Non-pharmacological and pharmacological interventions in patients with early arthritis: a systematic literature review informing the 2016 update of EULAR recommendations for the management of early arthritis

Abstract

ObjectiveTo perform a systematic literature review (SLR) on pharmacological and non-pharmacological treatments, in order to inform the European League Against Rheumatism (EULAR) recommendations for the management of early arthritis (EA).MethodsThe expert committee defined research questions concerning non-pharmacological interventions, patient information and education, non-steroidal anti-inflammatory drug, glucocorticoid (GC) and disease-modifying antirheumatic drugs (DMARDs) use, as well as on disease monitoring. The SLR included articles published after the last EULAR SLR until November 2015 found in the MEDLINE, EMBASE and Cochrane databases and abstracts from the 2014 and 2015 American College of Rheumatology and EULAR conferences.ResultsExercise programmes may improve pain and physical function in patients with EA. Patients with EA treated within the first 3 months of symptoms have better clinical and radiological outcomes than those treated beyond 3 months. The clinical and radiological efficacy of GCs is confirmed, with similar efficacy of oral and parenteral administrations. Long-term data raise concerns regarding cardiovascular safety when using GCs. Step-up DMARD therapy is as effective as intensive DMARD therapy ‘ab initio’ for the long-term outcome of EA. Short-term superiority of intensive therapy with bDMARDs is not maintained on withdrawal of bDMARD. Patients with early psoriatic arthritis have better skin and joint outcomes when tight control is used compared to standard care.ConclusionsThe findings confirm the beneficial effect of exercise programmes and the importance of early drug therapy and tight control. They support the use of methotrexate and GCs as first-line drugs, although the long-term use of GCs raises safety concerns.

Rheumatoid Arthritis: A Brief Overview of the Treatment

“…Until now, there is convincing data showing the benefits of combinations of conventional synthetic DMARDs over MTX monotherapy. However, biological and synthetic DMARDs in combination are reported to be better than MTX but with more side effects and greater costs [11, 14, 19]. …”

Chronic Inflammation in Rheumatoid Arthritis and Mediators of Skeletal Muscle Pathology and Physical Impairment: A Review

“…Free‐living physical activity is defined as “the level of physical activity that individuals, within their physical limitations, at their own pace, and in their own environment, typically perform.” Free‐living physical activity and prescriptive exercise are associated with a myriad of health benefits in individuals with RA, including improvement of disease activity, fatigue, pain, quality of life, physical performance, aerobic capacity, cardiovascular risk, and bone and joint health (). A recent systematic review that guided the 2016 update of the European League Against Rheumatism recommendations for the management of early arthritis supports the beneficial effect of exercise programs on pain and physical function (). Additionally, a recent Cochrane review showed that there was moderate evidence that both short‐term (<3 months) and long‐term (>3 months) land‐based dynamic exercise programs (endurance training and/or strength training) have positive effects on aerobic capacity and muscle strength in individuals with RA, with no adverse effects on disease activity ().…”

Upcoming value of gene expression analysis in rheumatology

“…Поэтому любая терапия, прежде всего, направлена на ингибирование болевого синдрома [46]. Лечение боли при РА включает нефармакологические методы, такие как физические упражнения [47], а также использование некоторых фармакологических препаратов в случае хронической боли [48,49]. При этом уменьшение боли на 30% считается хорошим результатом терапии, хотя значительное число симптомов сохраняется приблизительно у 60% больных РА [50].…”