UMMS Affiliation

Department of Medicine, Division of Preventive and Behavioral Medicine

Publication Date


Document Type



Antirheumatic Agents; Arthritis, Rheumatoid; Biological Markers; Cohort Studies; Endpoint Determination; Humans; Multicenter Studies as Topic; Patient Selection; Pharmacogenetics; Prospective Studies; Quality Assurance, Health Care; Registries; Research Design; Rheumatology; Tumor Necrosis Factor-alpha; United States


Biological Factors | Immune System Diseases | Musculoskeletal Diseases | Rheumatology


BACKGROUND: Comparative effectiveness research has recently attracted considerable attention. The Comparative Effectiveness Registry to study Therapies for Arthritis and Inflammatory Conditions (CERTAIN) is an ongoing prospective cohort study of adult patients with Rheumatoid Arthritis (RA).

METHODS/DESIGN: CERTAIN uses the existing Consortium of Rheumatology Researchers of North America (CORRONA) network of participating private and academic sites in order to recruit patients fulfilling the 1987 ACR criteria that have at least moderate disease activity. Patients starting or switching biologic agents either anti-TNF therapy or a non anti-TNF biologic are eligible for enrollment, depending on the treatment selected by their physician. Enrollment is expected to be completed by March of 2014, and 2711 patients will participate in the study. As of October 7th 2013, 2234 patients have been enrolled. Patient visits and laboratory blood work are mandated every three months for one year. Safety data is collected through one year and beyond. The primary comparative effectiveness endpoint is attainment of low RA disease activity at one year among patients who have been exposed to at least one prior TNF-alpha inhibitor agent prior to enrollment. Multiple secondary effectiveness and safety endpoints will be addressed by investigating the entire population enrolled (naive and biologic experienced).

DISCUSSION: The unique design features of CERTAIN will inform comparative effectiveness and safety questions for choosing biologic agents for the management of RA.

Rights and Permissions

© 2014 Pappas et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.

DOI of Published Version



BMC Musculoskelet Disord. 2014 Apr 1;15:113. doi: 10.1186/1471-2474-15-113. Link to article on publisher's site

Journal/Book/Conference Title

BMC musculoskeletal disorders

Related Resources

Link to Article in PubMed

PubMed ID