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Four rheumatologists kept a log of the diagnoses of all patients seen their offices for 2 months. The great majority of patients had rheumatic complaints. Musculoskeletal pain syndromes and back syndromes were encountered most frequently; rheumatoid arthritis and osteoarthritis were also common. Patients with SLE and connective tissue diseases were relatively infrequent.
OBJECTIVE: To systematically review the (1) timeliness of publication of randomized controlled trials (RCTs) in rheumatology, (2) impact of the COVID-19 pandemic on time to publication, and (3) factors associated with publication delays. METHODS: We searched Medline, Embase, EBM Reviews, Cochrane Central Register of Controlled Trials, and Scopus from January 1, 2018, to June 30, 2023 for Phase 3, superiority, parallel-design RCTs that evaluated any treatment for a rheumatologic illness or a rheumatologic treatment for COVID-19 and reported clinical primary efficacy outcome. Outcomes of interest were time to publication after trial completion and publication delay of >2 years after trial completion. RESULTS: 448 RCTs were included in this systematic review. Median time from completion to publication was 549 days and 65.9 % RCTs were published within 2 years of completion. Compared with RCTs on rheumatologic diseases, RCTs on COVID-19 were published sooner (253 vs. 549 days; p < 0.001) and were more likely to be published within 2 years (adjusted OR 9.49, 95 % CI 2.07 to 43.61). Compared with RCTs completed before March 1, 2020, RCTs completed after March 1, 2020, were published sooner (327 vs. 724 days; p < 0.001) and were more likely to be published within 2 years (adjusted OR 9.40, 95 % CI 5.14 to 17.21). Time from RCT completion to submission accounted for most (67 %) of the time to publication. CONCLUSIONS: Publication delay continues to be an important concern in dissemination of clinical research. Most of the delays in publication were attributable to delays in submission to journals after trial completion.
Evidence of cytomegalovirus infection was sought in 131 patients attending a rheumatology clinic, 211 blood donors, and 14 patients before and after the initiation of cytotoxic immunosuppressive therapy for a rheumatologic condition. The titer of complement-fixing antibody to cytomegalovirus was significantly related to age and sex, but not to rheumatologic disease. After adjustment for age and sex differences, the proportion of patients treated with corticosteroids who had measurable antibody was lower than that of controls (P less than 0.025). Immunosuppressive therapy with azathioprine or cyclophosphamide did not affect the proportion of patients with antibody, but there was a significantly increased titer of antibody in those who were seropositive (P = 0.04). Cytomegalovirus was isolated from the urine of 20% of patients receiving cytotoxic immunosuppressive drugs, but not from any of the patients receiving corticosteroids or neither form of therapy (P = 0.001). Eight of 14 patients followed prospectively after the initiation of therapy with immunosuppressive drugs became infected with cytomegalovirus as demonstrated by a fourfold or greater rise in complement-fixing titer, viruria, or both. Seven of the eight patients were seropositive before therapy, a finding suggesting that immunosuppression acts largely by reactivating latent infection. It is postulated that immunosuppressive agents alone may account for a large proportion of cytomegalovirus infections seen after allograft transplantation.
Mendelian randomisation (MR) has become abundant in the literature, with variation in quality and frequent overinterpretation of causality. This creates a problem for clinical readers, reviewers, and editors: some MR studies can sharpen causal thinking, prioritise drug targets, and challenge misleading observational claims, whereas others are little more than automated exposure-outcome scans with causal claims disproportionate to the evidence. MR can strengthen causal inference when randomised trials are impractical and conventional observational studies are vulnerable to confounding, reverse causation, or selection bias. In rheumatology, credible MR can contribute to questions about disease aetiology, modifiable risk factors, therapeutic target validation, adverse-effect anticipation, and phenotype validation. However, its interpretation depends on whether the exposure is plausibly instrumentable, whether the genetic instruments are biologically defensible, whether assumptions are interrogated in ways appropriate to the design, and whether findings are triangulated with clinical, observational, experimental, and mechanistic evidence. Instead of recapitulating all methodological issues of MR, this review aims to help rheumatologists distinguish robust MR from weak or overinterpreted analyses quickly. We provide an accessible framework for reading and triaging MR studies in rheumatology. Papers that use poorly justified instruments, treat medication use as drug-target evidence, interpret genetic liability as diagnosis, rely on mechanical sensitivity analyses, ignore prior evidence or ask no clinically meaningful question can often be passed over by readers. The goal is not to discourage MR in rheumatology, but to raise the standard; useful MR should clarify causal reasoning rather than simply generate another statistically significant association.
