Abatacept or tocilizumab after rituximab in rheumatoid arthritis? An exploratory study suggests non-response to rituximab is associated with persistently high IL-6 and better clinical response to IL-6 blocking therapy.

Objectives: To evaluate the efficacy and safety of two different targeted approaches-abatacept or tocilizumab-after rituximab therapy in rheumatoid arthritis, and to explain observed difference in efficacy using blood and synovial studies of interleukin 6 (IL-6) and B cells in patients receiving rituximab therapy.

Methods: Consecutive series of patients who had discontinued rituximab therapy owing to inefficacy or toxicity were treated with abatacept (n=16) or tocilizumab (n=35). Clinical response and reasons for discontinuation were evaluated.

Therapy of patients with rheumatoid arthritis: outcome of infliximab failures switched to etanercept.

Objective: The role of alternative tumor necrosis factor (TNF) antagonist therapies in the context of failure of initial TNF antagonist therapy in patients with rheumatoid arthritis (RA) has yet to be clearly defined. The goal of this study was to determine the efficacy of etanercept in patients who failed to respond to infliximab.

Methods: Ninety-five patients with RA who failed to respond to infliximab and methotrexate were treated with etanercept (with continuation of concomitant methotrexate).

Influences that drive clinical decision making among junior rheumatology nurses: a qualitative study.

This paper presents a qualitative study exploring the influences that drive clinical decision making among a small group of junior rheumatology nurses.A qualitative, descriptive design was chosen. Semi-structured interviews were used with a purposive sample of six junior staff nurses from two inpatient rheumatology wards in a large teaching hospital in the North of England.

Influences that drive clinical decision-making among rheumatology nurses. Part 1: literature review.

Decisions nurses make while providing patient care to their client group will impact on the patient's immediate and long-term outcomes and will also impact on service provision. Although many studies have focused on the clinical decision-making process itself within general nursing areas, little has been published as to what factors influence decisions in rheumatology nursing at the clinical level. Initial review of the literature suggested the following themes could influence decision-making: clinical decision-making, intuition, evidence-based practice, experiential learning, knowing the patient, skilled knowledge and rheumatology nursing.

C-reactive protein as a predictor of infliximab treatment outcome in patients with rheumatoid arthritis: defining subtypes of nonresponse and subsequent response to etanercept.

Objective: Nonresponse to anti-tumor necrosis factor alpha in patients with rheumatoid arthritis (RA) is poorly understood. The aims of this study were to define nonresponse patterns using infliximab and C-reactive protein (CRP) profiles, to assess the predictive power of a CRP response for outcome, and to correlate these findings with subsequent response to etanercept.

Methods: We studied 207 patients with resistant RA who were started on treatment with infliximab.