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Archive 1 | Archive 2 | Archive 3 | Archive 4 | Archive 5 |
doi: 10.1016/j.amjmed.2008.02.018 those who don't meet elegibility criteria but get biologicals anyway typically have a poorer response. JFW | T@lk 11:25, 21 May 2008 (UTC)
Two users have now tried to insert information on alcohol supposedly reducing the risk of RA. This seems to be based on doi: 10.1136/ard.2007.086314, an article that has not yet appeared in print and therefore has not yet received the scrutiny of the scientific community. The authors state that their findings need to be confirmed in further studies. This should probably be a prospective study. The paper also does not really explain why alcohol would interact with HLA-DRB1 except on an epidemiological level. JFW | T@lk 17:25, 12 June 2008 (UTC)
Have you ever seen that used in a Wikipedia article? That sounds like editorialising and fails WP:NOR. I have already explained my misgivings with the study. On the whole, citing single studies on anything is to be avoided on Wikipedia, as we cannot possibly place such a study in context. Multiple studies are easier, systematic reviews and meta-analyses are even easier. And finally the high-quality clinical review in a high-impact factor journal is the bee's knees. The only exception occurs when a single study is cited heavily for its remarkable achievements or notoriety. PMID 10608028 is such a study. It was never repeated but it is highly cited.
If you can find anything better on RA vs alcohol I'd be only too pleased to recommend it. The Scandinavian study contradicts earlier work, such as PMID 11838841, but is supported by PMID 7986867, and PMID 8311545 finds no definite answer. I think that the literature is too contradictory to suggest that alcohol protects against RA, and there is no systematic review that we can cite to the effect that "the jury is still out". JFW | T@lk 09:37, 15 June 2008 (UTC)
A single preliminary study is not sufficient to state that cannabis is used for RA. The survey cited in support by the authors does not differentiate reliably between OA and RA so that is specious. I strongly suggest we avoid discussing cannabis here; it has no regulatory approval and is illegal in many countries. JFW | T@lk 22:22, 2 August 2008 (UTC)
The article now seems not to mention antibiotics at all. Should we not have under Treatment a subsection "Alternative or controversial treatments" which can mention the use of antibiotics as discussed above on this talk page ? or if antibiotics are no longer used maybe it could be mentioned in the History section ? Rod57 ( talk) 06:44, 26 November 2008 (UTC)
Review for acupuncture [3] WLU (t) (c) Wikipedia's rules: simple/ complex 01:35, 10 October 2009 (UTC)
There seems to be little here about the causes of the disease. I was interested to see the earlier comment that RA is nothing to do with old age - it is a disease. I would like to know more about 'the disease'. Maybe I missed it. Spanglej ( talk) 13:54, 28 October 2009 (UTC)
Hello Jfdwolff,
You reverted to the revision of 23:46, 20 October 2009 by
Jfdwolff (your revision) argumenting that the contributions consisted in "addition of poorly sourced and dubious content". While this may be true for some contributions (word "pig" inserted or unsourced text on Ayurveda), I feel this does not apply for the contributions I (
Hippo99) have made.
Therefore, I would like to know your reasons.
The version of
12:37, 23 October 2009 included a clearer structure of chapter 3.
Etiology & Pathophysiology by adding headings.
Furthermore, I made an extensive review on the role of
Alimentary antigens which was also well-sourced.
Or was it just a
Twinkle-accident ?
Thank you for exposing your attitude towards the implication of alimentary antigens in the
etiology of RA.
Hippo99 (
talk)
07:54, 29 October 2009 (UTC)
Gabbe cited a Cochrane Review, perhaps the highest standard of medical evidence, to the fact that there is simply insufficient evidence to recommend any form of dietary approach to RA. The studies you have been quoting are consistently primary research studies, and WP:MEDRS makes very clear recommendations about the standard of references. Now before you reinsert your content please address the concerns raised by Gabbe and myself. JFW | T@lk 22:50, 20 March 2010 (UTC)
Hi Hippo99,
It sounds like you really want to figure out what the problems are. Here's my reaction to the first paragraph ("Alimentary antigens"). Perhaps it will help you figure out how MEDRS is applied. As a most important point, every single source you use should comply with all of MEDRS. It's not good enough to say that this one complies with the first section, and that one complies with the second standard: The best sources are, e.g., recent AND multi-study reviews AND published in reputable peer-reviewed journals AND so forth.
Text with refs | Problems found |
---|---|
Several studies suspect food-derived antigenes to be involved within a scenario of a "leaky mucosa"< ref >Is diet important in rheumatoid arthritis? Buchanan HM, Preston SJ, Brooks PM, Buchanan WW. Br J Rheumatol. 1991 Apr;30(2):125-34. PMID 2012942</ref> | What it says: "several well documented case reports [NOTE:
Case reports are not best described as "studies"] that occasional patients with rheumatoid arthritis (RA) may develop aggravation of their arthritis as a result of allergy"... "conflicting evidence...that patients with rheumatoid arthritis may have a 'leaky' intestinal mucosa"...
Oh, and they argue against dietary modification as a practical treatment: "this presupposes that patients entered into such a study are capable of improvement with dietary manipulation. Since this is often not the case..." This is almost 19 years old, which violates WP:MEDRS#Use_up-to-date_evidence. |
and that above all milk-products and cereals ( wheat, corn etc.) can trigger the autoimmune response.< ref >The gut-joint axis: cross reactive food antibodies in rheumatoid arthritis. Hvatum M, Kanerud L, Hällgren R, Brandtzaeg P. Gut. 2006 Sep;55(9):1240-7. PMID 16484508</ref>< ref >Preliminary results of a wheat-free and milk-free diet in rheumatoid arthritis. Seignalet J, Pauthe C, Reynier J, Moens P, Simon L. Presse Med. 1989 Nov 25;18(39):1931-2. PMID 2531874</ref>< ref >Effect of dietary restrictions on disease activity in rheumatoid arthritis. Beri D, Malaviya AN, Shandilya R, Singh RR. Ann Rheum Dis. 1988 Jan;47(1):69-72. PMID 3278696</ref> |
PMID
16484508: This is an original report of a small test. By 'original report', I mean "not the kind of multi-study review that
WP:MEDRS strongly prefers". By "small", I mean that there are some 73 million people with RA in Europe, and this author actually managed to get useable samples from a whopping fourteen of them.
PMID 2531874 is a letter to the editor -- not even a properly peer-reviewed original report. It's also 20 years old, which violates MEDRS. It should never have been used. PMID 3278696 is 22 years old. It had a really shocking dropout rate (89% of the people who started the diet dropped out), and most didn't stay on the diet long enough to make any measurable difference (two weeks is nothing in a disease that waxes and wanes like RA). There is no support in these sources (except possibly the French letter, which I discount entirely) for a claim that these substances can "trigger" the "autoimmune response". Oh, and corn can refer to at least three different grains. Maize, which is one of the least allergenic foods on the planet, was not tested, but nearly all American readers will assume from your description that it was. |
What your sources actually support is far smaller than what you seem to want to say: "Two decades ago, there was some interest in whether diet affects RA, either in triggering the onset of the disease, or in exacerbating symptoms."