An international workshop considered rheumatological education of the primary care physician. All medical students need exposure to rheumatology. Emphasis should be on the musculoskeletal component and on the better defined diseases. During the postdoctoral years, principles of total health care need to be taught by well trained rheumatologists in tertiary care rheumatic disease units with comprehensive ambulatory care facilities. Continuing education of the generalist needs to be relevant to his professional competence. He needs to acquire and update the knowledge to manage common rheumatic diseases and to learn when to ask for help. General educational objectives are applicable to the field of rheumatology: cognitive skills bring knowledge of the scientific basis and clinical facts; motor skills--the ability to examine competently patients with rheumatic diseases; affective skills--the understanding of and capacity to deal with chronic illness.
The majority of patients with rheumatologic problems are seen and followed by nonrheumatologists. Of concern is the perception that a significant number of United States medical schools do not have adequate teaching programs in the rheumatic diseases. Two thousand two hundred and seventy practicing physicians, trainees, and medical students were surveyed in the Intermountain West to determine what they think undergraduate medical students should learn about rheumatology. Most respondents felt that common diseases and problems should be emphasized and that basic skills in history taking and physical examination are more important than disease related information.
Creatine supplementation has demonstrated ergogenic and anabolic effects in healthy and clinical populations. However, its potential therapeutic role in individuals with chronic musculoskeletal pain treated in rheumatological contexts remains unclear. The aim was to evaluate the efficacy and safety of creatine supplementation on pain, physical function/disability, quality of life, muscle strength, skeletal muscle mass, and inflammatory markers in people with chronic musculoskeletal pain usually treated from the rheumatological field. A systematic review was conducted following PRISMA guidelines. Searches were performed in MEDLINE, Web of Science, CINAHL, Scopus, and EMBASE up to July 2026. Eligible studies were randomized or nonrandomized clinical trials that provided creatine supplementation alone or in combination with exercise as a treatment compared to a control or placebo group. Eight studies (n = 189) were included, encompassing fibromyalgia, osteoarthritis, rheumatoid arthritis, and juvenile idiopathic arthritis. Creatine dosages varied from chronic low-dose to loading protocols (20 g/d, 2-5 g/d). Combined creatine plus resistance training may improve strength, skeletal muscle mass, and quality of life beyond exercise alone in osteoarthritis. Trials on fibromyalgia suggest an increase in muscle strength, but inconsistent effects on pain. Rheumatoid arthritis studies suggest gains in skeletal muscle mass and, in pilot studies, reduced disease activity. No major adverse events were reported. In conclusion, creatine supplementation alone may be insufficient to obtain clinical benefits, while combined with resistance exercise it could offer potential benefits for muscle strength, skeletal muscle mass and certain aspects of quality of life in these clinical conditions. However, evidence on pain and inflammation remains limited; Furthermore, the response across different clinical conditions is heterogeneous, highlighting the need for larger, high-quality trials.
