Talk:Rheumatoid arthritis/Archive 3

NEJM 2011
I was looking for a recent review article, but this was the most recent one I could find. It's still pretty good, and it would fill in a lot of the gaps in this entry: Review Article: Mechanisms of Disease The Pathogenesis of Rheumatoid Arthritis Iain B. McInnes, F.R.C.P., Ph.D., and Georg Schett, M.D. N Engl J Med 2011; 365:2205-2219 December 8, 2011 DOI: 10.1056/NEJMra1004965 --Nbauman (talk) 06:48, 12 July 2015 (UTC)

Serious infections (DMARDs and biologicals)
Systematic review and meta-analysis 10.1016/S0140-6736(14)61704-9 JFW &#124; T@lk  14:50, 17 July 2015 (UTC)

Recent discussion of treatment choices and when to use biologics
Biologics or Conventional Drugs for Managing RA? discussed recent study results and reviews on costs of using biologics earlier vs later. - Rod57 (talk) 14:24, 28 January 2016 (UTC)

No mention of triple therapy
Triple Therapy Underused in RA: Why? says "the combination of methotrexate, sulfasalazine, and hydroxychloroquine is similar in efficacy to biologic therapy and is less costly," and rarely used despite the evidence. - Rod57 (talk) 02:08, 25 February 2016 (UTC)

Lancet seminar
10.1016/S0140-6736(16)30173-8 JFW &#124; T@lk  08:30, 2 September 2016 (UTC)

Lancet 2016
Rheumatoid arthritis.

Smolen JS, Aletaha D, McInnes IB.

Lancet. 2016 May 3. pii: S0140-6736(16)30173-8.

doi: 10.1016/S0140-6736(16)30173-8. [Epub ahead of print] Review.

--Nbauman (talk) 22:22, 4 June 2016 (UTC)


 * Link in the next section (didn't see this post!) JFW &#124; T@lk  08:31, 2 September 2016 (UTC)

Frontiers in Immunology
I have moved here this paragraph, supported by an article from Frontiers in Immunology:

Content read: One theory is that infections may provoke the autoimmune response characteristic of rheumatoid arthritis. One example of this theory is that unique bacterial species associated with periodontitis may initiate an autoimmune response in genetically susceptible individuals by citrullinating self-proteins, thus leading to the production of ACPAs. A meta-analysis published in 2016 found an association between periodontal disease and RA].

It has been suggested that Frontiers journals are not WP:MEDRS. Opinions?

Best regards.

--BallenaBlanca   (Talk)  23:09, 22 January 2017 (UTC)
 * Yep not the best journals. I was one the who said  - not suggested - that Frontiers is not great (I did not say it is not MEDRS), in response to edits made by the OP on some other article,  and I was the one who cited that journal  here.  So there is a bit of POINTY-ness to this posting in my view.  I cited Frontiers here because there was yet another tendentious editor who was insisting on fleshing this content out based on primary sources and this is the best review I could find.  I do not give a rat's ass if this content stays or goes and other people can fight this out.  It is research so is not very important.  Jytdog (talk) 23:47, 22 January 2017 (UTC)
 * Agree that it is not generally the best journal. If the claim is not extraordinary and there is nothing better than I do not see a huge issue with using it. Stating an association exists is not a huge claim. Doc James  (talk · contribs · email) 02:21, 23 January 2017 (UTC)
 * Viral infections and gut bacteria translocation and triggering other autoimmune disorders is a largely accepted scientific theory. I think the small piece of text should be retained in the article. The source is a systematic review and meta-analysis, the only dispute being the journal not being as top notch as others; I feel the source is of an acceptable standard. Sourcing standards (in my personal view) do not need to be applied strictly for content that is non-controversial if WP:WEIGHT and WP:NPOV are closely followed.-- Literaturegeek |  T@1k?  03:53, 23 January 2017 (UTC)
 * mm based on my reading of the literature, few details about gut bacteria and disease are "accepted knowledge" at this point; there is a broad agreement that gut bacteria are important and need to be studied more. Of course people that sell probiotic supplements or yoghurt would have people believe the science is far more advanced than it is, but that is par for the course in that world. Jytdog (talk) 05:43, 23 January 2017 (UTC)


