ABSTRACT
OBJETIVOS: 1) Revisar sistemática y críticamente la evidencia sobre las características de uso, eficacia y seguridad de los glucocorticoides (GC) en la artritis reumatoide (AR); 2) emitir recomendaciones prácticas sobre su utilización. MÉTODOS: Se realizó una revisión sistemática de la literatura con una estrategia de búsqueda bibliográfica sensible en Medline, Embase y Cochrane Library. Se seleccionaron ensayos clínicos aleatorizados que analizasen la eficacia y/o la seguridad de los GC en pacientes con AR. Dos revisores realizaron la primera selección por título y abstract y 10, la selección tras lectura en detalle y la recogida de datos. La calidad se evaluó con la escala de Jadad. En una reunión de grupo nominal con base en sus resultados se consensuaron una serie de recomendaciones. RESULTADOS: Se incluyeron 47 artículos. Los GC, en combinación con los fármacos antirreumáticos modificadores de la enfermedad, ayudan a controlar la actividad de la enfermedad y a inhibir la progresión radiográfica, especialmente en el corto-medio plazo y en las AR de inicio. Los GC pueden mejorar la función y el dolor. Distintos tipos y vías de administración son eficaces, sin que exista un esquema de tratamiento estandarizado (dosis de inicio, desescalada y duración del tratamiento con los GC) superior a otro. Los acontecimientos adversos de los GC son muy frecuentes, dependientes de la dosis, de gravedad variable, muchos de ellos leves. Se generaron 7 recomendaciones sobre el uso y la gestión del riesgo de los GC. CONCLUSIONES: Estas recomendaciones pretenden resolver algunos interrogantes clínicos habituales y facilitar la toma de decisiones con respecto al uso de GC en la AR
OBJECTIVES: 1) To systematically and critically review the evidence on the characteristics, efficacy and safety of glucocorticoids (CS) in rheumatoid arthritis (RA); 2) to generate practical recommendations. METHODS: A systematic literature review was performed through a sensitive bibliographic search strategy in Medline, Embase and the Cochrane Library. We selected randomized clinical trials that analyzed the efficacy and/or safety of CS in patients with RA. Two reviewers performed the first selection by title and abstract. Then 10 reviewers selected the studies after a detailed review of the articles and data collection. The quality of the studies was evaluated with the Jadad scale. In a nominal group meeting, based on the results of the systematic literature review, related recommendations were reached by consensus. RESULTS: A total of 47 articles were finally included. CS in combination with disease-modifying antirheumatic drugs help control disease activity and inhibit radiographic progression, especially in the short-to-medium term and in early RA. CS can also improve function and relieve pain. Different types and routes of administration are effective, but there is no standardized scheme (initial dose, tapering and duration of treatment) that is superior to others. Adverse events when using CS are very frequent and are dose-dependent and variable severity, although most are mild. Seven recommendations were generated on the use and risk management of CS. CONCLUSIONS: These recommendations aim to resolve some common clinical questions and aid in decision-making for CS use in RA
Subject(s)
Humans , Treatment Outcome , Glucocorticoids/therapeutic use , Arthritis, Rheumatoid/drug therapy , Drug Compounding/standards , Risk Management/standards , Societies, Medical/standardsABSTRACT
OBJECTIVES: 1) To systematically and critically review the evidence on the characteristics, efficacy and safety of glucocorticoids (CS) in rheumatoid arthritis (RA); 2) to generate practical recommendations. METHODS: A systematic literature review was performed through a sensitive bibliographic search strategy in Medline, Embase and the Cochrane Library. We selected randomized clinical trials that analyzed the efficacy and/or safety of CS in patients with RA. Two reviewers performed the first selection by title and abstract. Then 10 reviewers selected the studies after a detailed review of the articles and data collection. The quality of the studies was evaluated with the Jadad scale. In a nominal group meeting, based on the results of the systematic literature review, related recommendations were reached by consensus. RESULTS: A total of 47 articles were finally included. CS in combination with disease-modifying antirheumatic drugs help control disease activity and inhibit radiographic progression, especially in the short-to-medium term and in early RA. CS can also improve function and relieve pain. Different types and routes of administration are effective, but there is no standardized scheme (initial dose, tapering and duration of treatment) that is superior to others. Adverse events when using CS are very frequent and are dose-dependent and variable severity, although most are mild. Seven recommendations were generated on the use and risk management of CS. CONCLUSIONS: These recommendations aim to resolve some common clinical questions and aid in decision-making for CS use in RA.
