rheumatology current awareness newsletter november 2015 · journal of rheumatology november 2015...
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Rheumatology
Current Awareness Newsletter
November 2015
Outreach Your Outreach Librarian can help facilitate evidence-based practise for all Rheumatology staff, as well as assisting with academic study and research. We can help with literature searching, obtaining journal articles and books, and
setting up individual current awareness alerts.
Literature Searching We provide a literature searching service for any library member. For those embarking on their own research it is advisable to book some time with one of the librarians for a 1 to 1 session where we
can guide you through the process of creating a well-focused literature research and introduce you to the health databases
access via NHS Evidence.
Critical Appraisal Training We also offer one-to-one or small group training in
literature searching, accessing electronic journals, and critical appraisal/Statistics. These are essential courses that teach how to
interpret clinical papers.
For more information, email: [email protected]
Books Books can be searched for using SWIMS our online catalogue at
www.swims.nhs.uk. Books and journals that are not available on site or electronically may be requested from other locations.
Please email requests to: [email protected]
Contents
1: Tables of Contents from
November’s Rheumatology
journals
2: New NICE Guidance
3: Latest relevant Systematic
Reviews from the Cochrane
Library.
4: New activity in Uptodate
5: Current Awareness database
articles
Tables of Contents from
Rheumatology journals
The links below will take you to the full Tables of Contents.
If you require full articles please email: [email protected]
Rheumatology November 2015 Volume 54 Issue 11
Annals of Rheumatic Disease November 2015 Volume 74 Issue 11
Arthritis & Rheumatology November 2015 Volume 67 Issue 11
Journal of Rheumatology November 2015 Volume 42 Issue 11
Osteoporosis International November 2015 Volume 26 Issue 11
New NICE Guidance
DG18 Procalcitonin testing for diagnosing and monitoring sepsis (ADVIA Centaur BRAHMS PCT assay, BRAHMS PCT Sensitive Kryptor assay, Elecsys BRAHMS PCT assay, LIAISON BRAHMS PCT assay and VIDAS BRAHMS PCT assay)
Latest relevant Systematic Reviews
from the Cochrane Library
Hyaluronic acid and other conservative treatment options for osteoarthritis of the ankle Intra-articular corticosteroid for knee osteoarthritis
Library membership de-mystified… Why join the Library?
Print resources: borrowing rights for books and journals in both print and electronic formats E-resources: including essential point of care tools such as UpToDate and ClinicalSkills.net OpenAthens enrolment (unless you opt out): get access to UHBristol subscription resources Inter-library loans: if we don’t have an article or book that you need, we can get it for you Out of hours Library access: swipe card access to the Library from 7am – 11pm every day
How do I join the Library?
You can either…
Register in person at the Library
Complete a membership form electronically (click here or email [email protected]) and return it to the Library or to [email protected].
How can I find out more?
Check out our website: http://www.uhbristol.nhs.uk/for-clinicians/library-and-information-service/
Email us: [email protected] Visit us: Level 5, Education Centre
New activity in Uptodate
www.uptodate.com
You will need your NHS Athens username/password (register through http://openathens.nice.org.uk/)
North American treatment recommendations for ankylosing spondylitis and nonradiographic
axial spondyloarthritis (October 2015)
The optimal management approach for patients with ankylosing spondylitis (AS) and nonradiographic
axial spondyloarthritis (SpA) remains a matter of ongoing study. Recommendations based upon a
systematic literature review, structured grading of evidence for major treatment decisions, and a group
consensus process have now been issued by a collaborative effort of the American College of
Rheumatology (ACR), Spondylitis Association of America (SAA), and Spondyloarthritis Research and
Treatment Network (SPARTAN) [13]. Our management approach is generally consistent with these
recommendations, and is similar to those of the Assessment of SpondyloArthritis International Society
and the European League Against Rheumatism (EULAR), and of an international task force, which
were derived using other strategies. (See "Assessment and treatment of ankylosing spondylitis in
adults", section on 'Goals of management'.)
Guidelines for management of dry eye in Sjögren syndrome (October 2015)
There are few well-designed trials of measures to prevent the complications of dry eye in patients with
Sjögren syndrome (SS) and to inform patient care. The Committee for Ocular Clinical Guidelines in
the Management of Dry Eye Associated with Sjögren Syndrome, a panel of eye care providers and
consultants in the United States, has issued evaluation and management recommendations [18]. The
suggested strategy depends upon the severity of the disease and the response to therapy, and
is generally consistent with our approach. These guidelines, which are based upon a systematic
review and grading of the available evidence and a structured consensus process, are part of a larger
project of the Sjögren Syndrome Foundation to develop comprehensive clinical guidelines for the
management of SS. (See "Treatment of dry eye in Sjögren's syndrome", section on 'General
principles'.)
Quick exercise
OUTCOME RELIABILITY refers to consistency of the test results on repeat measurements. Match the definition to the form of reliability:
Looks at the level of agreement between assessments by one rater
of the same material at two or more different times.
Refers to the level of agreement between the initial test results and
the results of repeated measurements made at a later date.
This measures the level of agreement between assessments made by
two or more raters at the same time.
Inter-rater
reliability
Intra-rater
reliability
Test retest
reliability
To find out more about bias in research methodology, sign up for one of our
Critical Appraisal training sessions. For more details, email
Current Awareness database articles
If you require full articles please email: [email protected]
Title: Increased frequency of JC-polyomavirus detection in rheumatoid arthritis patients treated with multiple biologics. Citation: Medical microbiology and immunology, Oct 2015, vol. 204, no. 5, p. 613-618 (October 2015) Author(s): Verheyen, Jens, Maizus, Kseniya, Feist, Eugen, Tolman, Zebulon, Knops, Elena, Saech, Jasemine, Spengler, Lydia, Waterboer, Tim, Burmester, Gerd R, Pawlita, Michael, Pfister, Herbert, Rubbert-Roth, Andrea Abstract: Progressive multifocal leukoencephalopathy (PML) represents a rare but potentially fatal reactivation of JC-polyomavirus (JCPyV) recently also reported in patients with autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis (RA) treated with rituximab. The aim of the present study was to analyse the pattern of JCPyV infections in patients with RA undergoing treatment with biologic agents. Urine and blood samples were analysed from 80 patients for antibody levels and/or the presence of JCPyV DNA. Genotyping of the control region and VP1 was performed for all JCPyV DNA-positive specimens. Viremia of JCPyV was only temporarily detected in two patients, and these viruses did not carry any mutations associated with the occurrence of PML. JCPyV DNA was prevalent in initial urine samples of 33% of all patients. RA patients who have consecutively been treated with two or more biologic agents revealed significantly higher prevalence of JCPyV DNA in the urine compared to RA patients treated with their first biologic agent. The presence of JCPyV DNA in the urine closely correlated to JCPyV antibody positivity, and therefore, antibody titres were higher in RA patients who had consecutively received two or more biologic agents over time. Therefore, the overall number of biologic agents had an impact on the pattern of JCPyV detection in this study. Hence, JCPyV antibody screening might be useful as part of the PML risk stratification for RA patients in the future.
