Clinical and radiological efficacy of initial vs delayed treatment with infliximab plus methotrexate in patients with early rheumatoid arthritis

= 6 months, IFX was tapered and finally stopped. We aimed to correct for allocation bias using propensity scores. Functional ability was measured by the Health Assessment Questionnaire (HAQ), radiological progression by Sharp/van der Heijde scoring (SHS). Results: Baseline differences between the initial and delayed groups were no longer significant after propensity score adjustment. At 3 years after baseline, patients treated with initial MTX+IFX experienced more improvement in HAQ over time and were less likely to have SHS progression than patients treated with delayed MTX+IFX (p = 0.034). At 2 years after IFX initiation, more patients in the initial group compared with the delayed group could discontinue IFX after a good response (56% vs 29%, p = 0.008). Conclusions: The results of this post hoc analysis suggest that using MTX+IFX as initial treatment for patients with recent onset RA is more effective than reserving MTX+IFX for patients who failed on traditional DMARDs, with more HAQ improvement over time, more IFX discontinuation and less progression of joint damag

Drug-free remission, functioning and radiographic damage after 4 years of response-driven treatment in patients with recent-onset rheumatoid arthritis

0.05, group 4 versus groups 1 and 2, group 3 versus group 2). Conclusions: In patients with recent-onset active RA, drug-free remission was achieved in up to 18% of patients. DAS-driven treatment maintained clinical and functional improvement, independent of the treatment strategy. Joint damage progression remained significantly lower after initial combination therapy compared with initial monotherap

TREAT Early Arthralgia to Reverse or Limit Impending Exacerbation to Rheumatoid arthritis (TREAT EARLIER): a randomized, double-blind, placebo-controlled clinical trial protocol

Background: We present a study protocol for a randomized, double-blind, placebo-controlled trial that investigates the hypothesis if intervention

Using precision farming to improve animal welfare.

Animal welfare is a multidimensional phenomenon and currently its on-farm assessment requires complex, multidimensional frameworks involving farm audits which are time-consuming, infrequent and expensive. The core principle of precision agriculture is to use sensor technologies to improve the efficiency of resource use by targeting resources to where they give a benefit. Precision livestock farming (PLF) enables farm animal management to move away from the group level to monitoring and managing individual animals. A range of precision livestock monitoring and control technologies have been developed, primarily to improve livestock production efficiency. Examples include using camera systems monitoring the movement of housed broiler chickens to detect problems with feeding systems or disease and leg-mounted accelerometers enabling the detection of the early stages of lameness in dairy cows. These systems are already improving farm animal welfare by, for example, improving the detection of health issues enabling more rapid treatment, or the detection of problems with feeding systems helping to reduce the risk of hunger. Environmental monitoring and control in buildings can improve animal comfort, and automatic milking systems facilitate animal choice and improve human-animal interactions. Although these precision livestock technologies monitor some parameters relevant to farm animal welfare (e.g. feeding, health), none of the systems yet provide the broad, multidimensional integration that is required to give a complete assessment of an animal's welfare. However, data from PLF sensors could potentially be integrated into automated animal welfare assessment systems, although further research is needed to define and validate this approach

Susac syndrome: a report of four cases and a review of the literature

Pathophysiology and treatment of rheumatic disease

[Summary of the practice guideline 'Heavy menstrual bleeding']

Item does not contain fulltext- A new multidisciplinary practice guideline on heavy menstrual bleeding (HMB) has recently been published.- HMB may occur with or without structural abnormalities.- The pictorial blood loss assessment chart (PBAC) is the best method for estimating the amount of blood loss and for distinguishing between heavy and normal blood loss.- Haemoglobin levels should be determined at least once.- Transvaginal ultrasound is the preferred imaging technique.- Saline or gel infusion sonography should be used in cases where ultrasound results are suspect for intracavitary abnormalities. A hysteroscopy should only be performed if sonography results are inconclusive.- The very first treatment of choice should be placement of a hormone-impregnated intrauterine system.- For HMB without structural abnormalities, endometrial ablation is an alternative to hysterectomy, whereby second-generation ablation techniques are preferred to first-generation techniques.- For HMB with uterine fibroids, uterine artery embolisation is a good alternative to hysterectomy.- For HMB with submucosal fibroids, hysteroscopic resection of the fibroids is recommended