Mathieu Sylvain, Tournadre Anne, Soubrier Martin, Sellam Jérémie
Service de Rhumatologie, CHU Gabriel Montpied, Clermont-Ferrand, France.
Service de Rhumatologie, CHU Gabriel Montpied, Clermont-Ferrand, France.
Joint Bone Spine. 2022 Nov;89(6):105444. doi: 10.1016/j.jbspin.2022.105444. Epub 2022 Jul 28.
Osteoarthritis (OA) displays features of systemic and local inflammation, suggesting that DMARDs used in rheumatoid arthritis could potentially also be effective in OA. However, studies of the effects of DMARDs in OA have yielded conflicting data, and have been insufficiently large to draw conclusions. In this meta-analysis, we aimed to estimate the effect of DMARDs - such as methotrexate, hydroxychloroquine, TNF, and IL-1 inhibitors - on OA.
We searched for relevant articles of randomized controlled trials published up to March 2022, using Pubmed, EMBASE, and the Cochrane Library. Studies were reviewed in accordance with PRISMA 2020 guidelines. The effects of DMARDs on OA outcomes (symptoms, quality of life, ESR) were expressed as the standardized mean difference.
We retrieved 29 references. Among these, 23 randomized controlled trials compared the effects of DMARDs versus placebo or other treatments on disease activity, including 1143 DMARD-treated OA patients and 1155 OA patients in the control group. We found statistically significant improvement of pain and stiffness with methotrexate, especially in knee OA. TNF inhibitors improved the swollen joint count in hand OA, and inflammation parameters, without change in pain, stiffness, or function. Hydroxychloroquine and IL-1 inhibitors were not effective.
Overall, the presently available data regarding the effects of DMARDs on OA symptoms intensity are disappointing. Only methotrexate might have an analgesic effect, especially in knee OA, which warrants further investigation.
骨关节炎（OA）表现出全身和局部炎症特征，这表明类风湿关节炎中使用的改善病情抗风湿药（DMARDs）可能对OA也有效。然而，关于DMARDs对OA影响的研究得出了相互矛盾的数据，且规模不足以得出结论。在这项荟萃分析中，我们旨在评估DMARDs（如甲氨蝶呤、羟氯喹、肿瘤坏死因子（TNF）和白细胞介素-1（IL-1）抑制剂）对OA的影响。
我们使用PubMed、EMBASE和Cochrane图书馆检索了截至2022年3月发表的随机对照试验相关文章。研究按照PRISMA 2020指南进行综述。DMARDs对OA结局（症状、生活质量、红细胞沉降率（ESR））的影响以标准化平均差表示。
我们检索到29篇参考文献。其中，23项随机对照试验比较了DMARDs与安慰剂或其他治疗对疾病活动的影响，包括1143例接受DMARDs治疗的OA患者和1155例对照组OA患者。我们发现甲氨蝶呤在改善疼痛和僵硬方面有统计学意义，尤其是在膝关节OA中。TNF抑制剂改善了手部OA的肿胀关节计数和炎症参数，但疼痛、僵硬或功能无变化。羟氯喹和IL-1抑制剂无效。
总体而言，目前关于DMARDs对OA症状强度影响的现有数据令人失望。只有甲氨蝶呤可能具有镇痛作用，尤其是在膝关节OA中，这值得进一步研究。