 * , sorry, I do not know what you mean with this: "I was one the who said - not suggested - that Frontiers is not great (I did not say it is not MEDRS), in response to edits made by the OP on some other article, and I was the one who cited that journal here. So there is a bit of POINTY-ness to this posting in my view."
 * I was referring to this edit by, who added the ref  and this comment from other talk page.
 * Well, there is no problem accepting the reference. But we have to adjust to the content: "The studies included in our analysis were not investigating cause and effect but rather establishing the point prevalence of periodontitis and RA. Further longitudinal trials are required to establish the temporal nature of this association. (...) Conclusion: We present a systematic review and meta-analysis of the relationship between periodontitis and RA, which demonstrates a significant association between RA and periodontitis. Further studies are required in future to elucidate the mechanism of this association."
 * I adjusted . Toughts?
 * Best regards. --BallenaBlanca [[Image:BallenaBlanca.jpg|25px]] [[Image:Mars symbol (bold blue).svg|12px]] (Talk)  17:55, 23 January 2017 (UTC)
 * Self-reverted I had not seen the other references. Best regards. --BallenaBlanca [[Image:BallenaBlanca.jpg|25px]] [[Image:Mars symbol (bold blue).svg|12px]]  (Talk)  18:15, 23 January 2017 (UTC)

Additions
User:Drsoumyadeepb. Here and here, the following were added:


 * In 2017, a subset of pathologically expanded 'T peripheral helper' cells has been found to drive B cell mediated action in synovium of seropositive RA cells.


 * However the dominant TNF theory is being challenged by newer studies which show that a combined synovial IL-21 and TNF production mechanism induces bone and cartilage destruction in RA matrix metalloproteinase production by fibroblast-like synoviocytes.


 * A clinical trial published in 2017 found that Sirukumab, a human monoclonal antibody that selectively binds to the interleukin-6 cytokine improves signs and symptoms and was well tolerated in patients with active rheumatoid arthritis who did not respond to anti-TNF drugs or other biological agents.

Additionally, the following:


 * More than 75% of women with rheumatoid arthritis have symptoms improve during pregnancy but might have symptoms worsen after delivery. Methotrexate and leflunomide are teratogenic (harmful to foetus) and not used in pregnancy. It is recommended women of childbearing age should use contraceptives to avoid pregnancy and to discontinue its use if pregnancy is planned. Low dose of prednisolone, hydroxychloroquine and sulfasalazine are considered safe in pregnant persons with rheumatoid arthritis.

Was replaced with: Patients with RA do not have decreased fertility. Women of childbearing age having RA are recommended to use contraceptives to avoid pregnancy and to discontinue its use if pregnancy is planned. There is no evidence on increase in maternal and fetal deaths which can be attributed to RA .<ref name="ReferenceA"/

In more than 75% of women with rheumatoid arthritis symptoms improve during pregnancy and do not require any drugs but the symptoms might worsen after delivery. Methotrexate and leflunomide are teratogenic (harmful to foetus) and not used in pregnancy.Low dose of prednisolone, hydroxychloroquine and sulfasalazine are considered safe in pregnant persons with rheumatoid arthritis.Biologics should be stopped as soon as pregnancy is discovered.


 * Ref 1 is, a primary source
 * Ref 2 is, a primary source
 * Ref 3 is, a primary source
 * Ref 4 is is a "research highlight"; this is not a reliable secondary source per MEDRS
 * Refs 5, 6, and 7 were already in the article and are fine
 * Ref 8 is, which is indeed a review but an 11 year old one, which fails WP:MEDDATE; also per its website the journal is published by Medip Academy which is a predatory publisher. This source is not OK.    We also don't write "patients", we write "people", per MEDMOS.

