Recommendations of Czech Rheumatological Society for the treatment of rheumatoid arthritis. Efficacy and treatment strategies
Authors:
R. Bečvář 1; J. Vencovský 1; P. Němec 2; D. Suchý 3; L. Procházková 2; K. Pavelka 1
Authors‘ workplace:
Revmatologický ústav Praha, ředitel prof. MUDr. Karel Pavelka, DrSc.
1; II. interní klinika Lékařské fakulty MU a FN u sv. Anny Brno, přednosta doc. MUDr. Miroslav Souček, CSc.
2; Oddělení klinické farmakologie FN Plzeň, přednosta doc. MUDr. Otto Mayer, CSc.
3
Published in:
Vnitř Lék 2008; 54(1): 84-99
Category:
Guidelines
Overview
Rheumatoid arthritis (RA) is an autoimmune disease of unknown aetiology characterized by presence of chronic symmetric synovitis, which leads to the formation of joint erosions. Generally recommended method for activity assessment of RA is so called Disease Activity Score (DAS). In early RA when low disease activity is present with oligo– or monoarthritis antimalarials are drugs of choice, while sulfasalazine (SAS) is recommended in cases with medium activity without erosions. Initial treatment with methotrexate (MTX) or leflunomide (LEF) should be applied in a very active polyarthritis with a rapid development of erosions. MTX is often combined with other disease modifying drugs (DMARD) and the blockers of tumour necrosis factor α (TNF-α). LEF is to be administered to the patients in whom the other DMARD are contraindicated or not tolerated. In established RA with oligo- or monoarthritis with permanent low activity SAS is DMARD of choice. In cases with insufficient response and medium activity MTX is used and if it is inefficient LEF or combination of DMARD should be considered. In a very active disease with a rapid evolution of erosions high doses of MTX or LEF are recommended. When extraarticular symptoms of RA are present azathioprine is to be applied and in case of involvement of vital organs cyclophosphamide should be used. When DMARD are failing or contraindicated TNF-α blockers are to be applied. When one TNF-α blocker is inefficient it should by replaced by another one from the same group or another biological should be used. For indication of biologicals the activity limit is DAS28 5.1 and the decrease of DAS28 more than 1.2 is an efficacy criterion. Nonsteroidal antirheumatic drugs are an important part in the management of RA, and also corticosteroids are often of used in oral or parenteral form. To the complex therapy of RA nonpharmacological means are usually implemented – different physical procedures and various surgeries.
Key words:
rheumatoid arthritis – activity – disease modifying drugs – biological therapy
Sources
1. Hochberg MC Adult and juvenile rheumatoid arthritis: current epidemiological concepts. Epidemiol Ref 1981; 3: 27-44.
2. Harris ED jr Rheumatoid arthritis: pathophysiology and implications for therapy. N Engl J Med 1990; 322: 1277-1284.
3. Pavelka K, Bečvář R, Olejárová M et al. Revmatoidní artritida - Standardní postupy. Čes Revmatol 1999; 7(Suppl 1): 4-8.
4. Combe B, Landewe RB, Lukas C et al. EULAR recommendations for management of early arthritis. Ann Rheum Dis 2006; 5: (Epub, v tisku).
5. Pinals RS, Masi AT, Larsen RA et al. Criteria of remission in rheumatoid arthritis of the American Rheumatism Association Diagnostic and therapeutic Criteria Committee. Preliminary criteria for clinical remission in rheumatoid arthritis. Arthritis Rheum 1981; 24: 1308-1315.
6. Prevoo ML, van’t Hof MA, Kupper HH et al. Modified disease activity scores that include 28 joint counts: development and validation in a prospective longitudinal study in patients with rheumatoid arthritis. Arthritis Rheum 1995; 38: 44-48.
7. Sharp JT, Young DY, Bluhm GB et al. How many joints in the hands and wrists should be included in a score of radiologic abnormalities used to assess rheumatoid arthritis. Arthritis Rheum 1985; 28: 1326-1335.
8. Welsing PM, Landewe RB, van Riel PLCM et al. The relationship between disease activity and radiological progression in patients with rheumatoid arthritis: a longitudinal analysis. Arthritis Rheum 2004; 50: 2082-2093.
9. Arnett FC, Edworthy SM, Bloch DA et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988; 31: 315-324.
10. Anderson JJ, Wells G, Verhoeven AC et al. Factors predicting response to treatment in rheumatoid arthritis: the importance of disease duration. Arthritis Rheum 2000; 43: 22-29.