Subject(s)
Arthritis, Rheumatoid/drug therapy , Glucocorticoids/therapeutic use , Glucocorticoids/adverse effects , Humans , Treatment OutcomeABSTRACT
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Subject(s)
Humans , Female , Aged , Arthritis, Rheumatoid/drug therapy , Myasthenia Gravis/complications , Myasthenia Gravis/drug therapy , Rituximab/therapeutic use , Treatment Outcome , Autoimmune Diseases/complications , Autoimmune Diseases/drug therapy , Retreatment/trendsSubject(s)
Arthritis, Rheumatoid/drug therapy , Immunosuppressive Agents/therapeutic use , Myasthenia Gravis/drug therapy , Rituximab/therapeutic use , Aged , Antirheumatic Agents/adverse effects , Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/immunology , Drug Substitution , Etanercept/adverse effects , Etanercept/therapeutic use , Female , Humans , Myasthenia Gravis/chemically induced , Myasthenia Gravis/complications , Myasthenia Gravis/immunology , Prednisone/therapeutic use , Remission InductionABSTRACT
No disponible
Subject(s)
Humans , Female , Aged , Calcinosis/complications , Dermatomyositis/drug therapy , Dermatomyositis , Immunosuppressive Agents/administration & dosage , Diphosphonates/administration & dosage , Fever/complications , Fever/etiology , Colchicine/therapeutic use , Streptococcus mitis , Streptococcus mitis/isolation & purification , Escherichia coli , Escherichia coli/isolation & purificationSubject(s)
Calcinosis/etiology , Dermatomyositis/complications , Age of Onset , Aged , Anti-Bacterial Agents/therapeutic use , Breast Neoplasms , Calcinosis/pathology , Coinfection , Dermatomyositis/drug therapy , Escherichia coli Infections/complications , Escherichia coli Infections/drug therapy , Female , Humans , Immunosuppressive Agents/therapeutic use , Streptococcal Infections/complications , Streptococcal Infections/drug therapy , Streptococcus mitis , SuperinfectionABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Arthritis/etiology , Pityriasis Lichenoides/complications , Exanthema/etiology , Anti-Bacterial Agents/therapeutic useABSTRACT
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Subject(s)
Humans , Male , Female , Calcinosis/congenital , Calcinosis/genetics , Myositis/diagnosis , Myositis/genetics , Raynaud Disease/congenital , Raynaud Disease/metabolism , Fibrosis/pathology , Calcinosis/pathology , Myositis/rehabilitation , Myositis/therapy , Raynaud Disease/complications , Raynaud Disease/diagnosis , Fibrosis/congenital , Calcinosis/metabolismABSTRACT
The advent of biological therapies has revolutionized the management of rheumatoid arthritis, demonstrating effectiveness in controlling clinical and radiological damage. However, 20 to 40% of the patients will not respond to these therapies, which are associated to a very high cost. In addition, non-responder patients are exposed to possible adverse effects. For these reasons, we need to identify predictors of response to these treatments. These predictors are reviewed in this evidence-based paper and classified into genetic and non-genetic. Despite extensive search, nowadays there are no predictors powerful enough to be used in regular clinical practice. Serum factors, the presence of rheumatoid factor and anti-cyclic citrullinated peptide antibodies, are the only factors currently being used to predict the response to specific biological therapy. In the future, probably thanks to new technologies based on genomics, transcriptomics and proteomics, it will be possible to identify genetic predictors of response to biological drugs that will allow us to select suitable patients for a specific biological therapy.
