homes with a total of 629 residents. The prevalence of arthritis in the nursing home was estimated to be about 23 percent by both directors of nursing in the facilities and the patients' physicians. Fifteen percent of residents without dementia were initially placed in a nursing home primarily because of arthritis. Thirty percent of residents with arthritis but no dementia continued to be institutionalized because of arthritis. The patients without dementia did not appear capable of living outside of the nursing home. Residents with arthritis had more pain, required more assistance with functional tasks, and used a wheelchair more often than other residents without arthritis. However, it was concluded that despite the unfavorable effects of arthritis on functional abilities, arthritis is not a major cause of nursing home placement or continued institutionalization. (Consumer Summary produced by Reliance Medical Information, Inc.)

Rheumatoid arthritis, RA, is a chronic, destructive collagen disease characterized by inflammation and thickening of the lining of the joint capsule, or synovium, and joint swelling. Many therapeutic outcomes are measured in RA patients to determine whether the patient's condition is improving. However, multiple tests may not be necessary and may only provide a mass of confusing information. Some tests appear to give duplicate information, and others seem to be insensitive to changes in the patient's condition, registering only gross changes. Researchers evaluated the raw data from three different studies of treatment of RA patients: patients treated with methotrexate; those treated with gold; and those treated with D-penicillamine. All were controlled, placebo studies; one group of patients received the medication or treatment and one did not. The data from these studies included measurements of treatment effectiveness on 15 different elements or outcomes. These outcome measures included: disease activity in the joint itself, laboratory results, ability of the patient to function, and general assessment of the disease process. The authors believe that one measurement from each of these four groups is sufficient to assess patient improvement. They found that the most sensitive measures of patient improvement were: joint tenderness count, erythrocyte sedimentation rate, grip strength, and physician assessment of the patient. Using these four outcome measures it was possible to reliably evaluate the full spectrum of patient change that was covered by the 15 separate outcome tests. Use of the other 11 clinical measures provided little additional useful information.