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They are winning in part because Davis has made a series of smart signings by bringing in veterans like quarterback Rich Gannon and Jerry Rice, the former San Francisco wide receiver, and Gruden has blended the veteran roster into a sharp unit.
By 6 months 72% of patients on combination therapy had ACR-20 responses compared with 49% of patients on monotherapy, and median X-ray damage had increased by 1 Sharp unit with combined therapy and by 4 Sharp units with monotherapy.
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There were only very modest radiological deteriorations in these two treatment groups of 1.0 Sharp units and 1.6 Sharp units, respectively (the Sharp scale measures bony erosion and joint space narrowing, and the scale ranges from 0 to 398).
To visualise the adjusted relationship between the HAQ score and the Sharp score, Sharp scores were divided into six categories of 10 Sharp units each and estimated marginal means were calculated.
At year 2, patients receiving combination therapy continued to have significantly less radiographic progression (mean change 1.9 Sharp units) compared with those treated with either adalimumab (5.5 units) or MTX (10.4 units) monotherapy (P <0.001 for both comparisons).
After 2 years of treatment, patients receiving combination therapy continued to have significantly less radiographic progression (mean change, 1.9 Sharp units) compared with those receiving either adalimumab monotherapy (5.5 units) or MTX monotherapy (10.4 units) (P <0.001 for both comparisons).
Figure 2 shows estimated marginal means of the fitted model (mean HAQ scores adjusted for age, sex, DAS, treatment and time) for each category of 10 Sharp units and clearly points to an increasing trend.
A separate analysis, in which the Sharp score was replaced by the change in Sharp score, also indicated that the change in Sharp score (interval progression; Sharp units per year) was significantly and independently associated with the HAQ score (p = 0.001; table 2).
Patients receiving combination therapy demonstrated a mean increase in total Sharp score of 1.3 Sharp units, compared with 3.0 units in those receiving adalimumab monotherapy (P = 0.002) and 5.7 units in those receiving MTX mono-therapy (P <0.001) at 1 year.
The rationale for this particular cutoff was that the progression of radiographic joint damage by 20 Sharp units corresponds to an irreversible deterioration in physical function as defined by the HAQ disability index of 0.2, approximately the minimum clinically important difference for this outcome [ 26].
George Manahan, City Opera's music director, led a performance of self-effacing excellence; the orchestra is a much sharper unit than it was a decade ago.
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