Objectives
To systematically review the efficacy and safety of certolizumab pegol (CZP) plus methotrexate (MTX) for active rheumatoid arthritis.
Methods
The Cochrane Library, PubMed, EMbase, CBM, CNKI, VIP and WanFang Data were searched to collect randomized controlled trials (RCTs) on CZP plus MTX vs. MTX plus placebo for active rheumatoid arthritis from inception to May, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, data were analyzed by using Stata 11.0 software.
Results
Seven RCTs were included. The results of meta-analysis showed the CZP plus MTX group was superior to MTX plus placebo group in ACR20 (CZP400 mg: RR=2.86, 95%CI 1.70 to 4.79, P<0.001; CZP200 mg: RR=3.76, 95%CI 2.59, 5.46, P<0.001), ACR50 (CZP400 mg: RR=3.91, 95%CI 2.10 to 7.27, P<0.001; CZP200 mg: RR=4.86, 95%CI 3.20 to 7.39, P<0.001), and ACR70 (CZP400 mg: RR=5.65, 95%CI 1.99 to 16.06, P=0.001; CZP200 mg: RR=10.08, 95%CI 5.11 to 19.89, P<0.001). The CZP plus MTX group was also superior to MTX plus placebo group in swollen joint counts (SMD=–12.72, 95%CI –15.39 to –10.06,P<0.001), tender joint counts (SMD=–11.54, 95%CI –13.97 to –9.11,P<0.001), doctor's global assessment of disease activity (SMD=–11.78, 95%CI –13.81 to –9.75,P<0.001), patient's global assessment of disease activity (SMD=–9.62, 95%CI –11.09 to –8.15,P<0.001), and patient's assessment of pain (SMD=–9.10, 95%CI –10.91 to –7.30,P<0.001) and HAQ (SMD=–7.74, 95%CI –8.99, –6.49,P<0.001), respectively. However, the incidence of adverse events in CZP plus MTX group was higher than that in MTX plus placebo group.
Conclusions
CZP plus MTX is superior to MTX plus placebo for treatment of active rheumatoid arthritis but with higher adverse events. Due to limited quantity and quality of the included studies, the above conclusions are still needed to be verified by more high-quality studies.
Rheumatoid arthritis (RA) is one of the most common chronic inflammatory diseases. It mainly involves joints, as well as extra-articular organs. The extra-articular manifestations (EAM) are more common in patients with severe active disease, and the mortality of RA patients with EAM is 2.5 times of RA patients without EAM. Renal damage is rare in EAM, which mainly includes renal damage associated with RA itself, renal amyloidosis, and drug-induced secondary renal damage. In recent years, researches on RA renal damage have gradually increased, and mainly focused on therapy and prognosis. The recent research progress of RA renal damage are summarized in this review.
ObjectiveTo discuss the changes of joint fluid and blood-related indexes in patients with gouty arthritis and rheumatoid arthritis, and to analyze the clinical significance of these changes.
MethodsSeventy-five patients with gouty arthritis and 68 with rheumatoid arthritis treated between January and December 2014 were included in our study. Their joint fluid-related indicators including white blood cell count (WBC), total protein (TP), albumin (ALB), glucose (GLU), and uric acid (UA), and their blood indicators including immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin A (IgA), C3 and C4, rheumatoid factor (RF), anti-streptolysin O (ASO), and c-reactive protein (CRP) were detected.
