tailieunhanh - Báo cáo y học: "onsidering comorbidity in managing rheumatic diseases: going where trials cannot go"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: Considering comorbidity in managing rheumatic diseases: going where trials cannot go. | Aletaha and Dorner Arthritis Research Therapy 2011 13 116 http content 13 3 116 EDITORIAL L_ Considering comorbidity in managing rheumatic diseases going where trials cannot go Daniel Aletaha and Thomas Dorner It remains a great challenge to treat the complexity of systemic rheumatic diseases in clinical practice. In contrast to what one may think these challenges are not so much related to a lack of effective treatments as many powerful drugs are available for treating rheumatoid arthritis many of which became licensed over the course of the past decade 1 . The use of any of these new - as well as of the older - drugs is scientifically based on results of randomized controlled trials. The classical design of these trials however is what makes the step into clinical practice so challenging. With the strict inclusion and exclusion criteria of these trials the patient populations tested in those trials are in sharp contrast to patients requiring treatment in clinical practice. This is further supported by the fact that only a fraction of patients in a rheumatology practice would fulfill the criteria to enter phase II III trials 2 . A central reason for this is that patients with potential risk factors for an adverse reaction to an investigative drug are excluded from the beginning to make the trial safer but this group of patients constitutes a large portion of those who will ultimately require treatment in clinical practice. Until the recent calls for more pragmatic trials 3 that address patient populations with all the risk factors faced in daily practice have manifested in actual trial designs physicians will often need to make their own decisions weighing expected but sometimes unknown risks against the possible benefits. Although a number of management guidelines for different rheumatic diseases such as those by the European League Against Rheumatism EULAR or the American College of Rheumatology ACR are in the public domain the .