None of this is OK. Jytdog (talk) 17:34, 15 March 2017 (UTC)
 * User:Drsoumyadeepb you have reverted without an edit note, and without commenting here. Jytdog (talk) 17:56, 15 March 2017 (UTC)

You have also reverted without discussion.Editing wikipedia has become so much difficult because of editors who threaten without discussion and when the same is done to them they coerce citing rules. . I quit Wikipedia. Thanks Drsoumyadeepb (talk) 18:00, 15 March 2017 (UTC)
 * See above, which I posted before I removed this batch of content the 2nd time. Editing Wikipedia has become more difficult, but that is because articles are reaching decent quality and we have good strong guidelines and policies in place to keep them that way and make them even better.   It is hard to improve articles.  But why quit?  Why not learn to edit per WP:MEDRS and WP:MEDMOS instead? Jytdog (talk) 18:05, 15 March 2017 (UTC)
 * User:Drsoumyadeepb this is a major medical condition. There are lots and lots of excellent sources. We as medical experts should be using them as we are best positioned to know what they are and how to find them. Doc James  (talk · contribs · email) 00:18, 16 March 2017 (UTC)
 * I am sorry to see frustrated, but I think I recognize the pattern from my own experience; this is an academic writing style is somewhat out of place on WP. Because citation of high-quality primary sources is routine (expected!) in scientific publication, it can be hard for an academic to adapt to WP:MEDRS, WP:MEDMOS, and other WP standards. That said, these are WP standards for good reason (and there are processes for appeal if one wants to try that route). I hope that, after a pause, you will return to contribute further. &mdash; soupvector (talk) 03:07, 16 March 2017 (UTC)

Dear Jytdog, soupvector, Doc James I see that Wikipedia has successfully converted it into a rule-book throwing organisation without application of any common sense and etiquette. Rules exist to facilitate and not hinder and is not superseded by common-sense : 1. If a new patho-physiological mechanism is discovered which challenges previous dogma, do we wait for a decade till a review article comes up. (I hope everyone knows the pace at which science moves from bench to text book and then to implementation). This is what happened for the new "combined synovial IL-21 and TNF production mechanism ".. I have clearly stated that this is an emerging theory and readers would be smart enough to understand that. 2. I have edited the RA article extensively, including information almost all the secondary sources in this article which Jytdog is throwing at me now. I know the wiki rules well. I edit the article based on information needs of patients and so it is important to address information on - What is the evidence on this new drug Sirukumab (in this case only a single trial is available and systematic reviews are not likely to be available for next few years)? If I have RA does my fertility decrease ?If i get pregnant does it increase the risk of maternal death or foetal death ? Do I stop or not stopping drugs I am taking, how does it affect my symptom ? For pregnancy, a good editor would use his sense and either try to find better sources to refine the article.( Doc James mentions apparently there are plenty !). Instead Wikipedia editors, revert edits(without discussion) and then "troll" other editors by posting weird notices declaring war on the talk page. I can clearly see a pattern and the motivation, is to increase edit counts without actually contributing to better quality information being available. Editors with high edit counts, treat wikipedia as their personal fiefdom, reverting and threatening others at their free will without any consequences .Why threaten banning  ? Do I have to throw a rule book to stop online trolling ?By the way there is one which defines trolling as "nonconstructive edits to Wikipedia with the intent of provoking an angry reaction in other userss )" https://en.wikipedia.org/wiki/Wikipedia:Vandals_versus_Trolls#Trolls . So i am taking the advice "don't feed the trolls" and quitting wikipedia.  Drsoumyadeepb (talk) 05:57, 16 March 2017 (UTC)
 * I suppose if you are unable to conform to community norms when editing you may not be happy here, but that would be a shame. -Roxy the dog. bark 07:51, 16 March 2017 (UTC)
 * We may wait a couple of months for it to be covered in a review article. This is how we prevent stuff like the liberation procedure from misleading people, we wait for evidence of wider acceptance by the scientific community.
 * Here is a review on sirukumab  Doc James  (talk · contribs · email) 14:19, 16 March 2017 (UTC)