ResultsFor joint fluid-related indicators, TP and ALB levels were not significantly different between the two groups (P > 0.05), while WBC, GLU, UA, RF and ASO between the two groups were significantly different (P < 0.05); For blood indexes, C4 was not significantly different between the two groups (P > 0.05), but IgG, IgM, IgA, CRP, C3, UA, RF and ASO were significantly different between the two groups (P < 0.05). The detection rate of ASO from the joint fluid was significantly higher than that detected from the blood in both the two groups (P < 0.05), while UA level was not significantly different between the joint fluid and the blood (P > 0.05). In patients with rheumatoid arthritis, RF detection rate was not significantly different between the joint fluid and the blood (P > 0.05), but it was significantly different for patients with gouty arthritis (P < 0.05). The positive rate of ASO in the blood and joint fluid of patients with gouty arthritis was respectively 38.7% and 44.0%, and it was 75.0% and 73.5% for patients with rheumatoid arthritis. UA positive rate in the blood and joint fluid of patients with gouty arthritis was 92.0% and 80.0% respectively, while it was 38.2% and 32.4% for patients with rheumatoid arthritis. RF positive rate was 33.3% and 40.0% in the blood and joint fluid of patients with gouty arthritis, while the rate was 86.8% and 91.2% for patients with rheumatoid arthritis.
ConclusionThe joint fluid and blood indicators are in change in patients with gouty arthritis and rheumatoid arthritis, which has a certain clinical value in disease diagnosis and curative effect observation.
【摘要】隨著超聲心動圖的普及與發展,無癥狀性類風濕性關節炎心臟瓣膜改變的檢出率逐漸增多。臨床應重視類風濕性關節炎心臟瓣膜損害以及超聲心動圖在這類疾病中的診斷價值,以期改善患者預后。【Abstract】 Objective More and more cardiac valve changes are detected in asymptomatic patients with rheumatoid arthritis by echocardiography. It is essential to pay attention to the clinical features of heart valves damage and the diagnostic value of echocardiography on that in order to improve the prognosis of patients.
ObjectivesTo review the pharmacoeconomic evaluation of rheumatoid arthritis patients with an inadequate efficacy or intolerance with conventional synthetic disease modifying antirheumatic drugs (csDMARDs).MethodsCNKI, WanFang Data, VIP, PubMed, EMbase, Web of Science and The Cochrane Library were electronically searched to collect pharmacoeconomic studies about rheumatoid arthritis patients with an inadequate efficacy or intolerance with csDMARDs from inception to February 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of the included studies, then, descriptive analysis was performed.ResultsA total of 16 studies were included, where most compared the economics of different treatment methods from the perspective of the payer by cohort or individual model. The economic costs in the studies were primarily on direct cost. Sensitivity analyses were used to prove the robustness of the main analysis in each study. Biological disease-modifying antirheumatic drugs (bDMARDs) might be more cost-effective than csDMARDs. In addition, compared with the bDMARDs, new-marketed targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs) might be more cost-effective.ConclusionsIt could be considered to implement more new marketed tsDMARDs to improve patients’ condition to reduce the economic burden and optimize the allocation of health care resources.
Objective To study the risk factors of developing progressive pulmonary fibrosis (PPF) within one year in patients diagnosed with rheumatoid arthritis-associated interstitial lung disease (RA-ILD), and develop a nomogram. Methods A retrospective study was conducted in 145 cases of RA-ILD patients diagnosed and followed up in the Affiliated Hospital of Qingdao University from January 2010 to October 2022. Among them, 106 patients and 39 patients were randomly assigned to a training group and a verification group. The independent predictors of PPF in patients with RA-ILD within one year were determined by univariate and multivariate logistic regression analysis. Then a nomogram is established through these independent predictive variables. Calibration curve, Hosmer-Lemeshow test, receiver operating characteristic (ROC) curve and area under ROC curve (AUC) and clinical decision curve were used to evaluate the predictive efficiency of the nomogram model for PPF in RA-ILD patients within one year. Finally, internal validation was used to test the stability of the model. Results Of the 145 patients with RA-ILD, 62 (42.76%) developed PPF within one year, including 40 (37.7%) in the training group and 22 (56.41%) in the verification group. The PPF patients had higher proportion of subpleural abnormalities, higher visual score of fibrosis and shorter duration of RA. Logistic regression analysis showed that the duration of rheumatoid arthritis (RA), visual score of fibrosis and subpleural abnormality were independent risk factors for the occurrence of PPF within one year after diagnosis of RA-ILD. A nomogram was constructed based on these independent risk factors. The AUC values of the training group and the verification group were 0.798 (95%CI 0.713 - 0.882) and 0.822 (95%CI 0.678 - 0.967) respectively, indicating that the model had a good ability to distinguish. The clinical decision curve showed that the clinical benefit of PPF risk prediction model was greater when the risk threshold was between 0.06 and 0.71. Conclusion According to the duration of RA, the visual score of fibrosis and the presence of subpleural abnormalities, the predictive model of PPF was drawn to provide reference for the clinical prediction of PPF in patients with RA-ILD within one year after diagnosis.