I apologize if this seems like a hatchet job on your efforts, but there are serious problems, and I know that you want to be able to do better. WhatamIdoing ( talk) 16:57, 21 March 2010 (UTC)
I concur with JFW's actions, and WhatamIdoing's comments. -- Scray ( talk) 20:48, 21 March 2010 (UTC)
My addition to ==pathophysiology== of :
===Mechanism of spreading=== RA seems to spread from joint to joint and there is evidence that this is due to rheumatoid arthritis synovial fibroblasts (RASFs) traveling via the bloodstream. [1]
was removed apparently as it was supported by only a single study. However in case it is useful I leave it here for now. Rod57 ( talk) 01:38, 21 November 2009 (UTC)
What's the difference between rheumatoid arthritis and inflammatory arthritis?-- 达伟 ( talk) 11:25, 24 April 2010 (UTC)
Obvious POV edits with bad sources and no prior discussion. Mothball666 ( talk) 18:54, 28 June 2010 (UTC)
My Rheumatoid arthritis started 42 years ago when I was only thirteen years old. I am not certain but it started shortly after receiving a smallpox vaccination for a trip to Turkey. Over the years I tried many remedies but nothing was satisfactory, however two years ago I found a herbalist in our local French street market selling the dried root of Devil's Claw (Harpagophytum)after making an infusion I felt pain relief within 15 minutes of drinking and have now got tolerable pain levels and localised swelling markedly decreased within a few days. May be further investigation is worth while although I suspect that the pharmaceutical companies will not be keen because I only pay 2.3 Euros for two weeks supply of dried root. Hampshireoak ( talk) 08:43, 19 October 2010 (UTC)Hampshireoak 19th October 2010
I often see this phrase in WP articles and elsewhere, and change it wherever i find it. Maybe it's a stylistic difference of taste. Maybe i need to retune my ear, but to me it sounds wordy and unencyclopedic. Comments welcomed. Ragityman ( talk) 15:25, 15 December 2010 (UTC)
Seanwal111111 ( talk · contribs) removed the statement that smokers have a fourfold risk of lung cancer, citing doi:10.1136/ard.2008.096487 (Sugiyama et al) in his support. The problem is, Sugiyama is a pretty good WP:MEDRS on the subject, and it makes some very definite statements about smoking vs RA. I therefore thought it might be better to add some freely phrased information on the basis of this paper. Again, this was removed on the basis that I should have done a better job at representing the conclusions, but without an attempt to improve the content ( reaction on Seanwal's talkpage).
I think the conclusions of this paper should be represented in the article, as it gives a good idea about how smoking might adversely modify the risk of RA, and I am open to suggestions about how it should be phrased. JFW | T@lk 10:21, 11 March 2011 (UTC)
I see in the "Criteria" section you say that the new criteria is for diagnosing new onset RA, yet in the new Harrison (18) it specifically says that the new criteria is not for diagnosis and I quote "It is important to emphasize that the new 2010 ACR-EULAR criteria are "classification criteria" as opposed to "diagnostic criteria" and serve to distinguish patients at the onset of disease with a high likelihood of evolving into a chronic disease with persistent synovitis and joint damage."
Just thinking it would be wise to emphasize that here as well. Thank you — Preceding unsigned comment added by Avig70 ( talk • contribs) 18:55, 18 October 2011 (UTC)
The introduction seems to be a bit disorganized.
It looks like a laundry list of symptoms, in which somebody tried to work in as many technical concepts as possible -- as if they were preparing for an exam. The technical terms make it difficult for a non-specialist reader WP:NOTPAPER. I tried to improve that by adding the lay terms, but it's still difficult to read. It's still hard for me to read. It's more like a word puzzle than a clarifying explanation.
Another serious flaw is that it has no WP:RS. Basically this definition is somebody's WP:OR.
Last month's review article in the NEJM has what I consider a good introduction. In fact it has 2 good paragraphs both of which could be the basis of a good introduction:
and
NEJM, 8 Dec 2011, 365(23): 2205, Mechanisms of disease: The pathogenesis of rheumatoid arthritis, Ian B. Mcinnes and Georg Schett. http://www.nejm.org/doi/full/10.1056/NEJMra1004965
I think this introduces some important points: (1) RA is a systemic disease which most prominently affects the joints but also affects other systems, particularly the heart and lungs (2) RA is life-threatening, not just painful. (3) The progress of these life-threatening complications (and the pain) can be controlled by new drugs.
The main misconception I grew up with about RA is that it's a just a painful disease of the joints, like osteoarthritis. I think the introduction should make clear the important message that RA is not just a joint disease, it's an autoimmune disease. Also, it's not a bag of symptoms. There's an underlying autoimmune process, and each of those symptoms is the result of that process.
Wikipedia isn't a patient information handout; we're trying to help people understand the disease, whether they're patients or high school and college students who will later go on to study the disease. Wikipedia is also not a medical school exam preparation book. We don't have to start the introduction with a list of every symptom. How does it help the reader to understand RA to start out by knowing that it manifests in the sclera? How does it help the reader to understand RA if he or she first has to figure out a list of technical terms like "sclera" and "pericardium"?
Another issue is the new research into the molecular biology and immunology of RA, of which the NEJM article has quite a bit. I think that's more important than the details of diagnosis and pathology. -- Nbauman ( talk) 17:22, 2 January 2012 (UTC)
The following was added by Ilhamhafizovic ( talk · contribs) under "Future Treatments":
“ | As rheumatoid arthritis primarily attacks the synovial joints, future therapies may very well involve more targeted approaches through the use of nanoparticle drug delivery against the synovial fibroblasts. Hyperplasia in rheumatoid arthritis occurs primarily due to the cellular increase in numbers of the synovial fibroblasts. Although the reason is currently unknown, some research has indicated that an impaired apopotosis or senescence in these cells can explain the effect [2]. Recent research has shown that statins, competitive inhibitors of HMG-CoA reductase, utilized in lowering cholesterol may have anti-inflammatory effects that are beneficial to treating synovial fibroblast hyperplasia. Namely, these effects include suppressing pro-inflammatory cytokines and chemokines [3]. In 2006, various statin molecules were shown to decrease synovial fibroblast viability in a concentration and time dependent manner [4]. Simvastatin was shown to have a more pronounced effect on reducing viability in synovial fibroblasts than atorvastatin at concentrations greater than 3μM. However differences due to time were only observed after 72 hours of administration. The 2006 paper also showed that TNF-α stimulated fibroblast synovial cells, an important component of the pathogenesis of RA, showed a larger decrease in viability than unstimulated cells for both atorvastatin and simvastatin. Utilizing a TUNEL assay, the authors indicated that this reduced viability was primarily due to induction of apoptosis. In 2004 only atorvastatin was tested in a clinical trial with clinically significant but very modest outcomes in patients [5]. This may be due to an ineffective targeting of synovial fibroblasts, which could be overcome with future technology such as nanoparticle drug delivery. | ” |
The inherent problem with all those treatments is that even treatments from positive studies don't necessarily get adopted into clinical practice. This entire section is about statins, which are certainly not the only drugs under investigation. For sections of this kind, the medical WikiProject has set some pretty clear parameters. I would completely avoid citing individual studies, because they do not give a clear picture as to what we might expect in the next 10 years. Rather, I would want to base this section completely in treatments considered as thoroughly studied and likely to be adopted in secondary sources (reviews, textbook chapters). JFW | T@lk 06:24, 7 March 2012 (UTC)
i am not a doctor but there is academic paper about Flowers of Robinia pseudoacacia www.academicjournals.org/jmpr/PDF/pdf2012/30%20Apr/Ji%20et%20al.pdf predatory publisher it was written Chinese medicine is using that flowers for that disease. Maybe someone search — Preceding unsigned comment added by 176.30.26.195 ( talk) 07:06, 27 May 2012 (UTC)
Gramling, A (2012 May). "Initial management of rheumatoid arthritis". Rheumatic diseases clinics of North America. 38 (2): 311–25.