Infectious cause.. maybe
User:Autoimmunity rev, about this and this -- there was already content in the Research section about this. And even the Smolen ref makes it clear that the association is suggested, not confirmed. It still belongs in research. I added the quote from Smolen and have moved the content to the Research section and blended it with what was already there, in these diffs. Jytdog (talk) 00:18, 5 April 2017 (UTC)

reversal "we do not empty sections"
This reversal of a Good faith edit with the rather pompous pluralis maiestatis editsummary "we do not empty sections" makes no sense to me. I am restoring it. --Wuerzele (talk) 14:52, 19 July 2017 (UTC)

Edits
There are issues with these edits

Doc James (talk · contribs · email) 17:20, 19 July 2017 (UTC)
 * Onset is usually middle age per
 * The prevalence of 0.5 to 1% is NOT from 2016 per
 * Not sure why definition was removed from ?
 * This text "such as cigarette smoking and silica exposure influence manifestation of the disease." is not supported by the associated reference
 * Methotrexate is also often given by injection.
 * Not seeing were the cost of biologics is brought up in the source
 * Per WP:MEDMOS we use "Signs and symptoms" rather than "Symptoms and signs"
 * No idea why the map of deaths per million was moved to the section on vaccination

Omega-3 - newer references
I am not editing the article on this aspect because I have a COI (consultant to clients that sell fish oil dietary supplements) but want to offer for consideration meta-analyses that are more recent than what is currently cited in the article (Ruggiero 2009 and Miles 2012). David notMD (talk) 15:19, 27 October 2017 (UTC)


 * Senftleber NK, Nielsen SM, Andersen JR, Bliddal H, Tarp S, Lauritzen L, Furst DE, Suarez-Almazor ME, Lyddiatt A, Christensen R. Marine Oil Supplements for Arthritis Pain: A Systematic Review and Meta-Analysis of Randomized Trials. Nutrients. 2017 Jan 6;9(1). pii: E42. doi: 10.3390/nu9010042. Review. ;.


 * Jiang J, Li K, Wang F, Yang B, Fu Y, Zheng J, Li D. Effect of Marine-Derived n-3 Polyunsaturated Fatty Acids on Major Eicosanoids: A Systematic Review and Meta-Analysis from 18 Randomized Controlled Trials. PLoS One. 2016 Jan 25;11(1):e0147351. doi: 10.1371/journal.pone.0147351. eCollection 2016. Review. ;.


 * Di Giuseppe D, Crippa A, Orsini N, Wolk A. Fish consumption and risk of rheumatoid arthritis: a dose-response meta-analysis. Arthritis Res Ther. 2014 Sep 30;16(5):446. doi: 10.1186/s13075-014-0446-8. ;.


 * Lee YH, Bae SC, Song GG. Omega-3 polyunsaturated fatty acids and the treatment of rheumatoid arthritis: a meta-analysis. Arch Med Res. 2012 Jul;43(5):356-62. doi: 10.1016/j.arcmed.2012.06.011. Epub 2012 Jul 24..


 * What would you like to propose as a summary? Doc James  (talk · contribs · email) 20:40, 27 October 2017 (UTC)


 * I did not look at the lit on gamma-linolenic acid, so would leave that with the existing ref. For omega-3, remove the two existing refs and add the four I listed above. The end result is that the updated evidence for omega-3 is a bit weaker than previously stated. Proposed text and refs to replace what is there now. David notMD (talk) 13:18, 28 October 2017 (UTC)


