Positive and negative predictive values from published studies can be misleading for decision-making in clinical practice.

Re: Surgery in rheumatoid arthritis SIR, I read with great interest the review on published studies of hand surgery in rheumatoid arthritis by Ghattas et al. [1], which gives the state of the art on the literature for this topic. In their key messages (p. 841), the authors state that medical therapy has reduced the need for surgery in rheumatoid arthritis. Unfortunately they do not provide any data or references which support this statement. Could the authors clarify this point, which might be responsible for misunderstandings between rheumatologists and orthopaedic surgeons. Surgery in rheumatoid arthritis: reply SIR, The correspondence by Dr Trieb raises the important issue of whether and to what extent medical therapy has reduced the need for surgery in rheumatoid arthritis (RA). Recently introduced drugs have effectively slowed down disease progression in RA patients, thus delaying the onset of disabilities and improving the overall quality of life [1, 2]. These improvements in medical treatment may explain, at least in part, the reduced need for surgery that has been reported in large cohorts of RA patients [3, 4]. It should be noted, however, that the indications for surgical treatment in the setting of RA remain uncertain and somewhat controversial [5]. It is hoped that further clinical investigation may soon provide a better assessment of the role of surgery in the clinical management of RA patients. Declining use of orthopedic surgery in patients with rheumatoid arthritis ? Results of a long-term , population-based assessment. management of the rheumatoid hand : consensus and controversy among rheumatologists and hand surgeons