Evaluation of two interventions to reduce the ancillary costs of outpatient care for rheumatoid arthritis

Katz, Jeffrey N.; Wright, Elizabeth A.; Lynch, K; Weinblatt, Michael E.

doi:10.1002/art.1780390127

Cited by 3 publications

(1 citation statement)

References 9 publications

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“…In other disciplines, efforts to reduce costs of tests by modifying test‐ordering behavior have already been made (35). At times when vigorous attempts are made to contain health care costs (16, 36), the potential for savings may be particularly important. For some drugs or certain side effects such recommendations are already available (7, 14, 37), but they have been mostly derived by consensus of expert opinions (17) rather than by evidence.…”

Section: Discussionmentioning

confidence: 99%

Laboratory testing in rheumatoid arthritis patients taking disease‐modifying antirheumatic drugs: Clinical evaluation and cost analysis

Aletaha¹,

Smolen²

2002

Arthritis & Rheumatism

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Objective. To develop and validate evidence-based recommendations for routine laboratory tests in patients with rheumatoid arthritis (RA) receiving traditional disease-modifying antirheumatic drugs (DMARDs), and to calculate the monitoring costs. Methods. Outpatient charts of 362 RA patients taking DMARDs were reviewed, and all laboratory abnormalities recorded. Recommendations on monitoring DMARD therapy were derived and then tested in an independent validation cohort of 231 patients. Cost analysis was performed using a cost catalog. Results. Laboratory abnormalities were seen in 10% of treatment courses; relevant abnormalities were seen only during the first 4 months of therapy. Laboratory tests should be performed in week 2 and 4, then monthly for the first 4 months of therapy, then 2 to 4 times per year. These were capable of detecting 98.3% of laboratory abnormalities in a timely manner in another RA cohort. Up to 78% of costs can be saved when the presented recommendations are compared with those of international rheumatology societies. Conclusion. Laboratory tests can be reduced substantially in patients receiving DMARD therapy. In consequence, costs can decrease significantly without oversight of adverse events.

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Section: Discussionmentioning

confidence: 99%

Laboratory testing in rheumatoid arthritis patients taking disease‐modifying antirheumatic drugs: Clinical evaluation and cost analysis

Aletaha¹,

Smolen²

2002

Arthritis & Rheumatism

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Methotrexate Hepatotoxicity

West¹

1997

Rheumatic Disease Clinics of North America

120

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Hepatoxicity is a major adverse reaction that can occur during methotrexate treatment of the rheumatic diseases. The pathologic lesions are nonspecific and the pathogenesis is poorly understood. Early studies in psoriasis clearly established a relationship between hepatic injury and several risk factors, particularly alcohol use. Methotrexate hepatoxicity occurs less frequently in rheumatoid arthritis than previously reported in psoriasis patients. Consequently, the American College of Rheumatology guidelines for methotrexate monitoring do not recommend baseline and surveillance liver biopsies in low-risk patients. These guidelines seem to be useful and cost-effective.

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Antigenic triggers and molecular targets for anti-double-stranded DNA antibodies

Deocharan¹,

Qing

Beger

et al. 2002

Lupus

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While anti-double-stranded (ds)DNA antibodies are a characteristic serologic hallmark for SLE, the triggering antigen is unknown. Using phage display libraries, we identified DWEYSVWLSN as a peptide mimic of DNA for a pathogenic anti-dsDNA antibody. Peptide immunization of non-autoimmune mice induced anti-dsDNA as well as other lupus-associated antibodies. Molecular analysis of the induced anti-dsDNA antibodies revealed several similarities with anti-dsDNA antibodies that appear spontaneously in lupus mice. Furthermore, lupus-prone mice immunized with this peptide DNA mimic had higher autoantibody titers as well as more severe nephritis. Anti-DNA antibodies may contribute to lupus nephritis via cross-reactivity with renal antigen. Using western blotting of lysates of mesangial cells from a lupus mouse, we found that a pathogenic anti-DNA antibody binds to alpha-actinin. High titers of anti-alpha-actinin antibodies were present in the sera and kidney eluates of lupus mice with active disease. Binding to alpha-actinin was diminished in mesangial cells derived from BALB/c mice, suggesting that target antigen expression may play a role in determining autoantibody binding to the kidney. We conclude that a pathogenic, lupus-like autoantibody response can be induced by a peptide antigen, and that alpha-actinin is a cross-reactive renal target for the pathogenic anti-dsDNA autoantibody response in lupus mice.

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Evaluation of two interventions to reduce the ancillary costs of outpatient care for rheumatoid arthritis

Cited by 3 publications

References 9 publications

Laboratory testing in rheumatoid arthritis patients taking disease‐modifying antirheumatic drugs: Clinical evaluation and cost analysis

Laboratory testing in rheumatoid arthritis patients taking disease‐modifying antirheumatic drugs: Clinical evaluation and cost analysis

Methotrexate Hepatotoxicity

Antigenic triggers and molecular targets for anti-double-stranded DNA antibodies

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