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Clinical trials form the cornerstone of evidence-based medicine. Despite their crucial importance, clinicians involved in trials research face major challenges. These are highlighted by Janet Pope and other Canadian experts in this issue of The Journal 1. The concerns they raise have a Canadian focus but an international relevance. Clinically effective treatments and care pathways rely on clinical trials2. Without trials, clinical practice is reduced to anecdotes and expert opinions. Trials are complex, meeting high standards is demanding, and successfully completing trials requires dedication and expertise. As a consequence, involvement of clinical academics is essential.Experience in England echoes Canadian perspectives. Changes in funding arrangements have made trials run by the pharmaceutical industry today unattractive for clinical academics compared to historical times. There has been an increase in investigator-led trials funded by governmental bodies such as the UK National Institute for Health Research and charities like Arthritis Research UK, but it is difficult to attract sufficient research funding to cover research costs from these sources alone.Therapeutic innovations driven by large, successful clinical trials have revolutionized rheumatology. One crucial development has been the introduction of biological treatments3. That success reflected positive interactions between the pharmaceutical industry and clinical researchers. Examples of other innovations in inflammatory arthritis include focusing on early treatment4 and combining disease-modifying drugs5. These latter advances reflect investigator-led research in areas of limited commercial interest. This brief list highlights what trials can achieve. It is not in any way comprehensive.While many innovations in disease management have emerged from recent rheumatology trials, important clinical problems remain to be solved. Here are 3 examples: (1) how to increase the numbers of patients with inflammatory arthritis achieving sustained remissions6; (2) how to make biological treatments more cost effective7 … Address correspondence to Professor D.L. Scott, Weston Education Centre, King’s College London, 10 Cutcombe Road, London SE5 9RS, UK. E-mail: d.scott1{at}nhs.net

Delivering Future Clinical Trials in Rheumatology