Title: Guided Imagery for Arthritis and Other Rheumatic Diseases: A Systematic Review of Randomized Controlled Trials. Citation: Pain management nursing : official journal of the American Society of Pain Management Nurses, Oct 2015, vol. 16, no. 5, p. 792-803 (October 2015) Author(s): Giacobbi, Peter R, Stabler, Meagan E, Stewart, Jonathan, Jaeschke, Anna-Marie, Siebert, Jean L, Kelley, George A Abstract: Many individuals suffering from arthritis and other rheumatic diseases (AORD) supplement pharmacologic treatments with psychosocial interventions. One promising approach, guided imagery, has been reported to have positive results in randomized controlled trials (RCTs) and is a highly scalable treatment for those with AORD. The main purpose of this study was to conduct a systematic review of RCTs that have examined the effects of guided imagery on pain, function, and other outcomes such as anxiety, depression, and quality of life in adults with AORD. Ten electronic bibliographic databases were searched for reports of RCTs published between 1960 and 2013. Selection criteria included adults with AORD who participated in RCTs that used guided imagery as a partial or sole intervention strategy. Risk of bias was assessed using the Cochrane Risk of Bias Assessment Instrument. Results were synthesized qualitatively. Seven studies representing 306 enrolled and 287 participants who completed the interventions met inclusion criteria. The average age of the participants was 62.9 years (standard deviation = 12.2). All interventions used guided imagery scripts that were delivered via audio technology. The interventions ranged from a one-time exposure to 16 weeks in duration. Risk of bias was low or unclear in all but one study. All studies reported statistically significant improvements in the observed outcomes. Guided imagery appears to be beneficial for adults with AORD. Future theory-based studies with cost-benefit analyses are warranted. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
Title: Non-Biologic Nanodelivery Therapies for Rheumatoid Arthritis. Citation: Journal of biomedical nanotechnology, Oct 2015, vol. 11, no. 10, p. 1701-1721, 1550-7033 (October 2015) Author(s): Gouveia, Virgínia M, Lima, Sofia A Costa, Nunes, Cláudia, Reis, Salette Abstract: Rheumatoid arthritis is a common chronic inflammatory disease characterized by progressive bone and cartilage destruction causing severe functional limitations, increased morbidity and mortality rate, which results in a strong negative socioeconomic impact. Current therapies only slow the progression of the disease and try to enhance quality of life. Furthermore, such therapies present several drawbacks due to the adverse effects caused by the lack of selectively of the drugs and frequent and long-term dosing that lead to patient non-compliance. Drug delivery systems based on nanocarriers represent a promising approach to overcome the current therapeutic limitations because they can selectively carry drugs to inflamed synovium allowing for improved drug efficacy, thereby reducing the biodistribution of anti-rheumatic drugs. Additionally, controlled drug release can lead to the reduction of drug dosages. The increasing interest and confidence that nanocarriers can revolutionize the treatment of rheumatoid arthritis has led to an increased number of investigations in this field. In this context, the present review focuses on drug delivery system strategies for non-biological drugs developed for the treatment of rheumatoid arthritis.
Title: Antidiabetogenic effects of hydroxychloroquine on insulin sensitivity and beta cell function: a randomised trial. Citation: Diabetologia, Oct 2015, vol. 58, no. 10, p. 2336-2343 (October 2015) Author(s): Wasko, Mary Chester M, McClure, Candace K, Kelsey, Sheryl F, Huber, Kimberly, Orchard, Trevor, Toledo, Frederico G S Abstract: Hydroxychloroquine (HCQ), an antimalarial drug with anti-inflammatory properties, is employed in rheumatic diseases. In observational studies, patients with rheumatic diseases treated with HCQ have a lower risk of developing diabetes. However, the physiological mechanisms remain unexplained. We hypothesised that HCQ may have favourable effects on insulin sensitivity and/or beta cell function. This was a randomised, double-blind, parallel-arm (placebo vs HCQ 400 mg/day) trial at the University of Pittsburgh. Randomisation was conducted by a computer system with concealment by sealed envelopes. Treatment duration was 13 ± 1 weeks. Randomised participants (HCQ n = 17; placebo n = 15) were non-diabetic volunteers, age >18, overweight or obese, with one or more markers of insulin resistance. All participants were included in intention-to-treat analysis. Outcomes were changes in insulin sensitivity and beta cell function measured by intravenous glucose tolerance tests and minimal model analysis. There was a positive change in insulin sensitivity with HCQ but not placebo (mean ± SEM: +20.0% ± 7.1% vs -18.4% ± 7.9%, respectively; p < 0.01; difference: 38.3% ± 10.6%; 95% CI: 17%, 60%). Improvement in beta cell function was also observed with HCQ but not placebo (+45.4% ± 12.3% vs -19.7% ± 13.6%; p < 0.01; difference: 65% ± 19%; 95% CI: 27%, 103%). There were modest treatment effects on fasting plasma glucose and HbA1c (p < 0.05) but circulating markers of inflammation (IL-6, IL-1, TNF-α, soluble intercellular adhesion molecule) were not affected in either group. In contrast, adiponectin levels increased after HCQ treatment but not after placebo (+18.7% vs +0.7%, respectively; p < 0.001). Both low- and high-molecular-weight adiponectin forms accounted for the increase. There were no serious or unexpected adverse effects. HCQ improves both beta cell function and insulin sensitivity in non-diabetic individuals. These metabolic effects may explain why HCQ treatment is associated with a lower risk of type 2 diabetes. An additional novel observation is that HCQ improves adiponectin levels, possibly being a mediator of the favourable effects on glucose metabolism. Our findings suggest that HCQ is a drug with considerable metabolic effects that warrant further exploration in disorders of glucose metabolism. Trial registration Clinicaltrials.gov NCT01326533 Funding This study was funded by National Institutes of Health no. 5R21DK082878, UL1-RR024153 and UL-1TR000005.
