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May 2023, Volume 73, Issue 5

Letter to the Editor

Comment on Muhammad Bilal, et al. (J Pak Med Assoc. 72, No-5: 839- 842, 2022) Efficacy of rituximab in patients with rheumatoid arthritis

Nevin Adel Amer  ( Nursing Department, College of Applied Medical Sciences, Jouf University, KSA. )
Amera Bekhatroh Rashed  ( Nursing Department, College of Applied Medical Sciences, Jouf University, KSA. )

Madam, we have read the article, "Efficacy of rituximab in patients with rheumatoid arthritis" (JPMA, Vol 72, No-5, May 2022) with support and agreement on the authors view that internationally much work has been done to explore the treatment modalities with minimum adverse effects among rheumatoid arthritis patients. However, there are some equivocal points that require the attention and are hereby enlisted: The title section the study setting isn’t presented, introduction section couldn't give a full idea about the gap of knowledge the current study tried to cover moreover the significance of the study wasn’t stated clearly. Regarding research hypothesis or research question, none was formulated however they ensure the entire research methodologies are scientific and valid moreover; helps to describe research study in concrete terms rather than theoretical terms.

In relation to study design, the specific type of research design used to conduct this study wasn’t specified in addition the authors did not provide neither a rationale for selecting the study setting nor setting selection procedure, which may affect the generalizability of the results. Appropriate research setting selection and accurate description is critical since the results might been affected heavily by the study setting.

Piloting the data collection instruments was not done despite pilot study is a crucial element of a good study design and it would be important to test the clarity, applicability and time needed for filling in the instruments.

The data collection instruments weren’t tested for both validity and reliability. The validity testing of a data collection instruments is the degree to which it measures what it claims to measure. Reliability refers to the consistency of a measure in other words; whether the results can be reproduced under the same conditions.

Nothing mentioned regarding the way of meeting participants or how the participants’ responses to study instruments taken neither at the baseline nor at the follow up visit.

It would be better to advice patients to return for two follow up visits one after 12 weeks and one after 24 weeks instead of one follow up after 24 weeks, which would help in ensuring association between study variables.

In the results section no data presented to assess side effects patient might complain from rituximab used while the authors mentioned in the introduction section, “internationally much work has been done to explore the treatment modalities with minimum AEs among RA patients”. While it is appositive point for the authors to mention this as a limitation of the study

In the conclusion section, the authors recommended that glucocorticoid premedication does seem to reduce or prevent infusion reaction despite no data was collected or presented in the results section to indicate assessment of the infusion reaction.




1.      Polit, D.F. and Beck, C.T. (2017) Nursing Research: Generating and Assessing Evidence for Nursing Practice. 10th Edition, Wolters Kluwer Health, Philadelphia, 784 p.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: