Good medicine

摘要

In "Bad medicine: rheumatoid arthritis" Spence combines unsupported assertions with misleading interpretations of publications about the disease. We agree thatthe severity of rheumatoid arthritis is declining. Strong evidence shows that this reflects better medical management, including early intensive treatment, and improved healthcare organisation. We disagree, however, with many other points. The diagnosis of rheumatoid arthritis is not "increasingly subjective." The objective finding of joint swelling on examination is the key component of all classification criteria; ultrasound imaging provides confirmatory evidence.