Title: Intra-articular etanercept treatment in inflammatory arthritis: A randomized double-blind placebo-controlled proof of mechanism clinical trial validating TNF as a potential therapeutic target for local treatment. Citation: Joint, bone, spine : revue du rhumatisme, Oct 2015, vol. 82, no. 5, p. 338-344 (October 2015) Author(s): Aalbers, Caroline, Gerlag, Danielle, Vos, Koen, Vervoordeldonk, Margriet, Landewé, Robert, Tak, Paul Peter Abstract: There is an increased interest in developing gene therapy approaches for local delivery of therapeutic genes in patients with arthritis. Intra-articular (i.a.) gene delivery, using an adeno-associated virus encoding a TNF soluble receptor, resulted in reduced paw swelling in an arthritis animal model, but i.a. treatment with a similar vector did not induce robust clinical improvement in patients. It is unclear whether this can be explained by for instance insufficient transduction efficiency or the fact that TNF is not a good therapeutic target for i.a treatment. The objective of this study was to explore the effects of i.a TNF blockade. Thirty-one patients with rheumatoid or psoriatic arthritis were assigned to a single i.a. injection of 25mg etanercept or placebo in a double-blind randomised controlled clinical trial. The primary end point was target joint improvement, determined by a composite change index. Twenty-two patients received etanercept and 9 received placebo. Treatment was generally well tolerated. Treatment with etanercept resulted in a prompt and statistically significant improvement of the index (P<0.001) in comparison with placebo. As expected in light of the half-life of etanercept, the beneficial effect was transient and only statistically significant at week 1 and 2 after i.a. injection. The results support the development of novel approaches for long-term inhibition of TNF at the site of inflammation, such as gene therapy. The Netherlands National Trial Register (NTR), www.trialregister.nl, NTR-1210. Copyright © 2015 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.
Title: Usefulness of a pre-procedure ultrasound scanning of the lumbar spine before epidural injection in patients with a presumed difficult puncture: A randomized controlled trial. Citation: Joint, bone, spine : revue du rhumatisme, Oct 2015, vol. 82, no. 5, p. 356-361 (October 2015) Author(s): Darrieutort-Laffite, Christelle, Bart, Geraldine, Planche, Lucie, Glemarec, Joelle, Maugars, Yves, Le Goff, Benoit Abstract: Ultrasound (US) is widely used in rheumatology to study and guide injection of peripheral joints. It can also provide useful information about the anatomy of the lumbar spine. Studies have shown that US examination of the spine was a useful tool to help perform epidural anaesthesia. The purpose of the study was to determine if the selection of the optimum puncture level by US may facilitate epidural steroid injection in case of presumed difficult puncture (BMI>30kg/m(2), age>60years or lumbar scoliosis). We performed a prospective randomized controlled study. Eighty patients were randomized in two groups: US group (n=40) which underwent a pre-procedure spinal US to determine the optimal lumbar level for injection or control group (n=40) for which the level of injection was determined by palpation. Primary endpoint was the pain during the procedure assessed using the Visual Analogue Scale (VAS). We found a positive correlation between depth of the epidural space and BMI (P<0.001) and a negative correlation between size of the interspinous spaces and age (P<0.01). Visibility of the epidural space was not altered by obesity or age. We observed a trend toward a reduction in pain intensity during the procedure in the US group compared to the control group with a mean difference at -0.94 [-1.90; 0.02] but the difference was not significant (P=0.054). US of the lumbar spine was feasible in patients with lumbar conditions even in obese and old ones and allowed the visualization of the epidural space. However, pre-procedure US examination did not reduce pain during the procedure. Copyright © 2015 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.
Title: Ultrasound-guided synovial biopsy: a systematic review according to the OMERACT filter and recommendations for minimal reporting standards in clinical studies. Citation: Rheumatology (Oxford, England), Oct 2015, vol. 54, no. 10, p. 1867-1875 (October 2015)
Author(s): Lazarou, Ilias, D'Agostino, Maria-Antonietta, Naredo, Esperanza, Humby, Frances, Filer, Andrew, Kelly, Stephen G Abstract: To describe existing techniques of US-guided synovial biopsy (USG-SB) and critically appraise the literature on this technology through the OMERACT filter. USG-SB techniques are described and compared. A systematic literature search of PubMed and Embase was performed for original research reports including US and SB. The subjects, procedure protocols and reported results were analysed. A future research agenda is proposed. USG-SB can be performed using a portal-and-forceps or a dedicated semi-automatic guillotine-type biopsy needle approach. Of 50 reports identified, 7 were included in the review. Large, intermediate and small joints were all amenable to USG-SB. We found great heterogeneity with regard to indications for and definition of a successful procedure and of synovitis. Adverse events were assessed in most papers with an overall major complication rate of 0.4%. However, there was a lack of construct validity using a histological comparator. Relatively few papers reported details on the technique used, tissue processing, synovitis scoring and blinding for tissue analysis. USG-SB can be regarded as a valuable tool for large-scale synovial tissue sampling. Standardization of the techniques of USG-SB and tissue processing is needed. Future research should focus on the reliability, responsiveness and feasibility of this procedure in prospective studies. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: [email protected].
Title: Predicted vs. observed radiographic progression in early rheumatoid arthritis (POPeRA): results from a randomized trial. Citation: Scandinavian journal of rheumatology, Oct 2015, vol. 44, no. 5, p. 348-353 (October 2015) Author(s): Levitsky, A, Forslind, K, van Vollenhoven, R F, On Behalf Of The Swefot Trial Group Abstract: The aim of this study was to apply a previously published method for evaluating radiographic progression, namely, predicted vs. observed radiographic progression in early rheumatoid arthritis (POPeRA), to the Swedish pharmacotherapy (SWEFOT) trial. In SWEFOT, 487 patients with eRA were given methotrexate (MTX), and non-responders were randomized to group A [triple therapy: MTX + sulfasalazine (SSZ) + hydroxychloroquine (HCQ)] and group B [anti-tumour necrosis factor (anti-TNF) therapy: MTX + infliximab]. Responders continued on MTX. Predicted progression for 343 eligible patients was calculated based on the baseline total Sharp/van der Heijde score (SHS) divided by symptom duration, compared to observed progression at 12 and 24 months. Observed radiographic progression was reduced from predicted by a mean of 50.1% (A), 72.3% (B), and 73.9% (MTX) at 12 months and by 87.2, 89.8, and 87.8% at 24 months, respectively. Among completers, reductions of 56.7% (A) and 76.5% (B) at 12 months and of 91.0% and 96.0% at 24 months, respectively, were observed. At 12 months, there were no significant between-group differences. At 24 months, progression was reduced more in group B than in group A (first quartile difference 8.5% favouring group B) and in MTX [n = 316, 89.8% (sd ± 32.0) vs. 87.2% (± 32.2), p = 0.021; vs. 87.8% (± 27.8), p = 0.013, respectively]. The POPeRA method confirms the original SWEFOT finding in that anti-TNF therapy was statistically marginally superior (2.6%) to triple therapy in preventing radiographic progression at 24 months among initial MTX non-responders. The simulation provided through POPeRA may facilitate comparisons of the relative efficacy of various treatments in preventing radiographic progression.