Autoimmune nephrological and rheumatological diseases involve macrophage-driven inflammation, yet disease activity is often assessed using invasive or non-specific measures. Soluble CD163 (sCD163), released from activated monocytes and macrophages, is emerging as a biomarker of macrophage-mediated inflammation in these conditions. This narrative review summarizes current evidence on the diagnostic, prognostic, and disease-monitoring potential of sCD163 measured in blood, urine, and synovial fluid in autoimmune nephrological and rheumatological diseases. This review is based on a narrative analysis of selected publications investigating the clinical utility of sCD163 in autoimmune kidney and rheumatic diseases, with emphasis on correlations with disease activity, histopathological findings, and clinical outcomes. Urinary sCD163 shows excellent diagnostic accuracy for active lupus nephritis (area under the receiver operating characteristic [AUROC] 0.89-0.998), correlates with histological activity index (but not chronicity), and distinguishes ongoing inflammation from chronic damage during treatment. In IgA nephropathy, it predicts remission failure and greater benefit from corticosteroids. In ANCA-associated vasculitis, it identifies active renal involvement (AUROC 0.95 in multicenter cohorts). In rheumatoid arthritis (RA), serum sCD163 correlates with early disease activity, predicts radiographic progression, and detects subclinical macrophage activation in remission. In spondylarthritis, synovial fluid sCD163 reflects a disease-specific M2-polarized macrophage phenotype distinct from RA. Utility is compartmentalized: urinary levels indicate intrarenal macrophage activation, synovial fluid local joint inflammation, and serum systemic activation. sCD163 is a promising macrophage-specific biomarker across autoimmune diseases, but its compartmentalized nature requires context-specific measurement. Before clinical implementation, assay standardization, multicenter validation, and interventional trials showing the benefit of sCD163-guided management are needed.
An artificial language that makes it possible to put summarized results into a computer. Application of this method to the study of the results of one year consultations with 5650 patients in a institute of rheumatology. The authors present the results of one year's external consulta-with 5650 patients in the Rheumatology Institute of the Faculty of Medicine at Paris Cochin. These results were obtained by computer using an artificial language that made it possible to record and play back a spoken version of the summarized data from the patient's histories.
Improved laboratory investigative techniques now foster an increased clinical interest in and awareness of the rheumatologic disease. This review is a discussion of the relevance of laboratory tests used in the more common rheumatologic disorders and of their role in both the diagnosis and assessment of these diseases from the standpoint of the practising clinician.
Rheumatological complaints accounted for 10.6 per cent of new presentations in this general-practice survey. Spinal problems formed almost half of this total and led to a greater degree of disability than other locomotor system disorders. Active participation in the treatment of pain by the practitioner's use of manipulation and injection techniques is shown to be quite feasible in general. Forty-six per cent of all hospital referrals were simply requests for physiotherapy, and we suggest that physiotherapy departments should offer open access and so lead to a marked reduction in over-strained rheumatology consultant outpatient clinics.
The laboratory diagnostics essentially contributed to the pathogenetic clarification of rheumatological problems and gives multifarious support to the rheumatologist in differential and activity diagnostics and thus also decisively contributes to early diagnostics and therapy. When the acute-phase-reactions serve for the differentiation of inflammatory-rheumatic diseases and degenerative diseases and for the establishment of the degree of activity, so the ASR further the diagnostic ascertainment of a rheumatic fever, the agglutination tests for proving the rheumatoid factor further the differential diagnosis of the rheumatoid arthritis, the LE-phenomenon and the ANF further the differential diagnosis of the LEV, the proof of cardiac auto-antibodies essentially furthers the diagnostics of carditis, the increase of uric acid the early recognition of gout, the synovial diagnostics at length became necessary for the clarification of clinically unclear mon- or oligoarthritides and the determination of the local activity for the observation and judgment of the course. Notwithstanding the primate of the clinic without an effective laboratory diagnostics a modern rheumatology can no more be performed nowadays.
Californian specialists in the treatment of rheumatic diseases were surveyed to determine the spatial distribution of rheumatologic services in the state, the amount of patient care time available for the rhematic diseases in each county, the physicians' capacity to treat all rhemmatic disease patients who seek their care, and their perception of the need for more specialists in their area. The data resulting from the survey are analyzed by four methods to assess the sufficiency of medical manpower resoruces.
Regional musculoskeletal diseases are exceedingly common in all segments of society, and dramatically so in industry. For generations, medicine has assumed that many such entities are use-associated. A critical review of several examples of back and upper extremity disease demonstrates that the literature supporting these assumptions is almost entirely anecdotal. It is argued that if defined patterns of usage were associated with defined clinical syndromes, such knowledge would have considerable therapeutic and prophylactic potential. Industrial rheumatology is proposed as an investigative discipline for the study of such relationships. The prerequisites in terms of assumptions and methods as well as potential fallacies and pitfalls are discussed.