11. Mottonen T, Paimela L, Leirisalo-Repo M et al. Only high disease activity and positive rheumatoid factor indicate poor prognosis in patients with early rheumatoid arthritis treated with “sawtooth” strategy. Ann Rheum Dis 1998; 57: 533-539.
12. Goronzy JJ, Matteson EL, Fulbright JW et al. Prognostic markers of radiographic progression in early rheumatoid arthritis. Arthritis Rheum 2004; 50: 43-54.
13. Vencovský J, Macháček S, Šedová L et al. Autoantibodies can be prognostic markers of an erosive disease in early rheumatoid arthritis. Ann Rheum Dis 2003; 62: 427-430.
14. Combe B, Dougados M, Goupille P et al. Prognostic factors for radiographic damage in early rheumatoid arthritis: a multiparameter prospective study. Arthritis Rheum 2001; 44: 1736-1743.
15. Dixey J, Solymossy C, Young A. Is it possible to predict radiological damage in early rheumatoid arthritis (RA)? A report on the occurrence, progression, and prognostic factors of radiological erosions over the first 3 years in 866 patients from the Early RA Study (ERAS). J Rheumatol Suppl 2004; 69: 48-54.
16. McQueen FN, Benton A, Crabbe J et al. What is the fate of erosions in early rheumatoid arthritis? Tracking individual lesions using x rays and magnetic resonance imaging over the first two years of disease. Ann Rheum Dis 2001; 60: 859-868.
17. Grigor C, Capell H, Stirling A et al. Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial. Lancet 2004; 364: 263-269.
18. Felson DT, Anderson JJ, Boers M. The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials. Arthritis Rheum 1993; 36: 729-740.
19. Van der Heijde DA, Dankert T, Nieman F et al. Reliability and sensitivity to change of a simplification of the Sharp/van der Heijde radiological assessment in rheumatoid arthritis. Rheumatology (Oxford) 1999; 38: 941-947.
20. Fries JF, Spitz P, Kraines RG et al. Measurement of patient outcome in arthritis. Arthritis Rheum 1980; 23: 137-145.
21. Ware JE. SF-36 health survey manual and interpretation guide. The Medical Outcomes Trust. Boston (MA): Nimrod Press 1997.
22. EuroQol Group. EuroQol: a new facility for the measurement of health - related quality of life. Health Moling 1990; 16: 199-208.
23. American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines: Guidelines for the Management of Rheumatoid Arthritis. Arthritis Rheum 2002; 46: 328-346.
24. Růžičková O, Bayer M, Pavelka K et al. Doporučení pro prevenci a léčbu glukokortikoidy indukované osteoporózy u pacientů s revmatickým onemocněním. Čes Revmatol 2004; 4: 163-174.
25. Van Gestel AM, Anderson JJ, van Riesl PLCM et al. ACR and EULAR improvement criteria have comparable validity in rheumatoid arthritis trials. American College of Rheumatology European League of Associations for Rheumatology. J Rheumatol. 1999; 26: 705-711.
26. American College of Rheumatology ad hoc committee on clinical guidelines. Guidelines for management of rheumatoid arthritis. Arthritis Rheum 1996; 39: 713-722.
27. Felson D, Anderson JJ, Meenan RF. The comparative efficacy and toxicity of second-line drugs in rheumatoid arthritis. Arthritis Rheum 1990; 33: 1449-1461.
28. Scott DL, Smolen JS, Kalden JR et al. Treatment of active rheumatoid arthritis with leflunomide: two-year follow-up of a double blind, placebo controlled trial versus sulfasalazine. Ann Rheum Dis 2001; 60: 913-923.
29. Boers M, Verhoeven AC, Markusse HM et al. Randomised comparison of combined step-down prednisolone, methotrexate and sulfasalazine with sulfasalazine alone in early rheumatoid arthritis. Lancet 1997; 350: 309-318.
30. Van der Heijde DM, van Riel PLCM, Nuver-Zwart IH et al. Effects of hydroxychloroquine and sulfasalazine on progression of joint damage in rheumatoid arthritis. Lancet 1989; 333: 1036-1038.
31. Kremer JM, Phelps CT. Long-term prospective study of use of methotrexate in the treatment of rheumatoid arthritis - update after a mean of 90 months. Arthritis Rheum 1992; 35: 138-145.