Title: Risk of liver injury among methotrexate users: A meta-analysis of randomised controlled trials. Citation: Seminars in arthritis and rheumatism, Oct 2015, vol. 45, no. 2, p. 156-162 (October 2015) Author(s): Conway, Richard, Low, Candice, Coughlan, Robert J, O'Donnell, Martin J, Carey, John J Abstract: Methotrexate is an effective treatment for a variety of inflammatory diseases. Robust evidence on the risk of serious liver injury is lacking. The aim of this study was to evaluate the relative risk and severity of liver disease among patients treated with methotrexate. We searched PubMed and the Cochrane Central Register of Controlled Trials from 1 January 1990 to 24 April 2014 for double-blind randomised controlled trials of methotrexate versus comparator agents in adults with rheumatoid arthritis, psoriasis, psoriatic arthritis or
inflammatory bowel disease. Studies with less than 100 subjects or of less than 24 weeks׳ duration were excluded. Two investigators independently searched both the databases. All authors reviewed the selected studies. We compared relative risk (RR) differences using the Mantel-Haenszel random effects method to assess total liver adverse events, minor liver enzyme abnormalities (≤3 ULN), major liver enzyme abnormalities (>3 ULN or treatment withdrawal) and a composite outcome of liver failure, fibrosis, cirrhosis or death. A total of 32 studies with 13,177 participants met our inclusion criteria. Methotrexate was associated with an increased risk of total adverse liver events, RR = 2.19 (95% CI: 1.73-2.77, I(2) = 68%), as well as minor and major liver enzyme abnormalities, RR = 2.16 (95% CI: 1.67-2.79, I(2) = 68%) and RR = 2.63 (95% CI: 1.90-3.64, I(2) = 10%), respectively. Patients treated with methotrexate were not at increased risk of liver failure, cirrhosis or death, RR = 0.12 (95% CI: 0.01-1.09, I(2) = 0%). Our study found an increased risk of elevated transaminases but not liver failure, cirrhosis or death with methotrexate compared to other agents. We were unable to assess long-term liver toxicity due to the short duration of included clinical trials. Copyright © 2015 Elsevier Inc. All rights reserved.
Title: Health-related quality of life in patients with long-standing rheumatoid arthritis in the era of biologics: data from the German biologics register RABBIT. Citation: Rheumatology (Oxford, England), Oct 2015, vol. 54, no. 10, p. 1858-1866 (October 2015) Author(s): Gerhold, Kerstin, Richter, Adrian, Schneider, Matthias, Bergerhausen, Hans-Joachim, Demary, Winfried, Liebhaber, Anke, Listing, Joachim, Zink, Angela, Strangfeld, Anja Abstract: To compare the 24-month course of health-related quality of life (HRQoL) in patients with long-standing RA treated with a conventional synthetic (cs) or a first, second or third biologic (b) DMARD in daily rheumatological care. Patients enrolled in the German biologics register RABBIT who were observed over at least 12 months were stratified according to the nth bDMARD started at enrolment. HRQoL was captured by the SF36 health survey. Within strata of sequential bDMARD therapy, we examined patients' HRQoL at baseline and at follow-ups in comparison with the general population, the 24-month course of HRQoL of different bDMARDs and the proportion of patients exceeding the minimal detectable improvement of physical and mental health sum scores. All patients reported remarkably lower scores of physical and mental health than the general population at baseline and month 12. In each stratum of sequential bDMARD therapy, patients improved significantly by month 12 and remained stable until month 24. The improvement of HRQoL was not attributable to a particular bDMARD. The following proportions of patients exceeded the minimal detectable improvement of at least 17.85 Physical Component Scale scores or 22.18 Mental Component Scale score points: csDMARD (n = 1113) 31.1%/22.3%, first bDMARD (n = 1352) 39.9%/29.7%, second bDMARD (n = 730) 37.3%/26.2% and third bDMARD (n = 680) 34.2%/30.9%. Lasting improvement of both physical and mental health is achievable even for severely affected RA patients with a history of more than one bDMARD failure. Nevertheless, impairment of HRQoL in RA patients is enormous compared with the general population. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology.
Title: Behaviour change interventions to promote physical activity in rheumatoid arthritis: a systematic review. Citation: Rheumatology international, Oct 2015, vol. 35, no. 10, p. 1631-1640 (October 2015) Author(s): Larkin, Louise, Gallagher, Stephen, Cramp, Fiona, Brand, Charles, Fraser, Alexander, Kennedy, Norelee Abstract: Research has shown that people who have rheumatoid arthritis (RA) do not usually participate in enough physical activity to obtain the benefits of optimal physical activity levels, including quality of life, aerobic fitness and disease-related characteristics. Behaviour change theory underpins the promotion of physical activity. The aim of this systematic review was to explore behaviour change interventions which targeted physical activity behaviour in people who have RA, focusing on the theory underpinning the interventions and the behaviour change techniques utilised using specific behaviour change taxonomy. An electronic database search was conducted via EBSCOhost, PubMed, Cochrane Central Register of Controlled Trials and Web of Science databases in August 2014, using Medical Subject Headings and keywords. A manual
search of reference lists was also conducted. Randomised control trials which used behaviour change techniques and targeted physical activity behaviour in adults who have RA were included. Two reviewers independently screened studies for inclusion. Methodological quality was assessed using the Cochrane risk of bias tool. Five studies with 784 participants were included in the review. Methodological quality of the studies was mixed. The studies consisted of behaviour change interventions or combined practical physical activity and behaviour change interventions and utilised a large variety of behaviour change techniques. Four studies reported increased physical activity behaviour. All studies used subjective methods of assessing physical activity with only one study utilising an objective measure. There has been varied success of behaviour change interventions in promoting physical activity behaviour in people who have RA. Further studies are required to develop and implement the optimal behaviour change intervention in this population.
