Psoriasis and Psoriatic Arthritis.

Psoriasis is a dynamic systemic disease that can have a profound affect on a patient's self-esteem. Fortunately, numerous therapeutic advances have been made over the last 10 years. In order to help patients manage their disease, healthcare providers should be aware of the modifiable risk factors that may exacerbate psoriasis. Additionally, exploring the impact the disease has on a patient and how it may change over their lifespan will help ensure appropriate therapies are used. Patients are unique so one medication will not fit all of our patients' needs. In this paper, the authors look at available treatment options for psoriasis and psoriatic arthritis. Educating psoriasis patients, in addition to collaborating with patients and other healthcare providers, may help initiate therapies that will result in patients living their lives to the fullest.

Proceedings of the 2013 Rheumatology Winter Clinical Symposia.

Advances in rheumatology occur at a rapid pace and staying abreast of important changes is a challenge for all. Both novel drug development and enhanced understanding of conventional or historic therapies have molded current day rheumatologic practice. Rheumatology has led the way in the use of outcome measures and imaging modalities in common disorders like rheumatoid arthritis, osteoarthritis, and gout. The expertise of the rheumatologist has widened such that knowledge of economics, legal issues, related disorders and extraarticular disease is essential. In February 2013, the 6th annual Rheumatology Winter Clinical Symposium was held. At this meeting, faculty and participants held discussions and exchanged knowledge about new scientific data and how it may impact the care of rheumatology patients. Excerpts from some of the lectures from the Rheumatology Winter Clinical Symposium 2013 are included in this review. These and other presentations can be viewed in their entirety at http://www.r-w-c-s.com.

Assessing adequate treatment response in patients with rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis (RA) presents a substantial socioeconomic burden that is potentially reduced by individualized, appropriate management strategies. Integral to such strategies is recognizing the need for treatment changes when patients inadequately respond or do not respond to treatment. However, there might be little or no agreement as to what constitutes treatment failure or an adequate response. Currently used American College of Rheumatology response criteria and the disease activity score may underestimate the magnitude of treatment failure when applied in clinical practice, and, having been designed to differentiate responses between large groups, they may be of limited value in monitoring individual patients. OBJECTIVE: The aim of this commentary was to assess how treatment failure and clinical remission/response have been defined in clinical studies. METHODS: A PubMed search (1948-2009) was conducted to identify clinical studies or reviews containing the following search terms: rheumatoid arthritis and treatment failure, inadequate response, biologic therapy, DMARD, radiographic response, and remission. Select clinical reports in patients with RA were included if remission or treatment failure, radiographic or other, was a study end point. RESULTS: Thirty-three studies were identified. The present assessment found no consensus as to what represents a practical definition of treatment failure or clinical remission in the clinical studies assessed. The definitions varied from the complete absence of any clinical disease to computer-generated numeric scales. The variability in clinical definitions of treatment failure or remission seems to have been mainly attributed to the time at which assessments were made, making it difficult to determine what treatment failure or remission means in individual patients with RA in clinical practice. CONCLUSIONS: Based on the findings of the present commentary, standard definitions of treatment failure or clinical remission/response are needed. Aggressive treatment strategies with specific clinical goals may result in better long-term outcomes. Early evidence of treatment effect may serve to improve clinical outcomes, including remission, and help define and align treatment goals in patients with RA.

Integrating patient questionnaire data into electronic medical records.

Electronic medical records allow the quick and easy incorporation of data into the medical records. By virtue of their design, questionnaire responses can be entered and used in the electronic environment with little or no effort on the part of the practicing physician. Data can be captured through various means, stored, and then viewed when the patient visits the office. Data can also be shared for use by other physicians in the practice or in large databases. Easy access and availability should allow for greater use of questionnaires by physicians, resulting in better patient care.

Data collection in private practice and implementation with electronic medical records.

The private clinical practice provides a unique environment for the collection of useful data on the severity of disease and on the management of patients with active diseases and conditions. By virtue of the higher volume of patients seen in a given period of time, compared to the academic setting, the continuity of care (in most practices), and the diversity of patients and disease states treated in the private setting is a potentially excellent source of valuable information. Yet these same features, particular the volume of patients needed to maintain an economically viable practice, and other necessary time commitments for practice in the private setting (bill paying, phone call management, general office management), present obstacles that most private practitioners find insurmountable.

Social and economic impact of inflammatory arthritis.

The inflammatory arthritides place a substantial burden on society with direct healthcare costs and indirect costs due to reduced productivity and social function. These progressive conditions cause significant pain, joint destruction, and reduced function, and therefore also place a substantial disease burden on affected patients and their families. This article reviews the epidemiology, social impact, and disease costs associated with 3 common inflammatory arthritides--rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis.