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Thrombotic thrombocytopenic purpura in systemic lupus erythematosus: a frequent and severe consequence of active disease

2006; Oxford University Press; Volume: 45; Issue: 9 Linguagem: Inglês

10.1093/rheumatology/kel224

1462-0332

Vikas Majithia, Valee Harisdangkul,

Platelet Disorders and Treatments

An error in the revised anti-TNF therapy guidelines for adult RA SIR, It has been brought to our attention that there is an error in the inefficacy criteria for anti-tumour necrosis factor (TNF) in rheumatoid arthritis (RA) [1].The criteria state that a patient should have a DAS28 score that improves by >1.2 at 3 months, or that reduces to 3.2.Clearly, the first criterion renders the second redundant, because if a patient starts at >5.1 (as they should) then a drop of 1.2 would lead to a DAS score of 3.9.This unfortunately perpetuates the same error that appeared in the original BSR guidelines [2].This is a misinterpretation and oversimplification of the EULAR response criteria [3].We have recently begun the task of updating the BSR guidelines for anti-TNF in RA.Whether we will continue to advocate eligibility and response criteria on the basis of DAS28s is up for debate, as we have discussed in an editorial [4].Recent evidence suggests that the Disease Activity Score (DAS) shows poor concordance with the physician's assessment, with the recommendation being that it should not be used as a sole determinant of RA activity [5].Other work advises that the DAS is improved by swopping the patient global assessment to a physician global assessment and the ESR for the CRP for assessing disease improvement [6].In the meantime, we advise colleagues to ignore the 3.2 figure and focus on the drop in DAS of >1.2 until further notice.We apologize for this error.