Title: Concomitant methotrexate and tacrolimus augment the clinical response to abatacept in patients with rheumatoid arthritis with a prior history of biological DMARD use. Citation: Rheumatology international, Oct 2015, vol. 35, no. 10, p. 1707-1716 (October 2015) Author(s): Takahashi, Nobunori, Fujibayashi, Takayoshi, Kida, Daihei, Hirano, Yuji, Kato, Takefumi, Kato, Daizo, Saito, Kiwamu, Kaneko, Atsushi, Yabe, Yuichiro, Takagi, Hideki, Oguchi, Takeshi, Miyake, Hiroyuki, Watanabe, Tsuyoshi, Hayashi, Masatoshi, Kanayama, Yasuhide, Funahashi, Koji, Hanabayashi, Masahiro, Hirabara, Shinya, Asai, Shuji, Takemoto, Toki, Terabe, Kenya, Asai, Nobuyuki, Yoshioka, Yutaka, Ishiguro, Naoki, Kojima, Toshihisa Abstract: This observational retrospective study examined whether abatacept efficacy could be augmented with concomitant methotrexate (MTX) or tacrolimus (TAC) in patients with rheumatoid arthritis (RA) who experienced failure with prior biological disease-modifying antirheumatic drugs (DMARDs) and in whom favorable therapeutic efficacy is difficult to achieve. All patients with a prior biological DMARD history who were treated with abatacept for 52 weeks and registered in a Japanese multicentre registry were included. Clinical efficacy and safety of abatacept according to the concomitant drug used, i.e., none (ABT-mono), MTX (ABT-MTX), and TAC (ABT-TAC), were compared. A greater mean percent change of DAS28-ESR was observed in the ABT-TAC group compared with the ABT-mono group at weeks 12 (-20.5 vs. -5.4 %, p = 0.035) and 24 (-25.0 vs. -11.0 %, p = 0.036). ABT-MTX and ABT-TAC groups had a significantly higher proportion of patients who achieved low disease activity (LDA) within 52 weeks compared with the respective baselines, while no significant change was observed in the ABT-mono group. A higher proportion of patients in the ABT-TAC group achieved EULAR moderate response compared with the ABT-mono group at week 52 (66.7 vs. 35.0 %, p = 0.025). Multivariate logistic regression analysis revealed that concomitant TAC use was independently associated with the achievement of LDA and EULAR response at 52 weeks, while concomitant MTX use was not. Concomitant TAC use may offer a suitable option for RA patients treated with abatacept after prior biological DMARD failure, likely because both abatacept and TAC affect T cell activation.
Title: The influence of behavioural and psychological factors on medication adherence over time in rheumatoid arthritis patients: a study in the biologics era. Citation: Rheumatology (Oxford, England), Oct 2015, vol. 54, no. 10, p. 1780-1791 (October 2015) Author(s): Morgan, Catharine, McBeth, John, Cordingley, Lis, Watson, Kath, Hyrich, Kimme L, Symmons, Deborah P M, Bruce, Ian N Abstract: To investigate levels of self-reported adherence to biologic treatment and establish the contribution of demographic, physical and psychological factors to biologic medication adherence in an RA cohort. Adalimumab-treated patients were recruited through the British Society for Rheumatology Biologics Register for RA between May 2007 and April 2009. Demographic and baseline psychological measures including illness and medication beliefs were collected. Disease activity (28-item DAS), physical function (HAQ) and quality of life (36-item Short Form Health Survey) were also measured at baseline and at 6, 12 and 18 months. Adherence was assessed at each follow-up using the patient self-completed Compliance Questionnaire for Rheumatology (CQR). Multilevel mixed effects modelling analysis was performed to investigate predictors of adherence. Of the 329 Adalimumab-treated patients included, low adherence (CQR score <65) was reported in
23%, with 41% reporting low adherence at at least one time point. After controlling for age and disease duration, factors independently predictive of increased adherence were increased belief in medication necessity, with baseline effect diminishing over time [β coefficient 1.68 (s.e. 0.19), P = 0.0001], lower medication concerns [0.50 (0.15), P = 0.001], with this effect remaining throughout follow-up, increased professional or family member support [0.81 (0.32), P = 0.01], strong views of illness being chronic [0.32 (0.14), P = 0.025] and increased treatment control [0.41 (0.19), P = 0.032]. Wider recognition of the importance of psychological factors, particularly medication beliefs, in driving medication adherence could have substantial clinical and health economic benefits in RA. The psychological factors we have identified are putative targets for strategies to improve adherence in RA. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology.
Title: 2015 Gout Classification Criteria: An American College of Rheumatology/European League Against Rheumatism Collaborative Initiative. Citation: Arthritis & rheumatology (Hoboken, N.J.), Oct 2015, vol. 67, no. 10, p. 2557-2568 (October 2015) Author(s): Neogi, Tuhina, Jansen, Tim L Th A, Dalbeth, Nicola, Fransen, Jaap, Schumacher, H Ralph, Berendsen, Dianne, Brown, Melanie, Choi, Hyon, Edwards, N Lawrence, Janssens, Hein J E M, Lioté, Frédéric, Naden, Raymond P, Nuki, George, Ogdie, Alexis, Perez-Ruiz, Fernando, Saag, Kenneth, Singh, Jasvinder A, Sundy, John S, Tausche, Anne-Kathrin, Vaquez-Mellado, Janitzia, Yarows, Steven A, Taylor, William J Abstract: Existing criteria for the classification of gout have suboptimal sensitivity and/or specificity, and were developed at a time when advanced imaging was not available. The current effort was undertaken to develop new classification criteria for gout. An international group of investigators, supported by the American College of Rheumatology and the European League Against Rheumatism, conducted a systematic review of the literature on advanced imaging of gout, a diagnostic study in which the presence of monosodium urate monohydrate (MSU) crystals in synovial fluid or tophus was the gold standard, a ranking exercise of paper patient cases, and a multicriterion decision analysis exercise. These data formed the basis for developing the classification criteria, which were tested in an independent data set. The entry criterion for the new classification criteria requires the occurrence of at least 1 episode of peripheral joint or bursal swelling, pain, or tenderness. The presence of MSU crystals in a symptomatic joint/bursa (i.e., synovial fluid) or in a tophus is a sufficient criterion for classification of the subject as having gout, and does not require further scoring. The domains of the new classification criteria include clinical (pattern of joint/bursa involvement, characteristics and time course of symptomatic episodes), laboratory (serum urate, MSU-negative synovial fluid aspirate), and imaging (double-contour sign on ultrasound or urate on dual-energy computed tomography, radiographic gout-related erosion). The sensitivity and specificity of the criteria are high (92% and 89%, respectively). The new classification criteria, developed using a data-driven and decision analytic approach, have excellent performance characteristics and incorporate current state-of-the-art evidence regarding gout. © 2015 The Authors. Arthritis & Rheumatology is published by Wiley Periodicals, Inc. on behalf of the American College of Rheumatology.
Title: A Randomized, Double-Blind, Placebo-Controlled, Sixteen-Week Study of Subcutaneous Golimumab in Patients With Active Nonradiographic Axial Spondyloarthritis. Citation: Arthritis & rheumatology (Hoboken, N.J.), Oct 2015, vol. 67, no. 10, p. 2702-2712 (October 2015) Author(s): Sieper, J, van der Heijde, D, Dougados, M, Maksymowych, W P, Scott, B B, Boice, J A, Berd, Y, Bergman, G, Curtis, S, Tzontcheva, A, Huyck, S, Weng, H H Abstract: Axial spondyloarthritis (SpA) is a chronic inflammatory disease characterized by back pain and stiffness. The objective of this study was to determine whether golimumab is superior to placebo in patients with nonradiographic axial SpA. This phase III, double-blind, randomized, placebo-controlled trial was performed to evaluate subcutaneous golimumab (50 mg) versus placebo in patients ages ≥18 years to ≤45 years who had active nonradiographic axial SpA according to the Assessment of SpondyloArthritis international Society (ASAS) criteria for ≤5 years since diagnosis, high disease activity, and an inadequate response to or
intolerance of nonsteroidal antiinflammatory drugs. Patients were randomized 1:1 to receive golimumab or placebo subcutaneously every 4 weeks. The primary end point was 20% improvement according to the ASAS criteria (ASAS20) at week 16. Key secondary end points were an ASAS40 response, ASAS partial remission, 50% improvement in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and change in the Spondyloarthritis Research Consortium of Canada (SPARCC) magnetic resonance imaging (MRI) index for sacroiliac (SI) joint inflammation (SPARCC score). Of the 198 patients randomized, 197 were treated (97 received golimumab, and 100 received placebo). The mean age of the patients was 31 years, and 57.1% were male. At baseline, the mean ± SD BASDAI was 6.5 ± 1.5, the mean ± SD ASDAS was 3.5 ± 0.9, and the mean ± SD SPARCC score was 11.3 ± 14.0. The primary end point, an ASAS20 response, was achieved by significantly more patients in the golimumab group compared with the placebo group (71.1% versus 40.0%; P < 0.0001). An ASAS40 response was also achieved by significantly more patients in the golimumab group compared with the placebo group (56.7% versus 23.0%; P < 0.0001). The incidence of adverse events did not differ meaningfully between groups. Patients with active nonradiographic axial SpA treated with golimumab had significantly greater improvement in symptoms compared with patients treated with placebo. Golimumab was well tolerated and had a favorable risk/benefit profile. © 2015 Merck Sharp & Dohme Corp. Arthritis & Rheumatology is published by Wiley Periodicals, Inc. on behalf of the American College of Rheumatology.
Title: Promotion of Hypercoagulability in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis by C5a-Induced Tissue Factor-Expressing Microparticles and Neutrophil Extracellular Traps. Citation: Arthritis & rheumatology (Hoboken, N.J.), Oct 2015, vol. 67, no. 10, p. 2780-2790 (October 2015) Author(s): Huang, Yi-Min, Wang, Huan, Wang, Chen, Chen, Min, Zhao, Ming-Hui Abstract: Patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV) have a high frequency of venous thromboembolic events and a hypercoagulable state. As C5a-primed neutrophils play an important role in the development of AAV, we investigated whether C5a-induced neutrophil tissue factor (TF)-expressing microparticles (MPs) and neutrophil extracellular traps (NETs) might promote hypercoagulability in AAV. TF-expressing MPs were measured by flow cytometry. TF-expressing NETs were assessed by confocal microscopy. Levels of thrombin-antithrombin complexes were determined by enzyme-linked immunosorbent assay. The effect of C5a in sera from AAV patients was evaluated by treating neutrophils with C5a receptor antagonist before incubation with sera from AAV patients with active disease. Treatment of C5a-primed neutrophils with antineutrophil cytoplasmic antibody (ANCA)-positive IgG resulted in the release of TF-bearing MPs and NETs. Neutrophils from healthy donors treated with sera from patients with active AAV released TF-bearing MPs and NETs, which were abolished by treatment with C5a receptor antagonist. Involvement of TF in MP- or NET-dependent thrombin generation was indicated by the findings of antibody neutralization studies. NETs with thrombin-generating capacity were demonstrated by DNase I treatment. C5a-primed neutrophils produce TF-expressing MPs and NETs after stimulation with ANCAs, indicating a mechanism for hypercoagulability in AAV that was not previously recognized. © 2015, American College of Rheumatology.
Title: Clinicopathologic, Immunophenotypic, Cytogenetic, and Molecular Features of γδ T-Cell Large Granular Lymphocytic Leukemia: An Analysis of 14 Patients Suggests Biologic Differences With γδ T-Cell Large Granular Lymphocytic Leukemia. Citation: American journal of clinical pathology, Oct 2015, vol. 144, no. 4, p. 607-619 (October 2015) Author(s): Yabe, Mariko, Medeiros, L Jeffrey, Wang, Sa A, Konoplev, Sergej, Ok, Chi Young, Loghavi, Sanam, Lu, Gary, Flores, Lauren, Khoury, Joseph D, Cason, R Craig, Young, Ken H, Miranda, Roberto N Abstract: T-cell large granular lymphocytic (T-LGL) leukemia is a rare disorder in which the neoplastic cells usually express the αβ T-cell receptor (TCR). To determine the significance of γδ TCR expression in this leukemia, we compared the clinicopathologic, immunophenotypic, and genetic features of patients with T-LGL leukemia expressing γδ TCR or αβ TCR. We used the World Health Organization classification criteria to confirm the diagnosis. All patients were diagnosed and treated at our institution. We identified 14 patients with γδ T-LGL leukemia, 11 men and three women; six (43%) patients had a history of rheumatoid arthritis, 10
(71%) had neutropenia, four (29%) had thrombocytopenia, and three (21%) had anemia. Eight (67%) of 12 patients had a CD4-/CD8- phenotype, and four (33%) had a CD4-/CD8+ phenotype. The median overall survival was 62 months. Patients with γδ T-LGL leukemia were more likely to have rheumatoid arthritis (P = .04), lower absolute neutrophil count (P = .04), lower platelet count (P = .004), and a higher frequency of the CD4-/CD8- phenotype (P < .0001). However, there was no significant difference in overall survival between the two groups (P = .64). Although patients with γδ and αβ T-LGL leukemia show some different clinical or phenotypic features, overall survival is similar, suggesting that γδ TCR expression does not carry prognostic significance. Copyright© by the American Society for Clinical Pathology. Full Text: Available from ProQuest in American Journal of Clinical Pathology
Title: Prevention of cardiovascular disease in rheumatoid arthritis. Citation: Autoimmunity reviews, Oct 2015, vol. 14, no. 10, p. 952-969 (October 2015) Author(s): Hollan, I, Dessein, P H, Ronda, N, Wasko, M C, Svenungsson, E, Agewall, S, Cohen-Tervaert, J W, Maki-Petaja, K, Grundtvig, M, Karpouzas, G A, Meroni, P L Abstract: The increased risk of cardiovascular disease (CVD) in rheumatoid arthritis (RA) has been recognized for many years. However, although the characteristics of CVD and its burden resemble those in diabetes, the focus on cardiovascular (CV) prevention in RA has lagged behind, both in the clinical and research settings. Similar to diabetes, the clinical picture of CVD in RA may be atypical, even asymptomatic. Therefore, a proactive screening for subclinical CVD in RA is warranted. Because of the lack of clinical trials, the ideal CVD prevention (CVP) in RA has not yet been defined. In this article, we focus on challenges and controversies in the CVP in RA (such as thresholds for statin therapy), and propose recommendations based on the current evidence. Due to the significant contribution of non-traditional, RA-related CV risk factors, the CV risk calculators developed for the general population underestimate the true risk in RA. Thus, there is an enormous need to develop adequate CV risk stratification tools and to identify the optimal CVP strategies in RA. While awaiting results from randomized controlled trials in RA, clinicians are largely dependent on the use of common sense, and extrapolation of data from studies on other patient populations. The CVP in RA should be based on an individualized evaluation of a broad spectrum of risk factors, and include: 1) reduction of inflammation, preferably with drugs decreasing CV risk, 2) management of factors associated with increased CV risk (e.g., smoking, hypertension, hyperglycemia, dyslipidemia, kidney disease, depression, periodontitis, hypothyroidism, vitamin D deficiency and sleep apnea), and promotion of healthy life style (smoking cessation, healthy diet, adjusted physical activity, stress management, weight control), 3) aspirin and influenza and pneumococcus vaccines according to current guidelines, and 4) limiting use of drugs that increase CV risk. Rheumatologists should take responsibility for the education of health care providers and RA patients regarding CVP in RA. It is immensely important to incorporate CV outcomes in testing of anti-rheumatic drugs. Copyright © 2015 Elsevier B.V. All rights reserved.