PMID
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Doc James (
talk ·
contribs ·
email) (if I write on your page reply on mine)
09:54, 9 October 2012 (UTC)
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Doc James (
talk ·
contribs ·
email) (if I write on your page reply on mine)
13:51, 24 March 2013 (UTC)Wikipedia is a great stating resource, that users can then branch out for further research based upon the information here. For rheumatoid arthritis, there have been double-blind, placebo controlled studies that suggest various "natural remedies" for inflammation, such as curcumin, boswellia, and collagen. What is wrong with indicating that this research is preliminary and the reader can do their own further research? Sthubbar ( talk) 13:08, 22 March 2013 (UTC)
Right now there are 7 secondary review references supporting the safety and efficacy of omega-3 in the treatment of RA. Instead of having a sentence for each reference, can we just consolidate to one or two sentences? I prefer strong language like "There is overwhelming evidence that omega-3 is effective and safe for the treatment of RA." or "Omega-3 is safe and effective for the treatment of RA". I would find it unfair to put any suspect words like "might" "could" or "promising". We already have 7 review articles. The evidence is overwhelming. Your idea? Sthubbar ( talk) 03:20, 25 March 2013 (UTC)
Should we be consistent and replace all instances of "rheumatoid arthritis" with RA, with the following exceptions: First instance remains defining the abbreviation, withing references will remain, hidden meta tags will remain, image titles will remain. Do you agree? Sthubbar ( talk) 03:46, 25 March 2013 (UTC)
Doc James, OK if there are many instances of inflammatory arthritis, what is the difference and shouldn't IA have it's own page instead of redirect to RA? This question was asked above and didn't get answered. I have noticed papers on PubMed that mention IA and I just assumed it was an alternate name for RA preferred in different cultures. Should we create a separate page for IA? — Preceding unsigned comment added by 111.193.223.228 ( talk) 12:25, 25 March 2013 (UTC) This was me Sthubbar ( talk) 12:28, 25 March 2013 (UTC)
I have been reviewing the Tourette syndrome and Asperger syndrome FA quality articles and a key difference I see between them and this article is that they don't have many subsection for the major table of content areas. They simply have a few paragraphs for each major TOC topic. I think to follow their lead we should try and remove the sub-headings from each of the major topics and turn it into prose. I'll see what I can do to help on that front. Sthubbar ( talk) 03:04, 26 March 2013 (UTC)
Due to the contradictory statements regarding patient percentaje and progression toward disability, I changed the opening statement about this subject( the opening section had different -much different- number than the number mentioned in the prognosis section); Not only it contradicted what was larter said on ths article but there was no -real- reference of it, because the appendix number only let to the John Hopkins Hospital Wikipedia page. It was not apropiate to put the first number about disability on the article opening section because this is a treatable disorder.—Preceding unsigned comment added by 206.248.106.166 ( talk • contribs) 20:12, 5 December 2007
Doc James, how can you and I work together to get this article to GA quality by March 5th? I can add reference for the DMARD and other areas. You are doing a good job with writing stuff in a medically accurate and quality way. You up for the challenge? Sthubbar ( talk) 12:30, 25 March 2013 (UTC)
Doc James, I propose we state right away that RA is an auto-immune disease like the first sentence in the background here. [6] I really like the first 3-4 sentences of that article. What do you think? Sthubbar ( talk) 08:23, 26 March 2013 (UTC)
I reverted the most recent change in the lead describing CAM for several reasons:
Yobol ( talk) 23:12, 3 May 2013 (UTC)
I agree with your general thrust about CAM, but it can be difficult to describe the failings of CAM in rigorous scientific terms. And we can't commit the same mistakes that CAM makes when we attack CAM.
It's true that if a treatment had good evidence to support it, it wouldn't be alternative medicine -- it would simply be medicine. OTOH, there are have been a (very) few CAM treatments that were finally supported by good evidence, so you can't rule them out. Artemisinin comes to mind. There aren't too many, but you don't want to miss something like artemisinin.
If we're going to write something attacking CAM, it has to strictly follow the scientific evidence and WP guidelines of WP:RS and WP:MEDMOS.
The original text said that the evidence for CAM is weak "and their use is not recommended," citing Efthimiou. I read the Efthimiou paper, and to my surprise, he didn't support that text; rather, he said what I put into the article, that the ACR recommends their careful use. If that differs from another ACR statement, I'd like to know the explanation.
I'm not sure what it means to say "their use is not recommended." I don't think it means anything. It's a passive voice, and it doesn't say who doesn't recommend their use. Besides, does it mean that "they" -- whoever "they" are -- recommend against their use, or that they simply have no recommendation?
The way you wrote the introduction, it says that "their use is not recommended." Who doesn't recommend their use? None of those 3 citations explicitly says that their use is not recommended. Efthimiou doesn't, Macfarlane doesn't, and even the NCCAM doesn't explicitly say that. Their statements are very qualified and guarded.
You can say that the ACR doesn't recommend it. You can't leave the implication that they recommend against it.
The politics of CAM are well known, which is why their statements are so qualified and guarded. But beyond that, there are many doctors, even academic doctors with any qualifications you can name, who not only accept CAM but use it themselves. And it is possible that some CAM treatments may be effective, but it just hasn't been proven yet.
When you write:
the word "sound" is a weasel word. What's "sound scientific evidence"? That phrase itself is not scientific terminology. "sound scientific evidence" is evidence a scientist agrees with. If he doesn't agree with it, he says it's not sound scientific evidence. I think it's a no true Scotsman fallacy. I'm not sure how much you know about medicine, but most medical practice isn't supported by Level 1 evidence. What's the evidence for corticosteroids in long-term treatment of back pain? What's the evidence for surgery in so many orthopedic conditions? What's the evidence for all that radiology?