 * Fatty acids: Gamma-linolenic acid, an omega-6 fatty acid, may reduce pain, tender joint count and stiffness, is generally safe. For omega-3 polyunsaturated fatty acids (found in fish oil), a meta-analysis on pain reported a favorable effect, although confidence in the effect was considered moderate. The same review reported less inflammation but no difference in joint function. A review examined the effect of marine oil omega-3 fatty acids on pro-inflammatory eicosanoid concentrations; leukotriene4 (LTB4) was lowered in people with rheumatoid arthritis but not in those with non-autoimmune chronic diseases. (LTB4) increases vascular permeabiltity and stimulates other inflammatory substances. A third meta-analysis looked at fish consumption. The result was a weak, non-statistically significant inverse association between fish consumption and RA. A fourth review limited inclusion to trials that had consumption ≥2.7 g/day and duration greater than three months. Use of pain relief medication was significantly decreased, but improvements in tender or swollen joints, morning stiffness and physical function were not significant. Collectively, the current evidence is not strong enough to determine that supplementation with omega-3 fatty acids or regular consumption of fish are effective treatments for rheumatoid arthritis.


 * Simplified a few things Doc James  (talk · contribs · email) 20:19, 28 October 2017 (UTC)
 * All good with me. I went ahead with this. David notMD (talk) 18:27, 30 October 2017 (UTC)

Research section
Removed vague preliminary content and sources below per WP:PRIMARY and WP:CRYSTAL. "theory" and "is thought" reflect conjecture = unencyclopedic content. --Zefr (talk) 14:03, 1 October 2017 (UTC)
 * There was an open discussion immediately above about EGCG content. Your multiples removals, in cabal with Jytdog, without any community discussion, even when active talk sections have been created, is completely inappropriate behaviour.  Your citing "CRYSTAL", without any explanation why is unconstructive. 120.17.210.246 (talk) 15:16, 1 October 2017 (UTC)
 * You tell users like User:Cathry to use Talk (which she already does), while you continually don't show that courtesy to anyone else.
 * You cite WP:BRD, while you're intentionally initiating edit waring and clearly provocative behaviour at every opportunity. Deny others the "cycle" that BRD requires and use BRD as excuse and front to regularly trash page content en-mass. Then have the audacity to report Cathry for what YOU have been starting, onto an Admins page? Appalling. 120.17.210.246 (talk) 15:36, 1 October 2017 (UTC)

One theory is that infections may provoke the autoimmune response characteristic of rheumatoid arthritis. One example of this theory is that unique bacterial species associated with periodontitis may initiate an autoimmune response in genetically susceptible individuals by citrullinating self-proteins, thus leading to the production of ACPAs. PMID 25534621 PMID 22274780 Porphyromonas gingivalis expresses a bacterial PAD that is thought to citrullinate alpha-enolase. PMID 20820197 The bacterial virulence factor leukotoxin A from Aggregatibacter actinomycetemcomitans was shown to induce hypercitrullination in neutrophils, and exposure to leukotoxin A is associated with ACPA and mediates the genetic risk conferred by HLA-DRB1 shared epitope alleles. PMID 28292977
 * It is not reason to delete info. There are plenty articles about theories themself at Wikipedia. If causes of illness not installed - theory is all you can know about it. Your deletion is against consensus, you mast revert it. Cathry (talk) 14:52, 1 October 2017 (UTC)
 * The removed content is just guessing; please read WP:CRYSTAL. --Zefr (talk) 14:57, 1 October 2017 (UTC)
 * WP:CRYSTAL is not relevant here at all. Cathry (talk) 15:00, 1 October 2017 (UTC)
 * I agree with Cathry, the edit should be reverted. EGCG and RA links have been investigated and proven for nearly two decades. Please cease bulk disruptive editing. 120.17.210.246 (talk) 15:24, 1 October 2017 (UTC)
 * The edit was fine. Jytdog (talk) 15:27, 1 October 2017 (UTC)
 * Calling something conjecture because it used the word "theory" and therefore irrelevant to Wikipedia, is just ridiculous (especially a research section). Gravity and evolution are 'just theory', but do you propose to delete those too? Your 'edit' also deleted other content on EGCG and you (Jytdog/Zefr, which I assume to be the same user), still haven't answered. There is no WP:CRYSTAL regarding the EGCG research. It's confirmed by multiple reviews and investigators. The very definition of research includes building theorems and theories. 120.18.15.25 (talk) 11:33, 5 October 2017 (UTC)
 * I am familiar with all of those references. The first (Ahmed 2010) states: "The efficacy of EGCG or GTE in human RA or OA using the phase-controlled trials is yet to be tested." Wu (2012) likewise "Data for human studies are essentially absent." Reigsecker's 2013 review describes no clinical trials. Granja's 2017 article cited only in vitro literature. A search at clinicaltrial.gov found no clinical trials in progress. Until there are multiple clinical trials published in peer-reviewed journals, properly reviewed as a published article, it is premature to incorporate the EGCG research into this article. David notMD (talk) 13:27, 27 October 2017 (UTC)
 * Thread continued from dupe in above. 120.21.5.180 (talk) 13:57, 2 November 2017 (UTC)