ObjectiveTo evaluate the application and effectiveness of bilateral total hip arthroplasty and total knee arthroplasty in the treatment of severe inflammatory arthropathies.
MethodsBetween September 2008 and September 2015, 31 patients with severe inflammatory arthropathies were treated with bilateral total hip arthroplasty and total knee arthroplasty. Of 31 cases, 22 were male and 9 were female with an average age of 30 years (range, 20 to 41 years); there were 15 cases of rheumatoid arthritis and 16 cases of ankylosing spondylitis with an average onset age of 14 years (range, 5-28 years); all 4 ankylosed joints were observed in 11 cases, 3 ankylosed joints in 2 cases, 2 ankylosed joints in 6 cases, 1 ankylosed joint in 1 case, and no ankylosed joint in 11 cases. Before operation, the hip range of motion (ROM) value was (17.82±28.18)°, and the knee ROM value score was (26.45±30.18)°; the hip Harris score was 29.64±11.58, and the hospital for special surgery (HSS) score was 27.07±11.04. The patients were grouped and compared in accordance with etiology and ankylosed joint.
ResultsOne-stage arthroplasty was performed in 1 case, two-stage arthroplasty in 22 cases, three-stage arthroplasty in 7 cases, and four-stage arthroplasty in 1 case. The total operation time was 325-776 minutes; the total blood loss was 900-3 900 mL; the total transfusion volume was 2 220-8 070 mL; and the total hospitalization time was 21-65 days. The patients were followed up 12-94 months (mean, 51 months). The hip and knee ROM values, Harris score and HSS score at last follow-up were significantly improved when compared with preoperative ones (P < 0.05). The subjective satisfaction degree was good in 16 cases, moderate in 10 cases, and poor in 5 cases. Periprosthetic infection occurred in 2 cases (3 knees), joint stiffness in 3 cases (6 knees), joint instability in 1 case (1 knee), leg length discrepancy of > 2 cm in 2 cases, and flexion deformity of 10° in 1 case (1 knee). The hip and knee ROM values, Harris score and HSS score showed no significant difference between patients with ankylosing spondylitis and patients rheumatoid arthritis at last follow-up (P > 0.05). The hip and knee ROM values of the patients with ankylosed joint were significantly lower than those of patients with no ankylosed joint (P < 0.05); the Harris score and HSS score of the patients with ankylosed joint were lower than those of patients with no ankylosed joint, but no significant difference was found (P > 0.05).
ConclusionA combination of bilateral hip and knee arthroplasty is an efficient treatment for severe lower extremities deformity, arthralgia and poor quality of life caused by inflammatory arthropathies. However, the postoperative periprosthetic infection and stiffness of knee are important complications influencing the effectiveness of operation.
