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20 March 2007 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians. These highlights are not intended to substitute for articles as sources of information. For an embargoed copy of an article, call 1-800-523-1546, ext. 2653, or 215-351-2653.

Flexible Use of Drugs with Close Patient Follow-up Can Successfully Control Rheumatoid Arthritis

In the second year of a study of treatments for early rheumatoid arthritis, 508 patients were assigned to one of four treatment groups using standard arthritis drugs (Article, p. 406). The disease status of all groups was evaluated every three months and medications were adjusted according to a protocol. All groups improved and maintained improvement during the second year. The two groups that began with combinations of drugs improved the fastest and had less damage to the arthritic joints. An editorial writer says that the study shows that most patients with early rheumatoid arthritis will preserve a high quality of life if clinicians have the flexibility to change therapy, maintain close contact with patients, and adjust therapy in a timely fashion until patients have achieved low levels of disease activity or are in remission (Editorial, p. 459).

Osteoporosis Drug Strengthens Bones in Men with Prostate Cancer

A small trial of 112 men with prostate cancer who were receiving androgen deprivation therapy found that men assigned to take an oral dose of alendronate had less bone loss or bone turnover and increased bone mineral density of the spine and hip at the end of one year than men assigned to a placebo (Article, p. 416). Androgen deprivation therapy involves reducing hormones such as testosterone that encourage cancer growth. Alendronate, a bisphosphonate, is best known as an anti-osteoporosis drug. The groups did not differ significantly in adverse side effects. The study was not designed to show whether alendronate reduces fractures.

Experts Show Physicians How to Initiate and Carry Through Timely and Effective Discussions about Hospice with Dying Patients

Hospice, a variable set of services for dying patients and their families, is underused, in part because it is difficult for physicians and their patients to talk about dying (Academia and Clinic, p. 443). Two experts suggest language that physicians can use to define the patientís goals for care, identify care needs and introduce the concept of hospice.

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