Furthermore, I'm not sure what the ACR's policy on CAM is. According to their program book, the 2012 annual meeting had the following session. They seem to support tai chi and yoga:
ACR/ARHP Annual Meeting, 2012
ACR SESSIONS 2:30 - 4:00 PM Ballroom A Complementary and Alternative Medicine: Evidence-based Options for Arthritis Patients Moderator: Sharon L. Kolasinski, MD Upon completion of this session, participants should be able to: • contrast traditional physical therapy with alternative exercise options • evaluate the literature supporting the use of alternative therapies • appreciate the role of tai chi and yoga among exercise options for patients 2:30 PM Overview of Complementary and Alternative Medicine To be announced 3:00 PM Tai Chi for Arthritis Chenchen Wang, MD, MSc 3:30 PM Role of Yoga in the Management of Arthritis Susan J. Bartlett, PhD
I would say that the evidence for CAM, including herbal treatments, is weak and inconclusive. That's what we should say. Some doctors recommend against it, some recommend for it, some doctors are unable to make a recommendation. I've heard a lot of doctors say, "If it makes you feel better, and it doesn't cost too much, try it out." If you want to come up with a quote from Simon Singh or Quackwatch blasting CAM for arthritis, go ahead and include it. Some treatments are dangerous, and that should go in. But I don't think that a broad dismissal of all CAM, if you can find one by a reputable authority, represents the medical consensus. -- Nbauman ( talk) 04:33, 4 May 2013 (UTC)
This was added "NSAIDs have a risk of gastrointestinal side effects such as stomach ulcers, while COX-2 inhibitors do not have that risk" COX2 inhibitors still have GI side effects just less than NSAIDs. Thus removed. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 21:09, 16 June 2013 (UTC)
There is an image with caption: "Appearance of synovial fluid from a joint with inflammatory arthritis." The article would be improved if normal synovial fluid could be shown alongside. pgr94 ( talk) 15:17, 19 July 2013 (UTC)
The ACR is clearly biased with their statement "There are no herbal medicines whose health claims are supported by sound scientific evidence"
1) Why are two long quotes allowed? I have been told by Doc James to paraphrase and not to quote. Why this exception?
2) Herbal medicines do not make health claims.
3) Sound scientific evidence.
4) The real meaning of the sentence.
5) Contradicts itself.
This should be enough evidence to prove conclusively that their first statement is clearly false and this should be made clear. Sthubbar ( talk) 15:26, 22 July 2013 (UTC)
Yobol, fair enough. I have summarized the statement that exactly summarizes the conclusions of the ACR. Sthubbar ( talk) 16:03, 22 July 2013 (UTC)
Yobol, this is way too much quoting and over weight given to this one article. I'm not an expert with all the WP:Rulewhatever, I'm pretty sure the is a WP:don'tquote and WP:weight rule. Please summarize all 3 of them and remove direct quotes. I propose "The ACR states that herbal remedies contain active ingredients similar to conventional medicine, are not regulated as drugs by the FDA and that there is no sound scientific evidence to support the health claims." What rewording will you accept? Sthubbar ( talk) 16:27, 22 July 2013 (UTC)
Yobol, I do not agree to any of the edits you have made. Consensus on the talk page means we agree here how to edit the sentence. You are pushing your point of view and ignoring the complete content of the article and all of the statements made. Get a consensus here before further edits. I also suggest to revert to the original wording until there is consensus here on the talk page. Sthubbar ( talk) —Preceding undated comment added 16:57, 22 July 2013 (UTC) It's also convenient how you ignore the statement "Accupuncture is safe". If you put "Accupuncture is safe and it's affect may be the same as placebo" or just put the whole quote as you seem to be fond of quoting. Sthubbar ( talk) 17:00, 22 July 2013 (UTC)
Yobol, I have stated very clearly that I disagree with every edit you have made. Your putting 88 words for your one citation should allow me to add 88 words for each of the following 10 citations instead of the current 8.5 words per citation. Sound good to you? Sthubbar ( talk) 17:28, 22 July 2013 (UTC)
Why is this accepted as a reliable citation? It is written by a single doctor and reviewed by a "Communications and Marketing Committee". There are no citations that this document refers to that indicate it is a review article. Sthubbar ( talk) 17:25, 22 July 2013 (UTC)
This is an excellent source. I have paraphrased some of the comments in question. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 03:17, 23 July 2013 (UTC)
Here's a nice summary of the ACR 2013 session by a rheumatologist/blogger who was there.
http://www.ronankavanagh.ie/blog/cannabis-arthritis-whats-story/
Medical Marijuana and the Rheumatologist’ was presented by Dr. Jason McDougall and Dr. Mary Ann Fitzcharles at the American College of Rheumatology Annual Scientfic Meeting October 2013
This may be a WP:RS:
http://www.rheumatologyupdate.com.au/latest-news/time-to-get-serious-about-medical-marijuana
Bottom line: Many patients find it useful, and there's a plausible mechanism, but there are no rigorous studies to demonstrate efficacy, and there are poorly-characterized risks. -- Nbauman ( talk) 19:54, 7 November 2013 (UTC)
There are mistakes in the English here - too tired to look in detail - maybe tomorrow - but the English needs 'sharpening up' a bit to read well. — Preceding unsigned comment added by 87.206.188.230 ( talk) 21:33, 15 May 2014 (UTC)
Hi from a personal experience can I suggest that cachexia merits an entry under e.g. symptoms or effects? Cachexia seems to be a significant aspect that is sometimes ignored. Gildomingue ( talk) 15:27, 29 September 2014 (UTC) Gil Domingue. 29.09.2014
Does the following description merit being in the lead section of RA? "RA can also produce diffuse inflammation in the lungs, the membrane around the heart, the membranes of the lung (pleura), and whites of the eye, and also nodular lesions, most common in subcutaneous tissue. " ( Drsoumyadeepb ( talk) 13:50, 17 October 2014 (UTC))
Was wondering if History and Epidemiology should be placed right after the lead rather than almost at the end.( Drsoumyadeepb ( talk) 08:15, 19 October 2014 (UTC))
Substantial robust and replicable data on genetic basis of RA exists and genetic factors account for more than 50% of disease. Should be part of project.With GWAS data available we need to include genetic basis of complex diseases information too- might be as a pilot for the task force.
