Art I agree...this is what I was asking for when asking rheums to change their standards of practice - that may mean different types of changes for different rheums, but using practice metrics, using labs more wisely, Changing FUV intervals, changing the time needed to detect a meaningful response (eg, from 12 weeks ot 6 or 8 weeks?), etc. If the rheumatologist does not change and improve the standards then you keep getting more of what you got before and have NOT moved the needle on achieving excellence. Vince Lombardi said .. "there is no "perfection", but the quest for perfection is where we find excellence"!