32. Tugwell P, Bennet K, Bell M et al. Methotrexate in RA. Ann Intern Med 1989; 110: 581-583.
33. Rau R, Hernom G, Kargen T et al. A double blind, randomized parallel trial of intramuscular methotrexate and gold sodium thiomalate in early erosive rheumatoid arthritis. J Rheumatol 1991; 18: 328-333.
34. Strand V, Cohen S, Sheriff M et al. Treatment of active rheumatoid arthritis with leflunomide compared with placebo and methotrexate. Arch Intern Med 1999; 159: 2542-2550.
35. Emery P, Breedveld FC, Lemmell EM et al. A comparison of the efficacy and safety of leflunomide and methotrexate for the treatment of rheumatoid arthritis. Rheumatol 2000; 39: 655-665.
36. Bathon JM, Martin RW, Fleischmann RM et al. A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis. N Engl J Med 2000; 343: 1586-1593.
37. Breedveld FC, Weisman MH, Kavanaugh AF et al. The PREMIER study. A multicenter, randomized, double-blind clinical trial of combination therapy with adalimumab plus methotrexate versus methotrexate alone or adalimumab alone in patients with early, aggressive rheumatoid arthritis who had not had previous methotrexate treatment. Arthritis Rheum 2006; 54: 26-37.
38. Smolen JS, Kalden JR, Scott DL et al. Efficacy and safety of leflunomide compared with placebo and sulfasalazine in active rheumatoid arthritis: a double blind, randomized, multicenter study. Lancet 1999; 353: 259-266.
39. Kalden JR, Scott DL, Smolen JS et al. European Leflunomide Study Group. Improved functional ability in patients with rheumatoid arthritis - longterm treatment with leflunomide versus sulfasalazine. European Leflunomide Study Group. J Rheumatol 2002; 29: 1983-1991.
40. Maddison P, Kiely P, Kirkham B et al. Leflunomide in rheumatoid arthritis: recommendations through a process of consensus. Rheumatology (Oxford) 2005; 44: 280-286.
41. Gerards AH, Landewe RB, Prins AP et al. Cyclosporin A monotherapy versus cyclosporin A and methotrexate combination therapy in patiens with early rheumatoid arthritis: a double blind randomised placebo controlled trial. Ann Rheum Dis 2003; 62: 291-296.
42. Tegzová D, Pavelka K, Šírová K et al. Kontrolovaná studie methotrexátu a cyklosporinu u vysoce aktivní RA. Rheumatológia 1998; 12: 123-127.
43. Cash JM, Klippel JH. Second-line drug therapy for rheumatoid arthritis. N Engl J Med 1994; 330: 1368-1375.
44. Ward JR, Williams HJ, Egger MJ et al. Comparison of auranofin, gold sodium thiomalate, and placebo in the treatment of rheumatoid arthritis: a controlled clinical trial. Arthritis Rheum 1983; 26: 1303-1315.
45. Woodland J, Chapuit de Saintonge DM, Evans SJ et al. Azathioprine in rheumatoid arthritis: double-blind study of full versus half doses versus placebo. Ann Rheum Dis 1981; 40: 355-359.
46. O’Dell JR, Haire CE, Erikson N et al. Treatment of rheumatoid arthritis with methotrexate alone, sulfasalazine and hydroxychloroquine or a combination of all three medications. N Engl J Med 1996; 334: 1287-1291.
47. Pavelka K Terapie revmatoidní artritidy. In: Pavelka K et al. (eds.) Farmakoterapie revmatických onemocnění. Praha: Grada Publishing, 2005; 224.
48. Tugwell P, Pincus T, Yocum D et al. Combination therapy with cyclosporine and methotrexate in severe rheumatoid arthritis. N Engl J Med 1995; 333: 137-141.
49. Haagsma CJ, van Riel PLCM, de Jong AJ et al. Combination of sulphasalazine and methotrexate versus the single components in early rheumatoid arthritis: a randomized, controlled, double-blind, 52 week clinical trial. Br J Rheumatol 1997; 36: 1082-1088.
50. Dougados M, Combe B, Cantagrel A. Combination therapy in early rheumatoid arthritis: a randomised, controlled, double blind 52 week clinical trial of sulphasalazine and methotrexate compared with the single components. Ann Rheum Dis 1999; 58: 220-225.