Subject(s)
Arthritis, Rheumatoid/therapy , Biological Therapy , Antibody Specificity , Arthritis, Rheumatoid/blood , Arthritis, Rheumatoid/genetics , Arthritis, Rheumatoid/immunology , Autoantibodies/blood , Autoantibodies/immunology , Autoantigens/immunology , Autoantigens/metabolism , Biomarkers , Cartilage Oligomeric Matrix Protein , Citrulline/metabolism , Cytokines/blood , Extracellular Matrix Proteins/blood , Genome-Wide Association Study , Glycoproteins/blood , Humans , Major Histocompatibility Complex , Matrilin Proteins , Polymorphism, Single Nucleotide , Prognosis , Protein Processing, Post-Translational , Proteome , Rheumatoid Factor/analysis , TranscriptomeABSTRACT
El desarrollo de las terapias biológicas ha supuesto un gran avance en el manejo de la artritis reumatoide (AR) al haber demostrado efectividad en el control de la clínica y daño radiológico. Sin embargo, entre un 20-40% de los pacientes no van a responder a estas terapias, lo que determina un alto coste económico a la vez que los expone a posibles efectos adversos, por lo que se precisa de la identificación de factores predictores de respuesta a ellos. Estos se revisan en el actual trabajo en función de su evidencia científica y se clasifican en genéticos y no genéticos. A pesar de su extensa búsqueda, en la actualidad no disponemos de potentes predictores que puedan ser utilizados en la práctica clínica diaria. Posiblemente a día de hoy sólo los factores séricos, positividad del factor reumatoide (FR) y anticuerpos antipéptido citrulinado (anti-CCP), permiten predecir la respuesta a determinados biológicos. En un futuro, probablemente gracias a las nuevas tecnologías basadas en la genómica, transcriptómica y proteómica se identificarán predictores genéticos que permita seleccionar pacientes idóneos para una determinada terapia biológica(AU)
The advent of biological therapies has revolutionized the management of rheumatoid arthritis, demonstrating effectiveness in controlling clinical and radiological damage. However, 20 to 40% of the patients will not respond to these therapies, which are associated to a very high cost. In addition, non-responder patients are exposed to possible adverse effects. For these reasons, we need to identify predictors of response to these treatments. These predictors are reviewed in this evidence-based paper and classified into genetic and non-genetic. Despite extensive search, nowadays there are no predictors powerful enough to be used in regular clinical practice. Serum factors, the presence of rheumatoid factor and anti-cyclic citrullinated peptide antibodies, are the only factors currently being used to predict the response to specific biological therapy. In the future, probably thanks to new technologies based on genomics, transcriptomics and proteomics, it will be possible to identify genetic predictors of response to biological drugs that will allow us to select suitable patients for a specific biological therapy(AU)
Subject(s)
Humans , Male , Female , Biological Therapy/methods , Biological Therapy , Arthritis, Rheumatoid/therapy , Rheumatoid Factor/immunology , Rheumatoid Factor , Biological Therapy/statistics & numerical data , Biological Therapy/trends , Rheumatoid Factor/metabolism , Rheumatoid Factor/physiology , Rheumatoid Factor/therapeutic useABSTRACT
No disponible
Subject(s)
Humans , Behcet Syndrome/complications , Vision Disorders/complications , Arthralgia/complications , Protein C Deficiency/diagnosisSubject(s)
Antibodies, Monoclonal/pharmacology , Antibodies, Monoclonal/therapeutic use , Antirheumatic Agents/pharmacology , Arthritis, Rheumatoid/drug therapy , Cholesterol, HDL/metabolism , Cholesterol, LDL/metabolism , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Adult , Aged , Antibodies, Monoclonal/administration & dosage , Antirheumatic Agents/administration & dosage , Female , Humans , Infliximab , Male , Middle Aged , Prospective StudiesABSTRACT
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