EGCG vs GTE
Per my undo (of the deletion), the reviews provided specifically refer to EGCG (not just Green Tea Extracts) and even name it as such in their titles. Here's another separate review on EGCG for RA again that can be added too:. I'm fine for the text to be modified to "Green tea extract and EGCG" if preferred, since EGCG is one of the components of green tea extracts. There's no point in just deleting it, since there's a vast number of studies and reviews all showing the same thing. Just update the wording if it's so concerning. The vast majority of other non-EGCG specific studies of GTEs contain EGCG as well anyway, having most of the same effect (although higher EGC to EGCG ratios result in a bit lower EGCG absorption/bioavailability). Anyway, here's also example of long-term (10 year), repeatedly NIH-funded research programs, where the grants started off on green tea polyphenols and then moved to EGCG specifically for some years (searched by one of the principle investigators in the field as example). If the U.S. NIH alone has spent at least 10 years renewing funding to RA research programs (apart from all the international work), then it's notable enough for an "RA Research" section:. 14.200.91.233 (talk) 09:58, 1 October 2017 (UTC)
 * Update: I updated the wording to read "green tea extracts and [..]". 14.200.91.233 (talk) 10:02, 1 October 2017 (UTC)
 * It's been deleted as WP:Crystal, without any explanation of how, even after this Talk section was set up. Please follow WP process and discuss changes before arbitrary opinion edits, especially when a Talk section has explicitly been created. Calling it WP:Crystal is non-sense. There's >17 years of research into EGCG and RA with extensive positive research findings. The results are highly relevant both to understanding of RA processes and identification of treatments. Note, the Zefr and Jytdog cabal have been working in tag-team on the EGCG page too, so no surprise they're burying content as a pack here also. I know the golden age of Encyclopedia Britannica was a few decades ago, but really WP can still creep a little bit into the current century. 120.17.210.246 (talk) 14:02, 1 October 2017 (UTC)
 * Still waiting on an answer User:Jytdog who deleted and User:Zefr who redeleted. Again, please stop ignoring Talk sections (this Talk existed before your tagteam redeleted it Zefr). Also, stop claiming that they're created against other users (e.g. Cathry), when you know that it regarded your own deletions without explanations. 120.17.83.90 (talk) 03:41, 4 October 2017 (UTC)

