Thornton Judith, Rangaraj Satyapal
School of Community-based Medicine, University of Manchester, Manchester, UK.
Cochrane Database Syst Rev. 2012 Sep 12;2012(9):CD007336. doi: 10.1002/14651858.CD007336.pub3.
Arthritis remains a relatively infrequent complication of cystic fibrosis, but is a cause of significant morbidity when it does occur. Two distinct types of arthritis are described in cystic fibrosis: cystic fibrosis-related arthropathy and hypertrophic osteoarthropathy. Management of arthritis in people with cystic fibrosis is uncertain and complex because of the underlying disease and its treatment.
To review the effectiveness and safety of disease-modifying anti-rheumatic drugs for the management of arthritis related to cystic fibrosis in adults and children.
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Cystic Fibrosis Trials Register which comprises references identified from comprehensive electronic database handsearches of relevant journal and abstract books of conference proceedings.Date of most recent search: 10 July 2012.
Randomised controlled trials which compared the efficacy and safety of disease-modifying anti-rheumatic drugs (e.g. methotrexate, gold, sulfasalazine, penicillamine, leflunomide, hydroxychloroquine and newer agents such as biologic disease modifying agents and monoclonal antibodies) with each other, with no treatment or with placebo for cystic fibrosis-related arthropathy or hypertrophic osteoarthropathy.
No relevant studies were identified.
No studies were included in this review.
AUTHORS' CONCLUSIONS: Although it is generally recognised that cystic fibrosis-related arthritis can be episodic and resolve spontaneously, treatment with analgesics and anti-inflammatory agents may be needed. But when episodic symptoms progress to persistent disease, disease-modifying anti-rheumatic drugs may be needed to limit the course of the disease. It is disappointing that no randomised controlled trials to rigorously evaluate these drugs could be found. This systematic review has identified the need for a well-designed adequately powered randomised controlled trial to assess the efficacy and safety of disease-modifying anti-rheumatic drugs for the management of cystic fibrosis-related arthropathy and hypertrophic osteoarthropathy in adults and children with cystic fibrosis. However, given the infrequency of cystic fibrosis-related arthritis and the range of symptoms and severity, randomised controlled trials may not be feasible and well-designed non-randomised observational studies may be more appropriate. Studies should also better define the two conditions.
关节炎仍是囊性纤维化相对罕见的并发症，但一旦发生，却是导致显著发病的原因。囊性纤维化中有两种不同类型的关节炎：囊性纤维化相关性关节病和肥厚性骨关节病。由于潜在疾病及其治疗方法，囊性纤维化患者关节炎的管理具有不确定性且较为复杂。
综述改善病情抗风湿药治疗成人和儿童囊性纤维化相关关节炎的有效性和安全性。
我们检索了Cochrane囊性纤维化和遗传疾病小组的囊性纤维化试验注册库，该注册库包含通过对相关期刊和会议论文摘要书籍进行全面电子数据库手工检索而确定的参考文献。最近一次检索日期：2012年7月10日。
比较改善病情抗风湿药（如甲氨蝶呤、金制剂、柳氮磺胺吡啶、青霉胺、来氟米特、羟氯喹以及生物改善病情药物和单克隆抗体等新型药物）相互之间、与未治疗或安慰剂相比，用于治疗囊性纤维化相关性关节病或肥厚性骨关节病的疗效和安全性的随机对照试验。
未识别出相关研究。
本综述未纳入任何研究。
尽管人们普遍认识到囊性纤维化相关关节炎可能呈发作性且可自发缓解，但可能需要使用镇痛药和抗炎药进行治疗。但是，当发作性症状进展为持续性疾病时，可能需要使用改善病情抗风湿药来限制疾病进程。令人失望的是，未找到严格评估这些药物的随机对照试验。本系统评价确定需要进行一项设计良好、有足够效力的随机对照试验，以评估改善病情抗风湿药治疗成人和儿童囊性纤维化患者囊性纤维化相关性关节病和肥厚性骨关节病的疗效和安全性。然而，鉴于囊性纤维化相关关节炎的罕见性以及症状和严重程度的范围，随机对照试验可能不可行，设计良好的非随机观察性研究可能更合适。研究还应更好地界定这两种情况。