doi:10.1016/j.amjmed.2014.06.036 is a meta-analysis of 44 trials looking into safety and discontinuation of anti-TNF biologics. Etanercept seems safer that the rest. JFW | T@lk 09:07, 4 December 2014 (UTC)
This article does not currently mention the use of laser therapy for the symptomatic relief of rheumatoid arthritis. This modality has been covered by Cochrane reviews and deemed an acceptable form of short-term symptom control. [4] I don't think there is enough to warrant an entire section for laser, but I am unsure which existing section is an appropriate location for a mention. I thought to include it in the 'Alternative Medicine" section, but the section currently says that there are no RCTs available for Alternative Medicine treatments for RA. Since the cochrane review for laser therapy includes multiple RCTs, it seems that perhaps laser is not considered alternative medicine? I will leave it here, hopefully someone can find an appropriate way to include the info. — Preceding unsigned comment added by 70.65.253.158 ( talk) 18:39, 18 January 2015 (UTC)
There is clear data on multiple reviews as well as in text books that infectious agents do not have a role in the disease process. This has been mentioned in our Wikipedia article itself. Why have a section on Vaccinations which clearly does not have any role on the basis of just one narrative review. Has it come in any guidelines by notable health bodies ? ( Drsoumyadeepb ( talk) 17:57, 3 November 2014 (UTC)) Drawing attention of Doc James
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This is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page. |
Archive 1 | Archive 2 | Archive 3 | Archive 4 | Archive 5 |
doi: 10.1016/j.amjmed.2008.02.018 those who don't meet elegibility criteria but get biologicals anyway typically have a poorer response. JFW | T@lk 11:25, 21 May 2008 (UTC)
Two users have now tried to insert information on alcohol supposedly reducing the risk of RA. This seems to be based on doi: 10.1136/ard.2007.086314, an article that has not yet appeared in print and therefore has not yet received the scrutiny of the scientific community. The authors state that their findings need to be confirmed in further studies. This should probably be a prospective study. The paper also does not really explain why alcohol would interact with HLA-DRB1 except on an epidemiological level. JFW | T@lk 17:25, 12 June 2008 (UTC)
Have you ever seen that used in a Wikipedia article? That sounds like editorialising and fails WP:NOR. I have already explained my misgivings with the study. On the whole, citing single studies on anything is to be avoided on Wikipedia, as we cannot possibly place such a study in context. Multiple studies are easier, systematic reviews and meta-analyses are even easier. And finally the high-quality clinical review in a high-impact factor journal is the bee's knees. The only exception occurs when a single study is cited heavily for its remarkable achievements or notoriety. PMID 10608028 is such a study. It was never repeated but it is highly cited.
If you can find anything better on RA vs alcohol I'd be only too pleased to recommend it. The Scandinavian study contradicts earlier work, such as PMID 11838841, but is supported by PMID 7986867, and PMID 8311545 finds no definite answer. I think that the literature is too contradictory to suggest that alcohol protects against RA, and there is no systematic review that we can cite to the effect that "the jury is still out". JFW | T@lk 09:37, 15 June 2008 (UTC)
A single preliminary study is not sufficient to state that cannabis is used for RA. The survey cited in support by the authors does not differentiate reliably between OA and RA so that is specious. I strongly suggest we avoid discussing cannabis here; it has no regulatory approval and is illegal in many countries. JFW | T@lk 22:22, 2 August 2008 (UTC)
The article now seems not to mention antibiotics at all. Should we not have under Treatment a subsection "Alternative or controversial treatments" which can mention the use of antibiotics as discussed above on this talk page ? or if antibiotics are no longer used maybe it could be mentioned in the History section ? Rod57 ( talk) 06:44, 26 November 2008 (UTC)
Review for acupuncture [3] WLU (t) (c) Wikipedia's rules: simple/ complex 01:35, 10 October 2009 (UTC)
There seems to be little here about the causes of the disease. I was interested to see the earlier comment that RA is nothing to do with old age - it is a disease. I would like to know more about 'the disease'. Maybe I missed it. Spanglej ( talk) 13:54, 28 October 2009 (UTC)
Hello Jfdwolff,
You reverted to the revision of 23:46, 20 October 2009 by
Jfdwolff (your revision) argumenting that the contributions consisted in "addition of poorly sourced and dubious content". While this may be true for some contributions (word "pig" inserted or unsourced text on Ayurveda), I feel this does not apply for the contributions I (
Hippo99) have made.
Therefore, I would like to know your reasons.
The version of
12:37, 23 October 2009 included a clearer structure of chapter 3.
Etiology & Pathophysiology by adding headings.
Furthermore, I made an extensive review on the role of
Alimentary antigens which was also well-sourced.
Or was it just a
Twinkle-accident ?
Thank you for exposing your attitude towards the implication of alimentary antigens in the
etiology of RA.
Hippo99 (
talk)
07:54, 29 October 2009 (UTC)
Gabbe cited a Cochrane Review, perhaps the highest standard of medical evidence, to the fact that there is simply insufficient evidence to recommend any form of dietary approach to RA. The studies you have been quoting are consistently primary research studies, and WP:MEDRS makes very clear recommendations about the standard of references. Now before you reinsert your content please address the concerns raised by Gabbe and myself. JFW | T@lk 22:50, 20 March 2010 (UTC)
Hi Hippo99,
It sounds like you really want to figure out what the problems are. Here's my reaction to the first paragraph ("Alimentary antigens"). Perhaps it will help you figure out how MEDRS is applied. As a most important point, every single source you use should comply with all of MEDRS. It's not good enough to say that this one complies with the first section, and that one complies with the second standard: The best sources are, e.g., recent AND multi-study reviews AND published in reputable peer-reviewed journals AND so forth.
Text with refs | Problems found |
---|---|
Several studies suspect food-derived antigenes to be involved within a scenario of a "leaky mucosa"< ref >Is diet important in rheumatoid arthritis? Buchanan HM, Preston SJ, Brooks PM, Buchanan WW. Br J Rheumatol. 1991 Apr;30(2):125-34. PMID 2012942</ref> | What it says: "several well documented case reports [NOTE:
Case reports are not best described as "studies"] that occasional patients with rheumatoid arthritis (RA) may develop aggravation of their arthritis as a result of allergy"... "conflicting evidence...that patients with rheumatoid arthritis may have a 'leaky' intestinal mucosa"...
Oh, and they argue against dietary modification as a practical treatment: "this presupposes that patients entered into such a study are capable of improvement with dietary manipulation. Since this is often not the case..." This is almost 19 years old, which violates WP:MEDRS#Use_up-to-date_evidence. |
and that above all milk-products and cereals ( wheat, corn etc.) can trigger the autoimmune response.< ref >The gut-joint axis: cross reactive food antibodies in rheumatoid arthritis. Hvatum M, Kanerud L, Hällgren R, Brandtzaeg P. Gut. 2006 Sep;55(9):1240-7. PMID 16484508</ref>< ref >Preliminary results of a wheat-free and milk-free diet in rheumatoid arthritis. Seignalet J, Pauthe C, Reynier J, Moens P, Simon L. Presse Med. 1989 Nov 25;18(39):1931-2. PMID 2531874</ref>< ref >Effect of dietary restrictions on disease activity in rheumatoid arthritis. Beri D, Malaviya AN, Shandilya R, Singh RR. Ann Rheum Dis. 1988 Jan;47(1):69-72. PMID 3278696</ref> |
PMID
16484508: This is an original report of a small test. By 'original report', I mean "not the kind of multi-study review that
WP:MEDRS strongly prefers". By "small", I mean that there are some 73 million people with RA in Europe, and this author actually managed to get useable samples from a whopping fourteen of them.
PMID 2531874 is a letter to the editor -- not even a properly peer-reviewed original report. It's also 20 years old, which violates MEDRS. It should never have been used. PMID 3278696 is 22 years old. It had a really shocking dropout rate (89% of the people who started the diet dropped out), and most didn't stay on the diet long enough to make any measurable difference (two weeks is nothing in a disease that waxes and wanes like RA). There is no support in these sources (except possibly the French letter, which I discount entirely) for a claim that these substances can "trigger" the "autoimmune response". Oh, and corn can refer to at least three different grains. Maize, which is one of the least allergenic foods on the planet, was not tested, but nearly all American readers will assume from your description that it was. |
What your sources actually support is far smaller than what you seem to want to say: "Two decades ago, there was some interest in whether diet affects RA, either in triggering the onset of the disease, or in exacerbating symptoms."