Title: Retention of the second-line biologic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis failing one tumor necrosis factor alpha inhibitor: data from the BioRx.si registry. Citation: Clinical rheumatology, Oct 2015, vol. 34, no. 10, p. 1787-1793 (October 2015) Author(s): Rotar, Ziga, Hočevar, Alojzija, Rebolj Kodre, Anamarija, Praprotnik, Sonja, Tomšič, Matija, Slovenian Rheumatologists Abstract: This study aimed to investigate the retention of the second-line biologic disease-modifying antirheumatic drugs (bDMARDs) in rheumatoid arthritis patients failing their first tumor necrosis factor alpha inhibitor (TNFi). Data was extracted from the Slovenian registry (BioRx.si) on December 15, 2012. Baseline patient characteristics were compared between second-line TNFi and non-TNFi, and potential confounders were identified by the means of binary logistic regression. Differential drug retention was assessed using the Kaplan-Meier method and crude and inverse probability-weighted Cox proportional hazards regression models (Cox model). Two hundred thirty-eight out of 688 patients who received a TNFi as the first biologic were
switched to another biologic: 130 to a second-line TNFi and 108 to either rituximab (31.5 %) or tocilizumab (68.5 %) (non-TNFi). Disease activity at starting second-line bDMARD and stopping the first-line TNFi due to either lack of effectiveness or loss of effectiveness were identified as potential confounders. There appears to be a statistically significant retention advantage of the non-TNFi over the second-line TNFi (log rank test, p = 0.000). This advantage is retained even after taking into account the possible effect of confounders which was tested using the inverse probability-weighted Cox model [hazard ratio (HR) 4.39; 95 % confidence interval (CI) 2.62-8.01, p < 0.001]. After the first-line TNFi's failure, a second-line TNFi is more likely to fail earlier than non-TNFi.
Title: Updated systematic review and meta-analysis of randomized controlled trials comparing low- versus high-dose rituximab for rheumatoid arthritis. Citation: Clinical rheumatology, Oct 2015, vol. 34, no. 10, p. 1801-1805 (October 2015) Author(s): Bredemeier, Markus, Campos, Guilherme G, de Oliveira, Fernando K Abstract: The purpose of this study is to update a systematic review and meta-analysis comparing low- (2 × 500 or 1 × 1000 mg) and high-dose (2 × 1000 mg) rituximab (RTX) for the treatment of rheumatoid arthritis (RA), considering the recent emergence of new evidence. The systematic literature review searching for randomized controlled trials (RCTs) was updated to November 6, 2014 using the PubMed, EMBASE, Cochrane Library, Web of Science databases, and hand searching. The primary outcomes were the American College of Rheumatology (ACR) criteria for 20 % improvement (ACR20), ACR50, and ACR70 responses and the Disease Activity Score in 28 joints (DAS28) at 24 and 48/52 weeks. The secondary outcomes were change in Health Assessment Questionnaire (HAQ) score, change in the radiographic modified Total Sharp Score (mTSS), levels of immunoglobulin G (IgG), and adverse events. In total, seven RCTs were identified, including two new full publication versions and one abstract of RCTs. There were no significant differences in the primary outcomes and change in HAQ, although the mean change in mTSS was 0.25 units (95 % CI, 0.01 to 0.49; P = 0.04) higher in low-dose group at week 52. Two RCTs did not demonstrate difference between the RTX regimens for maintaining clinical response (obtained initially using high-dose RTX) in anti-TNF-experienced patients. IgG levels were significantly higher (P ≤ 0.02), and first infusion reactions were less frequent in the low-dose group (P = 0.02). Our updated results further support the similar efficacy of both RTX regimens in different subsets of RA patients, demonstrating a better clinical and laboratory safety profile of the low-dose scheme.
Title: Rheumatologists' Views and Perceived Barriers to Using Patient Decision Aids in Clinical Practice. Citation: Arthritis care & research, Oct 2015, vol. 67, no. 10, p. 1463-1470 (October 2015) Author(s): Zong, Jeff Y, Leese, Jenny, Klemm, Alexandria, Sayre, Eric C, Memetovic, Jasmina, Esdaile, John M, Li, Linda C Abstract: To explore rheumatologists' perceptions of patient decision aids (PtDAs) and identify barriers to using them in clinical practice. A cross-sectional online survey of all members of the Canadian Rheumatology Association (CRA; n = 459) was conducted. We subsequently invited 10 respondents to participate in a 30-minute telephone interview to further explore their views on using PtDAs in clinical practice. Interview participants were purposefully sampled to achieve a balance in sex, years in clinical practice, and types of practice. In August and September 2013, 153 CRA members responded to the survey (response rate 33.3%); of those, 113 completed the entire questionnaire. Sixty-three respondents (55.8%) were male, 54 (47.8%) were ≥50 years of age, and 55 (48.7%) practiced in a multidisciplinary setting. When asked about their intention to use PtDAs, participants rated mean ± SD 5.7 ± 2.9 (where 0 = not likely and 10 = very likely). Sixty-four (56.6%) believed that rheumatologists were unfamiliar with PtDAs, and 76 (67.3%) thought that PtDAs would disturb their workflow. In-depth interviews revealed the following: the perception that PtDAs were no different from any other patient education tools, the concern that PtDAs were of limited value in real life since they relied solely on data from randomized controlled trials, and the fear that PtDAs could impair doctor-patient communication. There was a sense of ambivalence among rheumatologists about PtDAs. Our interviews further revealed concerns regarding the utility and benefits of PtDAs in clinical practice. The results show a
need to familiarize physicians with PtDAs and to develop strategies to support their integration in clinical practice. © 2015, American College of Rheumatology.