51. Calguneri M, Pay S, Caliskaner Z et al. Combination therapy versus monotherapy for the treatment of patients with rheumatoid arthritis. Clin Exp Rheumatol 1999; 17: 699-704.
52. O’Dell JR, Leff R, Paulsen G et al. Treatment of rheumatoid arthritis with methotrexate and hydroxychloroquine, methotrexate and sulfasalazine, or a combination of the three medications: results of a two-year, randomized, double-blind, placebo-controlled trial. Arthritis Rheum 2002; 46: 1164-1170.
53. Marchesoni A, Battafarano N, Arreghini M et al. Radiographic progression in early rheumatoid arthritis: a 12-month randomized controlled study comparing the combination of cyclosporin and methotrexate with methotrexate alone. Rheumatology (Oxford) 2003; 42: 1545-1549.
54. Gerards AH, Landewe RB, Prins AP et al. Cyclosporin A monotherapy versus cyclosporin A and methotrexate combination therapy in patiens with early rheumatoid arthritis: a double blind randomised placebo controlled trial. Ann Rheum Dis 2003; 62: 291-296.
55. Kremer JM, Genovese MC, Cannon GW et al. Concomitant leflunomide therapy in patients with active rheumatoid arthritis despite stable doses of methotrexate. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 2002; 137: 726-733.
56. Cannon GW, Holden WL, Juhaeri J et al. Averse events with disease modifying antirheumatic drugs (DMARD): a cohort study of leflunomide compared with other DMARD. J Rheumatol. 2004; 31: 1906-1911.
57. Choy EHS, Smith C, Doré CJ et al. A meta-analysis of the efficacy and toxicity of combining disease-modifying anti-rheumatic drugs in rheumatoid arthritis based on patient withdrawal. Rheumatology 2005; 44: 1414-1421.
58. Smolen JS, Sokka T, Pincus T et al. A proposed treatment algorithm for rheumatoid arthritis: aggressive therapy, methotrexate, and quantitative measures. Clin Exp Rheumatol 2003; 21(Suppl 31): S209-S210.
59. Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Allaart CF et al. Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): a randomized, controlled trial. Arthritis Rheum 2005; 52: 3381-3390.
60. Moreland LW, Schiff MH, Baumgartner SW et al. Etanercept therapy in rheumatoid arthritis. A randomized controlled trial. Ann Intern Med 1999; 130: 478-486.
61. Weinblatt ME, Kremer JM, Bankhurst AD et al. A trial of etanercept, a recombinant tumor necrosis factor receptor: Fc fusion protein, in patients with rheumatoid arthritis receiving methotrexate. N Engl J Med 1999; 340: 253-259.
62. Maini RN, Breedveld FC, Kalden JR et al. Therapeutic efficacy of multiple intravenous infusions of anti-tumor necrosis factor monoclonal antibody combined with low-dose weekly methotrexate in rheumatoid arthritis. Arthritis Rheum 1998; 41: 1552-1563.
63. Maini R, StClair EW, Breedveld F et al. Infliximab (chimeric anti-tumor necrosis factor alfa monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomised phase III trial. Lancet 1999; 354: 1932-1939.
64. Lipsky PE, van der Heijde DM, St. Clair EW et al. Infliximab and methotrexate in the treatment of rheumatoid arthritis. New Engl J Med 2000; 22: 1594-1602.
65. Lovell DJ, Giannini EH, Reiff A at al. Etanercept in children with polyarticular juvenile rheumatoid arthritis. New Engl J Med 2000; 11: 763-769.
66. Genovese MC, Bathon JM, Martin RW et al. Etanercept versus methotrexate in patients with early rheumatoid arthritis: two-year radiographic and clinical outcomes. Arthritis Rheum 2002; 46: 1443-1450.
67. Weinblatt ME, Keystone EC, Furst DE et al. Adalimumab, a fully human anti-tumor necrosis factor alpha monoclonal antibody,for the treatment of rheumatoid arthritis in patients taking concomitant methotrexate: the ARMADA trial. Arthritis Rheum 2003; 48: 35-45.
68. Klareskog L, Van der Heijde DM, De Jager JP et al. Therapeutic effect of the combination of etanercept and methotrexate compared with each treatment alone in patients with rheumatoid arthritis: double-blind randomised controlled trial. Lancet 2004; 363: 675-681.