I apologize if this seems like a hatchet job on your efforts, but there are serious problems, and I know that you want to be able to do better. WhatamIdoing ( talk) 16:57, 21 March 2010 (UTC)
I concur with JFW's actions, and WhatamIdoing's comments. -- Scray ( talk) 20:48, 21 March 2010 (UTC)
My addition to ==pathophysiology== of :
===Mechanism of spreading=== RA seems to spread from joint to joint and there is evidence that this is due to rheumatoid arthritis synovial fibroblasts (RASFs) traveling via the bloodstream. [1]
was removed apparently as it was supported by only a single study. However in case it is useful I leave it here for now. Rod57 ( talk) 01:38, 21 November 2009 (UTC)
What's the difference between rheumatoid arthritis and inflammatory arthritis?-- 达伟 ( talk) 11:25, 24 April 2010 (UTC)
Obvious POV edits with bad sources and no prior discussion. Mothball666 ( talk) 18:54, 28 June 2010 (UTC)
My Rheumatoid arthritis started 42 years ago when I was only thirteen years old. I am not certain but it started shortly after receiving a smallpox vaccination for a trip to Turkey. Over the years I tried many remedies but nothing was satisfactory, however two years ago I found a herbalist in our local French street market selling the dried root of Devil's Claw (Harpagophytum)after making an infusion I felt pain relief within 15 minutes of drinking and have now got tolerable pain levels and localised swelling markedly decreased within a few days. May be further investigation is worth while although I suspect that the pharmaceutical companies will not be keen because I only pay 2.3 Euros for two weeks supply of dried root. Hampshireoak ( talk) 08:43, 19 October 2010 (UTC)Hampshireoak 19th October 2010
I often see this phrase in WP articles and elsewhere, and change it wherever i find it. Maybe it's a stylistic difference of taste. Maybe i need to retune my ear, but to me it sounds wordy and unencyclopedic. Comments welcomed. Ragityman ( talk) 15:25, 15 December 2010 (UTC)
Seanwal111111 ( talk · contribs) removed the statement that smokers have a fourfold risk of lung cancer, citing doi:10.1136/ard.2008.096487 (Sugiyama et al) in his support. The problem is, Sugiyama is a pretty good WP:MEDRS on the subject, and it makes some very definite statements about smoking vs RA. I therefore thought it might be better to add some freely phrased information on the basis of this paper. Again, this was removed on the basis that I should have done a better job at representing the conclusions, but without an attempt to improve the content ( reaction on Seanwal's talkpage).
I think the conclusions of this paper should be represented in the article, as it gives a good idea about how smoking might adversely modify the risk of RA, and I am open to suggestions about how it should be phrased. JFW | T@lk 10:21, 11 March 2011 (UTC)
I see in the "Criteria" section you say that the new criteria is for diagnosing new onset RA, yet in the new Harrison (18) it specifically says that the new criteria is not for diagnosis and I quote "It is important to emphasize that the new 2010 ACR-EULAR criteria are "classification criteria" as opposed to "diagnostic criteria" and serve to distinguish patients at the onset of disease with a high likelihood of evolving into a chronic disease with persistent synovitis and joint damage."
Just thinking it would be wise to emphasize that here as well. Thank you — Preceding unsigned comment added by Avig70 ( talk • contribs) 18:55, 18 October 2011 (UTC)
The introduction seems to be a bit disorganized.
It looks like a laundry list of symptoms, in which somebody tried to work in as many technical concepts as possible -- as if they were preparing for an exam. The technical terms make it difficult for a non-specialist reader WP:NOTPAPER. I tried to improve that by adding the lay terms, but it's still difficult to read. It's still hard for me to read. It's more like a word puzzle than a clarifying explanation.
Another serious flaw is that it has no WP:RS. Basically this definition is somebody's WP:OR.
Last month's review article in the NEJM has what I consider a good introduction. In fact it has 2 good paragraphs both of which could be the basis of a good introduction:
and
NEJM, 8 Dec 2011, 365(23): 2205, Mechanisms of disease: The pathogenesis of rheumatoid arthritis, Ian B. Mcinnes and Georg Schett. http://www.nejm.org/doi/full/10.1056/NEJMra1004965
I think this introduces some important points: (1) RA is a systemic disease which most prominently affects the joints but also affects other systems, particularly the heart and lungs (2) RA is life-threatening, not just painful. (3) The progress of these life-threatening complications (and the pain) can be controlled by new drugs.
The main misconception I grew up with about RA is that it's a just a painful disease of the joints, like osteoarthritis. I think the introduction should make clear the important message that RA is not just a joint disease, it's an autoimmune disease. Also, it's not a bag of symptoms. There's an underlying autoimmune process, and each of those symptoms is the result of that process.
Wikipedia isn't a patient information handout; we're trying to help people understand the disease, whether they're patients or high school and college students who will later go on to study the disease. Wikipedia is also not a medical school exam preparation book. We don't have to start the introduction with a list of every symptom. How does it help the reader to understand RA to start out by knowing that it manifests in the sclera? How does it help the reader to understand RA if he or she first has to figure out a list of technical terms like "sclera" and "pericardium"?
Another issue is the new research into the molecular biology and immunology of RA, of which the NEJM article has quite a bit. I think that's more important than the details of diagnosis and pathology. -- Nbauman ( talk) 17:22, 2 January 2012 (UTC)
The following was added by Ilhamhafizovic ( talk · contribs) under "Future Treatments":
“ | As rheumatoid arthritis primarily attacks the synovial joints, future therapies may very well involve more targeted approaches through the use of nanoparticle drug delivery against the synovial fibroblasts. Hyperplasia in rheumatoid arthritis occurs primarily due to the cellular increase in numbers of the synovial fibroblasts. Although the reason is currently unknown, some research has indicated that an impaired apopotosis or senescence in these cells can explain the effect [2]. Recent research has shown that statins, competitive inhibitors of HMG-CoA reductase, utilized in lowering cholesterol may have anti-inflammatory effects that are beneficial to treating synovial fibroblast hyperplasia. Namely, these effects include suppressing pro-inflammatory cytokines and chemokines [3]. In 2006, various statin molecules were shown to decrease synovial fibroblast viability in a concentration and time dependent manner [4]. Simvastatin was shown to have a more pronounced effect on reducing viability in synovial fibroblasts than atorvastatin at concentrations greater than 3μM. However differences due to time were only observed after 72 hours of administration. The 2006 paper also showed that TNF-α stimulated fibroblast synovial cells, an important component of the pathogenesis of RA, showed a larger decrease in viability than unstimulated cells for both atorvastatin and simvastatin. Utilizing a TUNEL assay, the authors indicated that this reduced viability was primarily due to induction of apoptosis. In 2004 only atorvastatin was tested in a clinical trial with clinically significant but very modest outcomes in patients [5]. This may be due to an ineffective targeting of synovial fibroblasts, which could be overcome with future technology such as nanoparticle drug delivery. | ” |
The inherent problem with all those treatments is that even treatments from positive studies don't necessarily get adopted into clinical practice. This entire section is about statins, which are certainly not the only drugs under investigation. For sections of this kind, the medical WikiProject has set some pretty clear parameters. I would completely avoid citing individual studies, because they do not give a clear picture as to what we might expect in the next 10 years. Rather, I would want to base this section completely in treatments considered as thoroughly studied and likely to be adopted in secondary sources (reviews, textbook chapters). JFW | T@lk 06:24, 7 March 2012 (UTC)
i am not a doctor but there is academic paper about Flowers of Robinia pseudoacacia www.academicjournals.org/jmpr/PDF/pdf2012/30%20Apr/Ji%20et%20al.pdf predatory publisher it was written Chinese medicine is using that flowers for that disease. Maybe someone search — Preceding unsigned comment added by 176.30.26.195 ( talk) 07:06, 27 May 2012 (UTC)
Gramling, A (2012 May). "Initial management of rheumatoid arthritis". Rheumatic diseases clinics of North America. 38 (2): 311–25.
