TY - JOUR T1 - Law of the Vital Few: Choosing Variables of Disease Activity in Rheumatoid Arthritis JF - The Journal of Rheumatology JO - J Rheumatol SP - 2097 LP - 2098 DO - 10.3899/jrheum.141038 VL - 41 IS - 11 AU - BIANCA DUMITRU AU - MAYA BUCH AU - EDWARD M. VITAL Y1 - 2014/11/01 UR - http://www.jrheum.org/content/41/11/2097.abstract N2 - The Italian economist Vilfredo Pareto noticed that 20% of the pea pods in his garden contained 80% of the peas. His “Law of the Vital Few”1 seems to describe a wide variety of situations where 80% of the observed effect can be explained by 20% of the causes. The treatment of rheumatoid arthritis (RA) was revolutionized in the 1980s and 1990s by a small number of simple but powerful advances. Robust trials demonstrated the value of cheap, readily available drugs such as methotrexate. Simple clinical outcome measures such as the Disease Activity Score (DAS) were validated. Because our goals have since evolved to focus on smaller numbers of patients with resistant disease or poor prognosis or to personalize therapy, more complex and expensive techniques and interventions seem to be required to achieve better outcomes.The longterm goal of therapy in RA is the preservation of function and prevention of joint damage. Treat-to-target trials such as TICORA demonstrate that both doctors and patients underestimate how much therapy is needed to achieve this2. Not surprisingly, perhaps, more therapy leads to less inflammation and better short-term and longterm outcomes. Current “best practice” in early RA is based on the use of composite scores such as the DAS or its 28-joint version (DAS28) to direct escalation of therapy … Address correspondence to Dr. E.M. Vital, Chapel Allerton Hospital, Leeds LS7 4SA, UK; E-mail: e.m.j.vital{at}leeds.ac.uk ER -