69. St Clair EW, van der Heijde DM, Smolen JS et al. Combination of infliximab and methotrexate therapy for early rheumatoid arthritis. A randomized, controlled trial. Arthritis Rheum 2004; 50: 3432-3443.
70. Van der Heijde DM, Klareskog L, Rodriguez-Valverde V et al. Comparison of etanercept and methotrexate, alone and combined, in the treatment of rheumatoid arthritis. Two-year clinical and radiographic results from the TEMPO study, a double-blind, randomized trial. Arthritis Rheum 2006; 54: 1063-1074.
71. Smolen JS, Han C, Bala M et al. Evidence of radiographic benefit of treatment with infliximab plus methotrexate in rheumatoid arthritis patients who had no clinical improvement. A detailed subanalysis of data from Anti-tumor necrosis factor trial in rheumatoid arthritis with concomitant therapy study. Arthritis Rheum 2005; 52: 1020-1030.
72. Heiberg MS, Rodevand E, Mikkelsen K et al. Adalimumab and methotrexate is more effective than adalimumab alone in patients with established rheumatoid arthritis: results from a 6-month longitudinal, observational, multicentre study. Ann Rheum Dis 2006; 65: 1379-1383.
73. Kremer JM, Westhovens R, Leon M et al. Treatment of rheumatoid arthritis by selective inhibition of T-cell activation with fusion protein CTLA4Ig. N Engl J Med 2003; 349: 1907-1915.
74. Genovese MC, Becker JC, Schiff M et al. Abatacept for rheumatoid arthritis refractory to tumor necrosis factor in inhibition. N Engl J Med 2005; 353: 1114-1123.
75. Edwards JCW, Scepanski L, Szechinski J et al. The efficacy of B-cell-targeted therapy with rituximab in patients with rheumatoid arthritis. N Engl J Med 2004; 350: 2572-2581.
76. Emery P, Fleischmann R, Filipowicz-Sosnowska A et al. The efficacy and safety of rituximab in patients with active rheumatoid arthritis despite methotrexate treatment. Results of a phase IIb randomized, double-blind, placebo-controlled, dose-ranging trial. Arthritis Rheum 2006; 54: 1390-1400.
77. Cohen SB, Emery P, Greenwald MW et al. Rituximab for rheumatoid arthritis refractory to anti-tumor necrosis factor therapy: Results of a multicenter, randomized, double-blind, placebo-controlled, phase III trial evaluating primary efficacy and safety at twenty-four weeks. Arthritis Rheum 2006; 54: 2793-2806.
78. Weinblatt M, Combe B, Covucci A et al. Safety of the selective costimulation modulator abatacept in rheumatoid arthritis patients receiving background biologic and nonbiologic disease-modifying antirheumatic drugs: A one-year randomized, placebo-controlled study. Arthritis Rheum 2006; 54: 2807-2816.
79. Furst DE, Breedveld FC, Kalden JR et al. Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2006. Ann Rheum Dis 2006; 65 (Suppl 3): iii2-iii15.
80. Vencovský J, Tegzová D, Krofta K et al. Doporučení české revmatologické společnosti k biologické léčbě blokádou TNF - doplněk standardních léčebných postupů u revmatoidní artritidy. Čes Revmatol 2004; 12: 20-29.
81. St Clair EW, Wagner CL, Fasanmade AA et al. The relationship of serum infliximab concentrations to clinical improvement in rheumatoid arthritis. Arthritis Rheum 2002; 46: 1451-1459.
82. Gomez-Reino JJ, Carmona L and the BIOBADASER Group. Switching TNF antagonists in patients with chronic arthritis: an observational study of 488 patients over a four-year period. Arthritis Res Ther 2006; 8: R29.
83. Solau-Gervais E, Laxenaire N, Cortet B et al. Lack of efficacy of a third tumour necrosis factor a antagonist after failure of a soluble receptor and a monoclonal antibody. Rheumatology 2006; 45: 1121-1124.
84. Doyt L, Bonn MD, Sam Lim S. New role for an old friend: prednisone is a disease modifying agent in early rheumatoid arthritis. Curr Opin Rheumatol 2003; 125: 193-196.
85. Saag KG, Criswell LA, Sems KM et al. Low-dose corticosteroids in rheumatoid arthritis: a meta-analysis of their moderate-term effectiveness. Arthritis Rheum 1996; 39: 1818-1825.