Title: Magnetic Resonance Imaging-Assessed Vastus Medialis Muscle Fat Content and Risk for Knee Osteoarthritis Progression: Relevance From a Clinical Trial. Citation: Arthritis care & research, Oct 2015, vol. 67, no. 10, p. 1406-1415 (October 2015) Author(s): Raynauld, Jean-Pierre, Pelletier, Jean-Pierre, Roubille, Camille, Dorais, Marc, Abram, François, Li, Wei, Wang, Yuanyuan, Fairley, Jessica, Cicuttini, Flavia M, Martel-Pelletier, Johanne Abstract: Studies have proposed vastus medialis (VM) muscle cross-sectional area change as a variable associated with cartilage volume loss in knee osteoarthritis (OA). However, the VM also includes fat (%Fat), which may influence knee function. This study analyzed the VM area and %Fat data, separately and in combination, to predict symptoms, cartilage volume loss, and bone marrow lesion (BML) change in knee OA. This study included the according-to-protocol population (n = 143) of a 2-year knee OA randomized clinical trial having magnetic resonance imaging at baseline and 2 years. Correlations used multivariate analyses. Greater baseline value for VM area and %Fat were significantly associated with sex (male, area; female, %Fat), higher body mass index (BMI), and Western Ontario and McMaster Universities Osteoarthritis Index stiffness, function, and total scores (better, high area; worse, high %Fat). Moreover, a VM %Fat increase of 1% at 2 years was associated with worsening of cartilage volume loss in the global knee (P = 0.015) and some subregions (P ≤ 0.030), and with an increment of BML global score change (P < 0.001). A 1% decrease in VM area at 2 years was associated with worsening of knee pain score (P = 0.048). Importantly, the concurrent presence of low VM area, high VM %Fat, and high BMI identified a subgroup of patients with greater cartilage volume loss in the medial femur (P = 0.028) than the rest of the cohort. These data demonstrated, for the first time, that VM fat content is a strong predictor of cartilage volume loss and the occurrence and progression of BML. Importantly, the combined data of VM area, VM %Fat, and BMI identified patients at higher risk for OA progression. © 2015, American College of Rheumatology.
Title: Effectiveness of Nonpharmacologic Interventions in Systemic Sclerosis: A Systematic Review. Citation: Arthritis care & research, Oct 2015, vol. 67, no. 10, p. 1426-1439 (October 2015) Author(s): Willems, Linda M, Vriezekolk, Johanna E, Schouffoer, Anne A, Poole, Janet L, Stamm, Tanja A, Boström, Carina, Kwakkenbos, Linda, Vliet Vlieland, Theodora P M, van den Ende, Cornelia H M Abstract: To systematically and comprehensively document the effectiveness of nonpharmacologic interventions on physical functioning and psychological well-being in patients with systemic sclerosis (SSc). Multiple electronic databases were searched for studies on the effectiveness of nonpharmacologic interventions in SSc. Randomized clinical trials (RCTs), controlled clinical trials (CCTs), and observational designs (ODs) with ≥10 participants were included. Two reviewers independently assessed methodologic quality using the Downs and Black checklist. Twenty-three studies (9 RCTs, 4 CCTs, and 10 ODs) were included. Studies assessing comparable interventions were grouped, resulting in data for 16 different interventions. The total number of patients included per study ranged from 10 to 53. Seventeen different outcome domains were assessed, with hand function, limitations in activities, and quality of life being assessed most frequently. Three studies, all RCTs, were rated as high quality. These RCTs reported that 1) a multifaceted oral health intervention improves mouth hygiene, and additional orofacial exercises did not improve mouth opening, 2) a multidisciplinary team-care program improves limitations in activities, mouth opening, and hand grip strength, and 3) manual lymph drainage improves hand function, limitations in activities, and quality of life. The body of knowledge regarding nonpharmacologic care in SSc is very limited due to the wide variety in studied interventions and outcomes in the relatively uncommon but highly disabling disease. To structure and focus future research, an international consensus should be established to prioritize primary targets for nonpharmacologic treatment and the content of interventions and to agree on a core set of outcome measures. © 2015, American College of Rheumatology.
Title: Diagnosis, Monitoring, and Treatment of Systemic Lupus Erythematosus: A Systematic Review of Clinical Practice Guidelines. Citation: Arthritis care & research, Oct 2015, vol. 67, no. 10, p. 1440-1452 (October 2015) Author(s): Tunnicliffe, David J, Singh-Grewal, Davinder, Kim, Siah, Craig, Jonathan C, Tong, Allison Abstract: Management of systemic lupus erythematosus (SLE) is complex and variability in practices exists. Guidelines have been developed to help improve the management of SLE patients, but there has been no formal evaluation of these guidelines. This study aims to compare the scope, quality, and consistency of clinical practice guidelines on the diagnosis, monitoring, and treatment of patients with SLE. Electronic databases were searched up to April 2014. The Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument and textual synthesis was used to appraise and compare recommendations. Nine clinical practice guidelines and 5 consensus statements were identified, which covered 7 topics: diagnosis, monitoring, treatment, neuropsychiatric SLE, lupus nephritis, antiphospholipid syndrome, and other manifestations of lupus. The methodological quality of the guidelines was variable, with the overall mean AGREE II scores ranging from 31% to 75%, out of a maximum 100%. Scores were consistently low for applicability, with only 1 guideline scoring above 50%. There was substantial variability in the treatments recommended for class II and V lupus nephritis, the recommended duration of maintenance therapy for class III/IV lupus nephritis (from 1 to 4 years), and timing of ophthalmologic examination for patients taking corticosteroids. Published guidelines on SLE cover a complex area of clinical care, but the methodological quality, scope, and recommendations varied substantially. Collaborative and multidisciplinary efforts to develop comprehensive, high-quality evidence-based guidelines are needed to promote best treatment and health outcomes for patients with SLE. © 2015, American College of Rheumatology.
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