PMID
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Doc James (
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09:54, 9 October 2012 (UTC)
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Doc James (
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13:51, 24 March 2013 (UTC)Wikipedia is a great stating resource, that users can then branch out for further research based upon the information here. For rheumatoid arthritis, there have been double-blind, placebo controlled studies that suggest various "natural remedies" for inflammation, such as curcumin, boswellia, and collagen. What is wrong with indicating that this research is preliminary and the reader can do their own further research? Sthubbar ( talk) 13:08, 22 March 2013 (UTC)
Right now there are 7 secondary review references supporting the safety and efficacy of omega-3 in the treatment of RA. Instead of having a sentence for each reference, can we just consolidate to one or two sentences? I prefer strong language like "There is overwhelming evidence that omega-3 is effective and safe for the treatment of RA." or "Omega-3 is safe and effective for the treatment of RA". I would find it unfair to put any suspect words like "might" "could" or "promising". We already have 7 review articles. The evidence is overwhelming. Your idea? Sthubbar ( talk) 03:20, 25 March 2013 (UTC)
Should we be consistent and replace all instances of "rheumatoid arthritis" with RA, with the following exceptions: First instance remains defining the abbreviation, withing references will remain, hidden meta tags will remain, image titles will remain. Do you agree? Sthubbar ( talk) 03:46, 25 March 2013 (UTC)
Doc James, OK if there are many instances of inflammatory arthritis, what is the difference and shouldn't IA have it's own page instead of redirect to RA? This question was asked above and didn't get answered. I have noticed papers on PubMed that mention IA and I just assumed it was an alternate name for RA preferred in different cultures. Should we create a separate page for IA? — Preceding unsigned comment added by 111.193.223.228 ( talk) 12:25, 25 March 2013 (UTC) This was me Sthubbar ( talk) 12:28, 25 March 2013 (UTC)
I have been reviewing the Tourette syndrome and Asperger syndrome FA quality articles and a key difference I see between them and this article is that they don't have many subsection for the major table of content areas. They simply have a few paragraphs for each major TOC topic. I think to follow their lead we should try and remove the sub-headings from each of the major topics and turn it into prose. I'll see what I can do to help on that front. Sthubbar ( talk) 03:04, 26 March 2013 (UTC)
Due to the contradictory statements regarding patient percentaje and progression toward disability, I changed the opening statement about this subject( the opening section had different -much different- number than the number mentioned in the prognosis section); Not only it contradicted what was larter said on ths article but there was no -real- reference of it, because the appendix number only let to the John Hopkins Hospital Wikipedia page. It was not apropiate to put the first number about disability on the article opening section because this is a treatable disorder.—Preceding unsigned comment added by 206.248.106.166 ( talk • contribs) 20:12, 5 December 2007
Doc James, how can you and I work together to get this article to GA quality by March 5th? I can add reference for the DMARD and other areas. You are doing a good job with writing stuff in a medically accurate and quality way. You up for the challenge? Sthubbar ( talk) 12:30, 25 March 2013 (UTC)
Doc James, I propose we state right away that RA is an auto-immune disease like the first sentence in the background here. [6] I really like the first 3-4 sentences of that article. What do you think? Sthubbar ( talk) 08:23, 26 March 2013 (UTC)
I reverted the most recent change in the lead describing CAM for several reasons:
Yobol ( talk) 23:12, 3 May 2013 (UTC)
I agree with your general thrust about CAM, but it can be difficult to describe the failings of CAM in rigorous scientific terms. And we can't commit the same mistakes that CAM makes when we attack CAM.
It's true that if a treatment had good evidence to support it, it wouldn't be alternative medicine -- it would simply be medicine. OTOH, there are have been a (very) few CAM treatments that were finally supported by good evidence, so you can't rule them out. Artemisinin comes to mind. There aren't too many, but you don't want to miss something like artemisinin.
If we're going to write something attacking CAM, it has to strictly follow the scientific evidence and WP guidelines of WP:RS and WP:MEDMOS.
The original text said that the evidence for CAM is weak "and their use is not recommended," citing Efthimiou. I read the Efthimiou paper, and to my surprise, he didn't support that text; rather, he said what I put into the article, that the ACR recommends their careful use. If that differs from another ACR statement, I'd like to know the explanation.
I'm not sure what it means to say "their use is not recommended." I don't think it means anything. It's a passive voice, and it doesn't say who doesn't recommend their use. Besides, does it mean that "they" -- whoever "they" are -- recommend against their use, or that they simply have no recommendation?
The way you wrote the introduction, it says that "their use is not recommended." Who doesn't recommend their use? None of those 3 citations explicitly says that their use is not recommended. Efthimiou doesn't, Macfarlane doesn't, and even the NCCAM doesn't explicitly say that. Their statements are very qualified and guarded.
You can say that the ACR doesn't recommend it. You can't leave the implication that they recommend against it.
The politics of CAM are well known, which is why their statements are so qualified and guarded. But beyond that, there are many doctors, even academic doctors with any qualifications you can name, who not only accept CAM but use it themselves. And it is possible that some CAM treatments may be effective, but it just hasn't been proven yet.
When you write:
the word "sound" is a weasel word. What's "sound scientific evidence"? That phrase itself is not scientific terminology. "sound scientific evidence" is evidence a scientist agrees with. If he doesn't agree with it, he says it's not sound scientific evidence. I think it's a no true Scotsman fallacy. I'm not sure how much you know about medicine, but most medical practice isn't supported by Level 1 evidence. What's the evidence for corticosteroids in long-term treatment of back pain? What's the evidence for surgery in so many orthopedic conditions? What's the evidence for all that radiology?
