Has the Mathematization of Rheumatoid Arthritis Gone Too Far?

Mathematical Metrics

The paper written by Daniel Aletaha and Josef Smolen, “Remission in Rheumatoid Arthritis: Missing Objectives by Using Inadequate DAS28 Targets,” provides encouragement to rheumatologists who have maintained the Aristotelian ideal of advancing science through a metaphysic reasoning not dissociated from real life.¹¹

The staging of RA proposed by Otto Steinbrocker et al., and later refined with a scoring model by Desiree van der Heijde et al. and Robert Pinals et al., was fundamental because it created mathematical metrics and standardized clinical research, enabling advances in discovery and development of new treatments.^5,7,8

However, the scientific process demands physicians use their expertise to phenotype and individualize the management of our patients instead of mathematizing them. Unfortunately, the misuse of evidence-based medicine created a pseudo-science of statistics that has infected many medical specialties, including rheumatology. The deification of science has allowed many popes to pursue the idea of scientists as heralds of absolute truth, converting them to clergy of scientism.

Limits of Classification

Therapeutic and remission criteria are constantly being refined in the pursuit of a utopian perfection. Although such criteria as DAS28 and others may be useful to aid research, they may do more harm than good if misused in clinical practice, move the focus from patients to numbers.

We hope rheumatologists never lose the essence of what made most of us choose this specialty: the need to listen to, talk with and examine our patients. Thus, we believe that sharing experiences still is an excellent way of advancing knowledge, not just relying on statistics and numbers. We hope that, as physicians, we shall avoid the mathematization of the bedside medical practice. May math be our crutch, but never our feet.

Carlos Antonio Moura, MD, is a rheumatologist and staff of the internal medicine residency program at Hospital Santo Antônio and Hospital Geral Roberto Santos, in Salvador, Bahia, Brazil. He also teaches at Salvador University and Escola Bahiana de Medicina e Saúde Pública.

Ana Luísa Cerqueira, MD, is a resident in internal medicine at Hospital Santo Antônio, Salvador, Bahia, Brazil.

Carlos Geraldo Moura, MD, is a rheumatologist and chief of the internal medicine residency program at Hospital Santo Antônio in Salvador, Bahia, Brazil, and teaches at Escola Bahiana de Medicina e Saúde Pública.

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