Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Mod Rheumatol. 2022 Feb 28;32(2):313-322. doi: 10.1080/14397595.2021.1912922.
To provide an evidence base for clinical practice guidelines (CPG) for the management of rheumatoid arthritis (RA) in older adults.
PubMed, Cochrane library, and Japan Centra Revuo Medicina databases were searched for articles published between 1990 and 2019. Quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system, with some modifications.
Among 702 identified articles, there were 5 post-hoc analyses of randomized controlled trials and 10 observational studies. Meta-analysis of the former yielded a mean difference of the van der Heijde-modified total Sharp score of -2.79 (95% confidence interval [CI] - 3.74 to -1.84) for treatment with tumor necrosis factor inhibitors. The risk ratio (RR) for the American College of Rheumatology 50% response rate, and for serious adverse events was 2.83 (95%CI 1.90-4.21) and 1.32 (95%CI 0.53-3.31), respectively, for Janus kinase inhibitors. Meta-analysis of the observational studies yielded an RR for disease activity score-28 remission and serious infections of 0.76 (95%CI 0.64-0.91) and 1.92 (95%CI 1.31-2.81) for older-versus-younger patients receiving biological disease-modifying antirheumatic drugs, respectively.
This systematic review provides the necessary evidence for developing CPG for the management of RA in older adults.
为老年人类风湿关节炎（RA）管理的临床实践指南（CPG）提供循证依据。
检索 1990 年至 2019 年期间发表的文献，包括 PubMed、Cochrane 图书馆和日本 Centra Revuo Medicina 数据库。使用改良的 Grading of Recommendations Assessment, Development and Evaluation 系统评估证据质量。
在 702 篇确定的文章中，有 5 篇为随机对照试验的事后分析和 10 篇观察性研究。前者的荟萃分析得出，肿瘤坏死因子抑制剂治疗的 van der Heijde 改良总 Sharp 评分平均差值为-2.79（95%置信区间[CI]：-3.74 至-1.84）。美国风湿病学会 50%反应率和严重不良事件的风险比（RR）分别为 2.83（95%CI：1.90-4.21）和 1.32（95%CI：0.53-3.31），Janus 激酶抑制剂的 RR 分别为疾病活动评分 28 缓解和严重感染的 0.76（95%CI：0.64-0.91）和 1.92（95%CI：1.31-2.81）。
这项系统评价为制定老年人 RA 管理的 CPG 提供了必要的证据。