Furthermore, I'm not sure what the ACR's policy on CAM is. According to their program book, the 2012 annual meeting had the following session. They seem to support tai chi and yoga:
ACR/ARHP Annual Meeting, 2012
ACR SESSIONS 2:30 - 4:00 PM Ballroom A Complementary and Alternative Medicine: Evidence-based Options for Arthritis Patients Moderator: Sharon L. Kolasinski, MD Upon completion of this session, participants should be able to: • contrast traditional physical therapy with alternative exercise options • evaluate the literature supporting the use of alternative therapies • appreciate the role of tai chi and yoga among exercise options for patients 2:30 PM Overview of Complementary and Alternative Medicine To be announced 3:00 PM Tai Chi for Arthritis Chenchen Wang, MD, MSc 3:30 PM Role of Yoga in the Management of Arthritis Susan J. Bartlett, PhD
I would say that the evidence for CAM, including herbal treatments, is weak and inconclusive. That's what we should say. Some doctors recommend against it, some recommend for it, some doctors are unable to make a recommendation. I've heard a lot of doctors say, "If it makes you feel better, and it doesn't cost too much, try it out." If you want to come up with a quote from Simon Singh or Quackwatch blasting CAM for arthritis, go ahead and include it. Some treatments are dangerous, and that should go in. But I don't think that a broad dismissal of all CAM, if you can find one by a reputable authority, represents the medical consensus. -- Nbauman ( talk) 04:33, 4 May 2013 (UTC)
This was added "NSAIDs have a risk of gastrointestinal side effects such as stomach ulcers, while COX-2 inhibitors do not have that risk" COX2 inhibitors still have GI side effects just less than NSAIDs. Thus removed. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 21:09, 16 June 2013 (UTC)
There is an image with caption: "Appearance of synovial fluid from a joint with inflammatory arthritis." The article would be improved if normal synovial fluid could be shown alongside. pgr94 ( talk) 15:17, 19 July 2013 (UTC)
The ACR is clearly biased with their statement "There are no herbal medicines whose health claims are supported by sound scientific evidence"
1) Why are two long quotes allowed? I have been told by Doc James to paraphrase and not to quote. Why this exception?
2) Herbal medicines do not make health claims.
3) Sound scientific evidence.
4) The real meaning of the sentence.
5) Contradicts itself.
This should be enough evidence to prove conclusively that their first statement is clearly false and this should be made clear. Sthubbar ( talk) 15:26, 22 July 2013 (UTC)
Yobol, fair enough. I have summarized the statement that exactly summarizes the conclusions of the ACR. Sthubbar ( talk) 16:03, 22 July 2013 (UTC)
Yobol, this is way too much quoting and over weight given to this one article. I'm not an expert with all the WP:Rulewhatever, I'm pretty sure the is a WP:don'tquote and WP:weight rule. Please summarize all 3 of them and remove direct quotes. I propose "The ACR states that herbal remedies contain active ingredients similar to conventional medicine, are not regulated as drugs by the FDA and that there is no sound scientific evidence to support the health claims." What rewording will you accept? Sthubbar ( talk) 16:27, 22 July 2013 (UTC)
Yobol, I do not agree to any of the edits you have made. Consensus on the talk page means we agree here how to edit the sentence. You are pushing your point of view and ignoring the complete content of the article and all of the statements made. Get a consensus here before further edits. I also suggest to revert to the original wording until there is consensus here on the talk page. Sthubbar ( talk) —Preceding undated comment added 16:57, 22 July 2013 (UTC) It's also convenient how you ignore the statement "Accupuncture is safe". If you put "Accupuncture is safe and it's affect may be the same as placebo" or just put the whole quote as you seem to be fond of quoting. Sthubbar ( talk) 17:00, 22 July 2013 (UTC)
Yobol, I have stated very clearly that I disagree with every edit you have made. Your putting 88 words for your one citation should allow me to add 88 words for each of the following 10 citations instead of the current 8.5 words per citation. Sound good to you? Sthubbar ( talk) 17:28, 22 July 2013 (UTC)
Why is this accepted as a reliable citation? It is written by a single doctor and reviewed by a "Communications and Marketing Committee". There are no citations that this document refers to that indicate it is a review article. Sthubbar ( talk) 17:25, 22 July 2013 (UTC)
This is an excellent source. I have paraphrased some of the comments in question. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 03:17, 23 July 2013 (UTC)
Here's a nice summary of the ACR 2013 session by a rheumatologist/blogger who was there.
http://www.ronankavanagh.ie/blog/cannabis-arthritis-whats-story/
Medical Marijuana and the Rheumatologist’ was presented by Dr. Jason McDougall and Dr. Mary Ann Fitzcharles at the American College of Rheumatology Annual Scientfic Meeting October 2013
This may be a WP:RS:
http://www.rheumatologyupdate.com.au/latest-news/time-to-get-serious-about-medical-marijuana
Bottom line: Many patients find it useful, and there's a plausible mechanism, but there are no rigorous studies to demonstrate efficacy, and there are poorly-characterized risks. -- Nbauman ( talk) 19:54, 7 November 2013 (UTC)
There are mistakes in the English here - too tired to look in detail - maybe tomorrow - but the English needs 'sharpening up' a bit to read well. — Preceding unsigned comment added by 87.206.188.230 ( talk) 21:33, 15 May 2014 (UTC)
Hi from a personal experience can I suggest that cachexia merits an entry under e.g. symptoms or effects? Cachexia seems to be a significant aspect that is sometimes ignored. Gildomingue ( talk) 15:27, 29 September 2014 (UTC) Gil Domingue. 29.09.2014
Does the following description merit being in the lead section of RA? "RA can also produce diffuse inflammation in the lungs, the membrane around the heart, the membranes of the lung (pleura), and whites of the eye, and also nodular lesions, most common in subcutaneous tissue. " ( Drsoumyadeepb ( talk) 13:50, 17 October 2014 (UTC))
Was wondering if History and Epidemiology should be placed right after the lead rather than almost at the end.( Drsoumyadeepb ( talk) 08:15, 19 October 2014 (UTC))
Substantial robust and replicable data on genetic basis of RA exists and genetic factors account for more than 50% of disease. Should be part of project.With GWAS data available we need to include genetic basis of complex diseases information too- might be as a pilot for the task force.
doi:10.1016/j.amjmed.2014.06.036 is a meta-analysis of 44 trials looking into safety and discontinuation of anti-TNF biologics. Etanercept seems safer that the rest. JFW | T@lk 09:07, 4 December 2014 (UTC)
This article does not currently mention the use of laser therapy for the symptomatic relief of rheumatoid arthritis. This modality has been covered by Cochrane reviews and deemed an acceptable form of short-term symptom control. [4] I don't think there is enough to warrant an entire section for laser, but I am unsure which existing section is an appropriate location for a mention. I thought to include it in the 'Alternative Medicine" section, but the section currently says that there are no RCTs available for Alternative Medicine treatments for RA. Since the cochrane review for laser therapy includes multiple RCTs, it seems that perhaps laser is not considered alternative medicine? I will leave it here, hopefully someone can find an appropriate way to include the info. — Preceding unsigned comment added by 70.65.253.158 ( talk) 18:39, 18 January 2015 (UTC)
There is clear data on multiple reviews as well as in text books that infectious agents do not have a role in the disease process. This has been mentioned in our Wikipedia article itself. Why have a section on Vaccinations which clearly does not have any role on the basis of just one narrative review. Has it come in any guidelines by notable health bodies ? ( Drsoumyadeepb ( talk) 17:57, 3 November 2014 (UTC)) Drawing attention of Doc James
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