I'm re-adding this as after several days, nobody has substantiated their claims, or made any argument here for why it shouldn't be in Wikipedia. −	Multiple reviews of green tea extract and epigallocatechin gallate pre-clinical and animal studies have concluded that it has promising potential for inflammation and rheumatoid arthritis treatment , with one noting the lack of human clinical studies "despite promising pre-clinical findings and the thorough mechanistic insights", as "surprising". 120.17.218.156 (talk) 21:11, 4 October 2017 (UTC)
 * Posting this here and in the next section, too. I am familiar with all of those references. The first (Ahmed 2010) states: "The efficacy of EGCG or GTE in human RA or OA using the phase-controlled trials is yet to be tested." Wu (2012) likewise "Data for human studies are essentially absent." Reigsecker's 2013 review describes no clinical trials. Granja's 2017 article cited only in vitro literature. A search at clinicaltrial.gov found no clinical trials in progress. Until there are multiple clinical trials published in peer-reviewed journals, properly reviewed as a published article, it is premature to incorporate the EGCG research into this article. David notMD (talk) 13:27, 27 October 2017 (UTC)
 * Granja's 2017 review, cited literature that included in vivo results including "a rat model of adjuvant-induced arthritis (AIA)" (Singh et.al. 2016), not just in vitro. Granja's review states: "For this reason, new therapies are needed and EGCG may be a promising compound. In fact, EGCG has a high antioxidant activity and also capacity to decrease the inflammation response in the body [116–118]". Results of one cited paper: "Administration of EGCG (50 mg/kg/day) for 10 days ameliorated AIA in rats by reducing TAK1 phosphorylation and K48-linked polyubiquitination", conclusion "findings provide a rationale for targeting TAK1 for the treatment of RA with EGCG.". 120.21.5.180 (talk) 13:46, 2 November 2017 (UTC)
 * Morinobu et.al., Lee et.al. and several other studies cited in Granja's review show the same EGCG effectiveness in animal models of RA. There's far more than just in vitro theory. 120.21.5.180 (talk) 13:54, 2 November 2017 (UTC)
 * If there where multiple human clinical trials, it'd just be "Treatment" and specific health claims made, not noted under "Research". Clinical trials aren't necessary to say it's being investigated by an NIH funded program and other teams. 120.17.72.185 (talk) 14:41, 2 November 2017 (UTC)


 * Research is a continuous process, often grounded on in vitro and epidemiology, progressing to animal models, then if a drug, Phases I, II, III, then FDA review and approval. In the U.S., dietary supplement ingredients do not require FDA approval, and are often brought to market based on one, two or multiple clinical trials. Often industry funded rather than government grants (U.S. NIH or other). Wikipedia has its own criteria for inclusion in Research - ideally more than one clinical trial, consistent results, and at least one review that can be used as a citation. Your position is that if there is any research (those references), then it is appropriate to describe the work under "Research." This does not jibe with Wikipedia's definition of "Research." Basically, TOO SOON. See the content on fatty acids for an example of sufficient research, and even there, the reviews concluded that the evidence is not sufficiently consistent to recommend as a treatment. David notMD (talk) 15:28, 2 November 2017 (UTC)
 * The research cited is not industry funded, so not sure why that's raised in this context. One of the leading teams has in fact been funded repeatedly by U.S. NIH for 10+ years, specifically on GTE, then EGCG for RA. Could you please reference the requirement for (multiple) human clinical trials as prerequisite for inclusion with a Research section. Note, it's not a medical claim and WP:MEDRS has different applications in different contexts. You say 'ideally', but it's also not a requirement if that prevents improving Wikipedia, using otherwise reasonably verifiable information. The primary concern, should be whether there's likelihood for misstatements causing serious detrimental risk to readers. Which should be balanced against positive risk, that it may (and in this case is likely to) have positive outcomes, both due to efficacy in animal models and established safety profile. Importantly, the level of research is made entirely clear to readers, where they can ask their own GP and rheumatologist about it. As for my own (a top professor teaching rheumatology at the largest medical school in my country), he was very comfortable with me increasing green tea and fish oil consumption and giving a hydroxychloroquine prescription, for use in case symptoms persisted. They didn't. Anecdata isn't evidence, but the treatment plan was reasonable when patient informed and was based on available evidence and relative risk analysis (against alternative options). 120.17.50.29 (talk) 04:24, 10 November 2017 (UTC)

Lifestyle changes as treatment or Research
Perhaps add to Research rather than Lifestyle, given modest nature of the evidence for fasting and vegetarian diet. The existing citations in Lifestyle are all Cochrane Reviews. David notMD (talk) 22:55, 4 November 2017 (UTC)
 * This is common recommendations so IMO it is fine were it is.
 * Research is more for stuff that is being studied but not really done yet. Doc James  (talk · contribs · email) 07:53, 10 November 2017 (UTC)

