Academic Unit of Musculoskeletal Disease, Department of Rheumatology, Leeds, UK
Correspondence to: P. Emery, Academic Unit of Musculoskeletal Disease, Department of Rheumatology, 1st Floor, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK. E-mail: p.emery{at}leeds.ac.uk
We thank Dr Smith for his interest in our study. We were surprised to learn that the Australian government restricts anti-TNF- therapies to patients who are seropositive for rheumatoid factor (RF). Although RF has been associated with the severity of erosions [1] and increased disability [2], a significant amount of disease activity and disability is still present in those patients without RF. Indeed, a study which matched seropositive and seronegative patients for disease duration and age found no significant differences between the two groups [3]. Nearly one-third of the 308 patients with severe refractory RA referred to our biological assessment clinic described in the paper were RF-negative [4]. Both RF-positive and -negative patients had severe active disease with a high level of disability (Table 1). Although the mean Health Assessment Questionnaire (HAQ) score and disease activity score (DAS28) were significantly lower in the RF-negative group, the mean DAS28 in both groups was well above the level required to prescribe biologicals in the UK (DAS28
5.1).
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In this large cohort of patients, erosion scores were not routinely measured. However, virtually all patients were erosive, making statistical analysis of the influence of the presence of erosions on receiving biological therapy irrelevant.
We feel that the presence of RF should not influence which patients should receive biologicals.
P.E. has acted as a consultant for Aventis and Pharmacia. The other authors have declared no conflicts of interest.
References