Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, United Kingdom; National Institute for Health Research Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom; Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Jesi, Ancona, Italy.
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, United Kingdom; National Institute for Health Research Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
Semin Arthritis Rheum. 2021 Feb;51(1):266-277. doi: 10.1016/j.semarthrit.2020.11.008. Epub 2020 Dec 19.
To perform a systematic literature review (SLR) analysing all studies that reported on the efficacy and safety of pharmacological treatments for palindromic rheumatism (PR).
We performed a SLR using PubMed, Embase and Cochrane databases. Three main aspects of PR were considered: treating flares, preventing recurrence of flares (i.e. achieving remission), and preventing progression to RA or to other persistent arthritis. Quality assessment of the studies was performed using the Newcastle-Ottawa Scale (NOS).
Twenty-seven articles met the inclusion criteria: 6 (22.2%) retrospective studies, 8 (29.6%) longitudinal studies, and 13 (48.1%) case series/case reports. No randomized controlled trials (RCTs) were found. Most of the studies (21/27, 77.7%) had a high risk of bias according to NOS. Non-steroidal anti-inflammatory drugs were the most commonly reported treatments for flares of PR, with variable results. Anti-malarials, such as hydroxychloroquine and chloroquine phosphate, showed efficacy in reducing the frequency of the flares and, to a lesser extent, in preventing progression to RA. There was minimal evidence in support of other conventional/biological disease modifying anti-rheumatic treatments, or corticosteroids.
Although a frequent clinical dilemma for rheumatologists, the pharmacological management of PR has not been thoroughly evaluated, with no RCTs reported. Of all therapies, antimalarials have been the best studied and may be capable of reducing the recurrence of flares. The optimum treatment strategy for PR remains largely undefined and should be evaluated by robust RCTs in well-defined PR cohorts.
对所有报告关于缓解型类风湿关节炎（PR）的药物治疗的疗效和安全性的研究进行系统文献回顾（SLR）。
我们使用 PubMed、Embase 和 Cochrane 数据库进行了 SLR。考虑了 PR 的三个主要方面：治疗发作、预防发作复发（即达到缓解）以及预防进展为 RA 或其他持续性关节炎。使用纽卡斯尔-渥太华量表（NOS）对研究进行质量评估。
27 篇文章符合纳入标准：6 篇（22.2%）回顾性研究、8 篇（29.6%）纵向研究和 13 篇（48.1%）病例系列/病例报告。未发现随机对照试验（RCT）。根据 NOS，大多数研究（21/27，77.7%）存在高偏倚风险。非甾体抗炎药是最常报告的治疗 PR 发作的药物，但结果不一。抗疟药，如羟氯喹和磷酸氯喹，显示出降低发作频率的疗效，在一定程度上也能预防进展为 RA。其他常规/生物疾病修饰抗风湿治疗或皮质类固醇的证据很少。
尽管缓解型类风湿关节炎是风湿科医生经常面临的临床难题，但对其药物治疗尚未进行全面评估，也未报告 RCT。在所有治疗方法中，抗疟药研究最多，可能能够减少发作的复发。缓解型类风湿关节炎的最佳治疗策略仍基本未明，应在明确的缓解型类风湿关节炎队列中进行稳健的 RCT 进行评估。