86. Svensson B, Boonen A, Albertsson K et al. for the BARFOT Study Group. Low-dose prednisolone in addition to the initial disease-modifying antirheumatic drug in patients with early active rheumatoid arthritis reduces joint destruction and increases the remission rate. A two year randomised trial. Arthritis Rheum 2005; 52: 3360-3370.
87. Kirwan JR, ARC. Low Dose Glucocorticoid Study Group. The effect of glucocorticoids on joint destruction in rheumatoid arthritis. N Engl J Med 1995; 333: 142-146.
88. Wassenberg S, Rau R, Steinfeld P et al. Very low-dose prednisolone in early rheumatoid arthritis retards radiographic progression over two years: a multicenter, double blind, placebo controlled trial. Arthritis Rheum 2005; 52: 3371-3380.
89. Hickling P, Jacoby RK, Kirwan JR. Joint destruction after glucocorticoids are withdrawn in early rheumatoid arthritis. Arthritis and Rheumatism Council Low Dose Glucocorticoid Study Group. Br J Rheumatol 1998; 37: 930-936.
90. Capell HA, Madhok R, Hunter JA et al. Lack of radiological and clinical benefit over two years of low dose prednisolone for rheumatoid arthritis: results of a randomised controlled trial. Ann Rheum Dis 2004; 63: 797-803.
91. Van Everdingen AA, Jacobs JW, Siewertsz Van Reesema DR et al. Low-dose prednisone therapy for patients with early active rheumatoid arthritis: clinical efficacy, disease-modifying properties, and side effects: a randomized, double-blind, placebo-controlled clinical trial. Ann Intern Med 2002; 136: 1-12.
92. Quinn MA, Conaghan PG, Emery P. The therapeutic approach of early intervention for rheumatoid arthritis: what is the evidence? Rheumatology 2001; 40l: 1211-1220.
93. Lin AE, Paget SA. Principles of corticosteroids therapy. London: Arnold 2002.
94. Bijlsma JWJ, Boers M, Saag KG et al. Glucocorticoids in the treatment of early and late RA. Ann Rheum Dis 2003; 62: 1033-1037.
95. Gotzsche PC, Krogth Johansen H. Meta-analysis of short term low dose prednisolone versus placebo and non steroidal anti inflammatory drugs in rheumatoid arthritis. BMJ 1998; 316: 811-818.
96. Morrison E, Capell HA. Corticosteroids in the management of early and established rheumatoid disease. Rheumatology 2006; 45: 1058-1061.
97. Pavelka K et al. Farmakoterapie revmatických onemocnění. Praha: Grada 2005.
98. Hrnčíř Z. Význam série minipulzů metylprednisolonu v léčbě aktivní revmatoidní artritidy. Čas Lék Čes 1994; 133: 440-443.
99. Hrnčíř Z. Pulsní léčba u systémových onemocnění pojiva. In: Pavelka K. Pokroky v revmatologii. Praha: Alter 1996.
100. Brooks P, Emery P, Evans JF et al. Interpreting the clinical significance of the differential inhibition of cyclooxygenase-1 and cyclooxygenase-2. Rheumatology 1999; 38: 779-783.
101. Singh G, Triadafilopoulos G Epidemiology of NSAID-induced gastrointestinal complications. J Rheumatol 1999; 26(Suppl 1): 18-24.
102. Casimiro L, Brosseau L et al. Therapeutic ultrasound for the treatment of rheumatoid arthritis. Cochrane Database Syst Rev 2006; 4.
103. Brosseau L, Yonge KA et al. Transcutaneous electrical nerve stimulation (TENS) for the treatment of rheumatoid arthritis in the hand Cochrane Database Syst Rev 2006; 4.
104. Robinson VA, Brosseau L et al. Thermotherapy for treating rheumatoid arthritis. Cochrane Database Syst Rev 2006; 4.
105. Van den Ende CHM, Vliet Vlieland TPM et al. Dynamic exercise therapy for treating rheumatoid arthritis. Cochrane Database Syst Rev 2006; 4.
106. Gschwend N Modern surgical therapy of RA: chances, risks, results. Postgraduate lectures EFORT 1993. Masson 1993; 1: 4-9.
107. Miehlke R. Operative Therapie. In: Hetsenkofer HJ. Rheumatologie Stuttgart: Thieme, 1989; 392-418.
108. Sculo TP. Surgical Treatment of Rheumatoid Arthritis. Mosby Year Book, 1999.
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