Objective To assess effectiveness and safety in rheumatoid arthritis （RA）patients treated with the indigenous leflunomide in comparison with Airohua produced by Cinkate Corp. Methods A double blind and double dummy randomized controlled trial was conducted in the outpatient clinic of rheumatology. Fifty-six Chinese RA patients were divided into two groups who received either indigenous Leflunomide or Airohua of 20 mg daily and the two matching placebo tablets of Airohua or indigenous Leflunomide with the constant dose of Oxaprozin （0.4 g, qd） in the first 6 weeks. Clinical and laboratory data were collected every 6 weeks during 24 weeks of follow-up. Results This study showed that the patients of both groups significantly improved on main variables except erythrocyte sedimentation rate （EXR） at the 12th week . The variables such as ESR, and the level of c-reaction protein in both groups at 24th week showed no statistical difference compared with those at the baseline. There were also no statistical difference in the clinical characteristics and laboratory findings between the two groups at the 12th week and 24th week （P 〉0. 05）. The effcacy of Airohua（37% ） was lower than that of indigenous Leflunomide（64% ） at the 12th week （P 〈0. 05 ） and slightly better than indigenous Leflunomide group at the 24 week （81.5% vs 77.3% , （ P 〉0. 05）. The administration of Airohua and indigenous leflunomide presented a similar pattern and frequency of adverse events. Serious adverse events such as interstitial pneumonitis, pulmonary infiltration, and liver impairment etc. were not reported in either group. Conclusions The study shows that the indigenous Leflunomide has a superior therapeutic effect. Its efficacy and safety are similar to Airohua in the treatment of acfive RA patients in China.
Objective To evaluate the quality of diagnostic studies on detecting anti-cyclic citrullonated peptide antibody to diagnose rheumatoid arthritis. Methods We searched PubMed, EMbase, The Cochrane Library, and CBM to collect studies on using anti-cyclic citrullonated peptide antibody to diagnose rheumatoid arthritis. QUADAS items were used to evaluate the quality of included studies. Results A total of 195 studies were included. Sixty-nine were English studies and 126 were Chinese studies. All studies had good descriptions of the spectrum of patients and little potential for partial verification bias, differential verification bias, and incorporation bias. However, most studies were prone to disease progression bias, review bias, and clinical review bias. One study did not explain the intermediate test results, and another did not report part of the test results. The overall quality of English studies was better than that of Chinese studies. Conclusion The potential bias of the included studies mainly resulted from the absence of blinding when interpreting the test results. The reporting quality of the included studies was poor.
Objective To evaluate the efficacy and safety of Celecoxib and Naproxen for treating osteoarthritis or rheumatoid arthritis.Methods Such databases as EMbase, PubMed, The Cochrane Library, Chinese Biomedical Literature Database (CBM), China Journal Full-text Database (CJFD), and Chinese Scientific Journal Full-text Database (CSJD) were searched to collect the randomized controlled trials (RCTs) of Celecoxib and Naproxen for treating osteoarthritis or rheumatoid arthritis. Two reviewers independently assessed the quality of the included studies and extracted the data. The Review Manager (version 5.0) software was used to analyze the data. Results Four RCTs involving 2 931 patients were included. The results of meta-analyses were as follows: a) There were significant differences in the dose of Celecoxib and Naproxen for treating rheumatoid arthritis or osteoarthritis; b) There was no significant difference in gastrointestinal reaction between the Celecoxib group and the placebo group (RR=1.29, 95%CI 0.93 to 1.79); c) The were significant differences in gastrointestinal reaction between the Celecoxib group and the Naproxen group (RR=0.78, 95%CI 0.64 to 0.95); d) There were significant differences in inducing the severity of Stomach and Duodenum Endoscopy Score between the Celecoxib group and the Naproxen group when treating rheumatoid arthritis or osteoarthritis (RR=1.29, 95%CI 0.93 to 1.79). As the Intention-To-Treat (ITT) analysis showed, there were significant differences in inducing the severity of gastrointestinal reaction between the Celecoxib group and the Naproxen group when treating rheumatoid arthritis or osteoarthritis (RR=0.84, 95%CI 0.77 to 0.92). Conclusion Compared with Naproxen, there are significant differences in efficacy for treating rheumatoid arthritis and osteoarthritis with Celecoxib in different doses. The Celecoxib has no significant difference in gastrointestinal reaction compared with the placebo group. The Celecoxib group has fewer gastrointestinal side-effects as compared with the Naproxen group, so it can be used to treat rheumatoid arthritis and osteoarthritis in clinic. The results still need to be confirmed by high-quality RCTs.