Beef and milk bacteria a cause of RA?
http://www.dailymail.co.uk/health/article-5337265/Drinking-milk-eating-beef-cause-arthritis.html Someone knowledgeable should look up the original study and see if it is worth adding to this Wiki article. Phantom in ca (talk) 05:18, 1 February 2018 (UTC)
 * The study itself is a primary source, not WP:MEDRS. The Daily Mail is good for the nail on the outhouse door. -Roxy, Zalophus californianus. barcus 05:22, 1 February 2018 (UTC)

Removal of top image
I removed the top image, which showed an advanced case of RA in an elderly patient who did not have access to the medications we have today. It is no longer reflective of the disease and its progression and its placement on this page means it's one of the first images that pops up when you search for RA on the internet. I can tell you from personal experience that's a very upsetting thing to see, so why subject people to it when there are more representative images to use? — Preceding unsigned comment added by Thisnotnpov (talk • contribs)


 * You have a point, but the image can be highly illustrative. I agree that severe deformity is now unusual apart from in those who somehow do not receive timely treatment. Nevertheless, for most of history this was the ultimate fate of someone with RA. Medical textbooks contain similar images. If anything needs improving it is the caption under the image - this should emphasise that severe deformity is now the exception rather than the rule. JFW &#124; T@lk  21:58, 23 May 2019 (UTC)
 * Lots of older people still look like this. But sure. Doc James  (talk · contribs · email) 08:28, 24 May 2019 (UTC)
 * So keep the image in the entry, but not make it the top image? Why make the worst case scenario of a disease the illustration of it? — Preceding unsigned comment added by Thisnotnpov (talk • contribs) 23:16, 30 May 2019 (UTC)
 * This image does not show the condition. It is just a drawing and IMO is not as good.
 * People who do not have access to modern treatments still end up with significant deformity. We do not want people believing that RA is not serious. Doc James  (talk · contribs · email) 11:03, 3 June 2019 (UTC)
 * Disagree. The drawing shows how the disease works, whereas the photo shows its effects on one person who is not reflective of all sufferers of the disease. The photo is still in the article, it's just not being used as the image that represents the disease. Please stop reversing my edits because you want to catastrophize an illness. — Preceding unsigned comment added by Thisnotnpov (talk • contribs) 21:01, 3 June 2019 (UTC)
 * It is a serious condition. There is no rule that says the lead picture must represent all forms of the disease. For young people, who can afford proper treatment, yes the disease is not as severe any more. This is not the global or historical reality. We are not just writing for young wealthy people. Doc James  (talk · contribs · email) 03:06, 5 June 2019 (UTC)
 * This has nothing to do with "young wealthy people." This is about showing the most representative image of the disease. Showing the mechanisms of it is obviously much more informative as to what it is and does than a deformed hand. Your comments indicate that you do not know much about the reality of the disease beyond one potential outcome that you insist on presenting for shock value. Please stop changing the header image away from an informative diagram of how the disease works. Again, the hand photo is still in the article for you to gawk at; just not at the very top. — Preceding unsigned comment added by Thisnotnpov (talk • contribs) 20:18, 12 June 2019 (UTC)

Foundations 2 group 4B goals
Hello my group and I are hoping to edit other signs and symptoms to include those found in different body systems that increase with the the development of RA

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 * Part 2
 * The points included are verifiable with cited secondary sources. Risk of cancer was supported by data pooled from 74 randomized control trials and environmental risk factors were supported by population-based case control study.

YooCo (talk) 16:32, 6 August 2019 (UTC)

I just want to say that the opening section of this page reads like it was written 50 years ago. Splints, Braces, Painkillers as first line treatments? No diagnostic tests? Who wrote this? As someone who has RA this sort of nonsense is just frustrating. Especially when it comes to having new treatments funded (where I live), since everyone thinks it's "no big deal" or "everyone has it". Anti-CCP is a pretty good diagnostic blood test and first line treatment is csDMARDS, sometimes even biologics, not paracetamol and splints. Can someone who knows something please, please re-write it? Thanks.