9 e-Letters

  • Systemic glucocorticoid use in the C-VIEW study

    Dear Editor,

    I read with interest the results of the C-View study (1). In the study it is reported that 17 patients (19%) were on systemic glucocorticoids in the 48-week pre-baseline period, and 6 patients (7%) used systemic glucocorticoid in the certolizumab (CZP) treatment period. The report does not elaborate on the median dose used by each of these groups of people. Adverse events are increase with increasing doses of systemic glucocorticoid and reporting these doses would be of value to help assess the results of the trial.

    High doses in the pre-baseline period and low doses in the treatment period could have the effect of reducing the estimated treatment effect of CZP on acute anterior uveitis (AAU). Low doses in the pre-baseline period and high doses in the treatment period could have the opposite effect.

    In addition, it was reported that five patients (6%) entered the CZP treatment period with an AAU flare. It was not reported how these patients were assessed for the outcome. Were these flares on entry assumed to be a flare in the CZP treatment period or were only new onset flares in the CZP treatment period counted towards flares in the CZP treatment period?

    Philip C. Robinson
    University of Queensland, Brisbane, Australia

    1. van der Horst-Bruinsma I, van Bentum R, Verbraak FD, Rath T, Rosenbaum JT, Misterska-Skora M, et al. The impact of certolizumab pegol treatment on the incidence of anterior uveitis flares in patients w...

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  • Influence of body mass index on disease activity and therapeutic response in patients with axial spondyloarthritis

    Dear Editor,
    Jean W. Liew and collaborators recently reported a systematic literature review and meta-analysis comprising the association of body mass index (BMI) on disease activity in axial spondyloarthritis (axSpA) [1]. We consider these data very interesting, as BMI is a modifiable factor. The inclusion criteria defined by the authors were based on the following issues: 1) ankylosing spondylitis, non-radiographic axSpA or all spondyloarthropathies; 2) BMI as primary exposure; 3) a validated measure of disease activity or treatment response, measured by BASDAI or ASDAS as the primary outcome. The search date was 15th December 2019. The authors selected 20 articles for full-text review but then excluded 7 articles, three for not having the primary exposure or outcome of interest, three for not reporting disease activity stratified by BMI at baseline and one for incomplete reporting results (no references provided). Finally, the authors included 13 observational studies in the qualitative analysis and 12 studies in the quantitative meta-analysis. In spite of the broad literature search strategy employed by the authors, at least one article is missed in the included studies, which may reduce the strength of the final conclusions.
    Our research group published a manuscript, last February 2019 in the journal Arthritis Research and Therapy, attending this issue [2]. This reported the results of a prospective observational study including a total of 180 patients wit...

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  • The effect of glucocorticoids on bone health in rheumatoid arthritis

    To the Editor,

    I read the article by Hua et al.1 that was published in this journal with great interest. The authors provided an excellent review of the literature regarding the clinical efficacy and toxicity of glucocorticoids (GCs) in rheumatoid arthritis (RA). The review included comprehensive discussion about the efficacy of GCs as a bridging therapy in addition to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) based on the rapid onset of action of these drugs.1 The authors advocate that because even low-doses of GCs might have adverse effects, administration of these drugs should be restricted to the lowest dose for the shortest time.1 The first part about the effectiveness of GCs was well documented and convincing; however, the second part about the safety of these drugs seemed a little less convincing. This might be attributed to the fact that a small number of studies on the safety of GCs have been published. In particular, little evidence regarding bone-related adverse effects has been presented. We have obtained very preliminary data in our hospital about the effects of GCs on bone health, including fractures and osteoporosis, and would like to contribute these as a comment.

    We retrospectively reviewed the medical records of 883 patients with RA who visited our hospital in 2018. Of these, 364 patients (41.2%, Figure 1A) were prescribed GCs. At the last visits in 2018, appro...

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  • Trust IT lags behind smartphone capability
    Andrew J Clarkin

    This survey demonstrated that a significant proportion of clinicians use smartphones to share clinical information. While this rightly raises concerns over confidentiality and makes headlines in the press it is important to question why this situation has arisen. As Mobasheri and colleagues demonstrated, ownership is near ubiquitous among medical staff and this affords availability and immediacy of access. It is hardly...

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  • Response to the letter by Dr. Chiong and Prof. Attia
    Johanna Callhoff

    Thank you for your interest in our work. Your letter allows us to further explain aspects that could possibly be misunderstood. We stressed in the title and in the conclusion that depression was a predictor of the "risk to consider applying for work disability pension". The key messages could, however, be interpreted differently.

    Firstly, we decided to use a composite endpoint of obtaining work disability pens...

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  • Caveats in interpretation of the article: Depression is a stronger predictor of the risk to consider work disability in early arthritis than disease activity or response to therapy
    Fabian Chiong

    Dear Editor,

    We read with interest the article by Johanna Callhoff and colleagues regarding depression being a stronger predictor of the risk of work disability in early arthritis than disease activity or response to therapy. On reviewing the article, we thought it is important to highlight 3 caveats in interpretation of this article.

    Firstly, the outcome was not just those who had applied for or obtained...

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  • The effectiveness of Mobile Health Technologies and Their Potential Limitations
    Atif A Baig

    After reading the entire review, I would agree with the authors and I feel there must be areas and specialities to defined and considered where this system can be used. For example, using it for pharmacy practice in few places will bring in a high potential of false prognosis as per lesser knowledge of individuals.

    I would suggest a more wider studies with a summarised meta-analysis, where the use of this system...

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  • Re:A strong clinical need may still prevent innovation
    Paul G Yock

    Dr. Sharma: You've hit upon multiple issues that certainly complicate the innovation process. Subjectivity, bias, conflicting interests, and stakeholder resistance can all prevent worthwhile needs from being addressed and valuable solutions from reaching the market. Our hope is that by taking a systematic approach to medtech invention, innovators will at least be able to anticipate these potential roadblocks and more...

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  • A strong clinical need may still prevent innovation
    Neel Sharma
    Having recently completed the Singapore Stanford Biodesign programme, I found your piece particularly timely Paul. I would fully agree that the selection of an appropriate need is paramount with regards to the innovation process. If the disease in question is not a marketable burden, in terms of morbidity and mortality so to speak, then a need in this regard is not likely to attract potential investment from a stakeholder perspect...
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