Iannuzzi L, Dawson N, Zein N, Kushner I
N Engl J Med. 1983 Oct 27;309(17):1023-8. doi: 10.1056/NEJM198310273091704.
Many clinicians believe that slow-acting therapeutic agents, such as fold, penicillamine, the antimalarials, and cytotoxic drugs, can retard joint destruction in rheumatoid arthritis. We reviewed 60 published studies employing these drugs to evaluate critically the evidence that drug therapy can slow the radiographic progression of disease. Seventeen studies were found that included radiographic assessment of both treated and control groups; they were analyzed using methodologic criteria known to be important in affecting the results of drug trials. In addition to numerous qualitative methodologic deficiencies, many studies showed inadequacies in sample size and duration of treatment, and the drug dosage used varied from one study to another. We found evidence suggesting that both gold and cyclophosphamide can retard radiographic progression of joint destruction. At present, there are too few technically adequate studies to permit even provisional conclusions concerning other agents.
许多临床医生认为，慢效治疗药物，如金制剂、青霉胺、抗疟药和细胞毒性药物，可延缓类风湿性关节炎的关节破坏。我们回顾了60项已发表的使用这些药物的研究，以严格评估药物治疗可减缓疾病放射学进展的证据。发现有17项研究对治疗组和对照组均进行了放射学评估；采用已知对药物试验结果有重要影响的方法学标准对这些研究进行了分析。除了众多质量方法学缺陷外，许多研究在样本量和治疗持续时间方面也存在不足，而且各研究使用的药物剂量也各不相同。我们发现有证据表明金制剂和环磷酰胺均可延缓关节破坏的放射学进展。目前，技术上充分的研究太少，甚至无法就其他药物得出临时结论。
