Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
Barts Health NHS Trust, London, United Kingdom.
Clin Ther. 2023 Sep;45(9):841-851. doi: 10.1016/j.clinthera.2023.05.009. Epub 2023 Aug 2.
Psoriatic arthritis (PsA) is a multisystem inflammatory disorder associated with significant mortality and morbidity, including functional impairment and psychological disability. Although evidence-based treatment recommendations are available for the use of drug treatments in PsA, there is little guidance for health professionals on nonpharmacologic and psychological interventions that may be useful in PsA. The objective of this systematic review (SR) was to identify how lifestyle modifications and the use of nonpharmacologic and psychological interventions may improve the outcomes of patients with PsA.
Studies were included if they evaluated adults diagnosed with PsA and included exposure to nonpharmacologic interventions, psychological interventions, and lifestyle modifications. The outcomes used needed to have been validated in PsA. A systematic literature search was run on May 28, 2021, in the Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED), EMBASE, Global Health, MEDLINE, and PsycINFO databases to identify articles related to lifestyle modifications and nonpharmacologic or psychological interventions for adults with PsA published between 2010 and 2021. Two review authors independently screened and selected full-text studies for inclusion in the SR. Risk of bias was assessed with either the Risk of Bias 2 (ie, RoB 2) tool or Critical Appraisal Skills Program checklist depending on the study type.
The search strategy identified 26,132 references. Eight studies examining lifestyle modifications and the effect on PsA were eligible to be included in the SR. Three of the 8 studies were randomized controlled trials, and 5 were nonrandomized studies. Three studies assessed physical activity, 3 assessed diet, 1 study assessed smoking, and another study assessed mud bath therapy. There was large heterogeneity between studies, and the measures of disease activity, and psychological and functional outcomes varied widely between studies.
Although this SR identified 8 relevant studies, these studies did not provide high-quality evidence to guide patients for non-drug treatments of PsA. The effectiveness of these interventions has therefore not been established. We found that physical activity seems to have a positive impact on disease activity and psychological well-being. Further well-designed research studies are needed to develop treatment recommendations. PROSPERO identifier: CRD42021257404.
银屑病关节炎（PsA）是一种多系统炎症性疾病，与较高的死亡率和发病率相关，包括功能障碍和心理残疾。尽管有针对药物治疗在 PsA 中应用的循证治疗建议，但针对可能对 PsA 有用的非药物和心理干预措施，健康专业人员几乎没有指导。本系统评价（SR）的目的是确定生活方式改变和非药物及心理干预措施的应用如何改善 PsA 患者的结局。
如果研究评估了诊断为 PsA 的成年人，并包括非药物干预、心理干预和生活方式改变的暴露，则纳入研究。所使用的结局需要在 PsA 中得到验证。于 2021 年 5 月 28 日在 Cochrane 对照试验中央注册库（CENTRAL）、护理和联合健康文献累积索引（CINAHL）、联合与补充医学数据库（AMED）、EMBASE、全球健康、MEDLINE 和 PsycINFO 数据库中进行了系统文献检索，以确定 2010 年至 2021 年期间发表的与成年人 PsA 相关的生活方式改变和非药物或心理干预的文章。两位综述作者独立筛选并选择全文研究纳入 SR。使用风险偏倚 2 工具（即 RoB 2）或批判性评估技能计划检查表评估风险偏倚，具体取决于研究类型。
检索策略确定了 26132 篇参考文献。8 项研究检查了生活方式改变及其对 PsA 的影响，有资格纳入 SR。其中 3 项为随机对照试验，5 项为非随机研究。3 项研究评估了体力活动，3 项研究评估了饮食，1 项研究评估了吸烟，另 1 项研究评估了泥浴疗法。研究之间存在很大的异质性，疾病活动以及心理和功能结局的测量指标在研究之间差异很大。
尽管本 SR 确定了 8 项相关研究，但这些研究并未提供高质量的证据来指导患者进行 PsA 的非药物治疗。因此，这些干预措施的有效性尚未确定。我们发现，体力活动似乎对疾病活动和心理健康有积极影响。需要进一步设计良好的研究来制定治疗建议。PROSPERO 标识符：CRD42021257404。
