INTRODUCTION: Rheumatoid arthritis is a chronic autoimmune disease, which most often presents as a symmetrical polyarthritis of the hands and feet. Pharmacological treatments include non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids (GCs) and other disease-modifying anti-rheumatoid drugs (DMARDs), which may be synthetic (either conventional [csDMARDs] or targeted [tsDMARDs]) or biological (bDMARDs). METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical questions: What are the effects of methotrexate in combination with other csDMARDs versus methotrexate monotherapy in people with rheumatoid arthritis who have not previously received any DMARD treatment (first-line treatment)? What are the effects of bDMARDs as monotherapy versus methotrexate or other csDMARDs in people with rheumatoid arthritis who have not previously received any DMARD treatment (first-line treatment)? What are the effects of bDMARDs in combination with methotrexate versus methotrexate monotherapy or other csDMARDs in people with rheumatoid arthritis who have not previously received any DMARD treatment (first-line treatment)? What are the effects of glucocorticoids in combination with methotrexate or with other csDMARDs versus methotrexate or other csDMARDs in people with rheumatoid arthritis who have not previously received any DMARD treatment (first-line treatment)? We searched: Medline, Embase, The Cochrane Library and other important databases up to December 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). RESULTS: At this update, searching of electronic databases retrieved 2058 studies. Of the full articles evaluated, 10 systematic reviews, 22 RCTs, and one follow-up report were added at this update. We performed a GRADE evaluation for 18 PICO combinations. CONCLUSIONS: In this systematic overview, we categorised the efficacy for 22 comparisons based on information about the effectiveness and safety of bDMARDs (monotherapy or combined with csDMARDs), csDMARDs (monotherapy or combined with other csDMARDs), glucocorticoids combined with methotrexate or other csDMARDs, and methotrexate (monotherapy or combined with other csDMARDs), identifying interventions which were likely or unlikely to be beneficial.
INTRODUCTION:Rheumatoid arthritis is a chronic autoimmune disease, which most often presents as a symmetrical polyarthritis of the hands and feet. Pharmacological treatments include non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids (GCs) and other disease-modifying anti-rheumatoid drugs (DMARDs), which may be synthetic (either conventional [csDMARDs] or targeted [tsDMARDs]) or biological (bDMARDs). METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical questions: What are the effects of methotrexate in combination with other csDMARDs versus methotrexate monotherapy in people with rheumatoid arthritis who have not previously received any DMARD treatment (first-line treatment)? What are the effects of bDMARDs as monotherapy versus methotrexate or other csDMARDs in people with rheumatoid arthritis who have not previously received any DMARD treatment (first-line treatment)? What are the effects of bDMARDs in combination with methotrexate versus methotrexate monotherapy or other csDMARDs in people with rheumatoid arthritis who have not previously received any DMARD treatment (first-line treatment)? What are the effects of glucocorticoids in combination with methotrexate or with other csDMARDs versus methotrexate or other csDMARDs in people with rheumatoid arthritis who have not previously received any DMARD treatment (first-line treatment)? We searched: Medline, Embase, The Cochrane Library and other important databases up to December 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). RESULTS: At this update, searching of electronic databases retrieved 2058 studies. Of the full articles evaluated, 10 systematic reviews, 22 RCTs, and one follow-up report were added at this update. We performed a GRADE evaluation for 18 PICO combinations. CONCLUSIONS: In this systematic overview, we categorised the efficacy for 22 comparisons based on information about the effectiveness and safety of bDMARDs (monotherapy or combined with csDMARDs), csDMARDs (monotherapy or combined with other csDMARDs), glucocorticoids combined with methotrexate or other csDMARDs, and methotrexate (monotherapy or combined with other csDMARDs), identifying interventions which were likely or unlikely to be beneficial.
Authors: Monica Todoerti; Carlo Alberto Scirè; Nicola Boffini; Serena Bugatti; Carlomaurizio Montecucco; Roberto Caporali Journal: Ann N Y Acad Sci Date: 2010-04 Impact factor: 5.691
Authors: M Boers; A C Verhoeven; H M Markusse; M A van de Laar; R Westhovens; J C van Denderen; D van Zeben; B A Dijkmans; A J Peeters; P Jacobs; H R van den Brink; H J Schouten; D M van der Heijde; A Boonen; S van der Linden Journal: Lancet Date: 1997-08-02 Impact factor: 79.321
Authors: J N Hoes; J W G Jacobs; M Boers; D Boumpas; F Buttgereit; N Caeyers; E H Choy; M Cutolo; J A P Da Silva; G Esselens; L Guillevin; I Hafstrom; J R Kirwan; J Rovensky; A Russell; K G Saag; B Svensson; R Westhovens; H Zeidler; J W J Bijlsma Journal: Ann Rheum Dis Date: 2007-07-27 Impact factor: 19.103
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Authors: Ferdinand C Breedveld; Michael H Weisman; Arthur F Kavanaugh; Stanley B Cohen; Karel Pavelka; Ronald van Vollenhoven; John Sharp; John L Perez; George T Spencer-Green Journal: Arthritis Rheum Date: 2006-01
Authors: Paul Emery; Ferdinand C Breedveld; Stephen Hall; Patrick Durez; David J Chang; Deborah Robertson; Amitabh Singh; Ronald D Pedersen; Andrew S Koenig; Bruce Freundlich Journal: Lancet Date: 2008-07-16 Impact factor: 79.321
Authors: Victoria Bejarano; Mark Quinn; Philip G Conaghan; Richard Reece; Anne-Maree Keenan; David Walker; Andrew Gough; Michael Green; Dennis McGonagle; Ade Adebajo; Stephen Jarrett; Sheelagh Doherty; Lesley Hordon; Richard Melsom; Kristina Unnebrink; Hartmut Kupper; Paul Emery Journal: Arthritis Rheum Date: 2008-10-15
Authors: Daniel F McWilliams; Sneha Varughese; Adam Young; Patrick D Kiely; David A Walsh Journal: Rheumatology (Oxford) Date: 2013-11-15 Impact factor: 7.580
Authors: Philip Conaghan; Stanley Cohen; Gerd Burmester; Eduardo Mysler; Peter Nash; Yoshiya Tanaka; William Rigby; Jayeshkumar Patel; Tim Shaw; Keith A Betts; Pankaj Patel; Jianzhong Liu; Rochelle Sun; Roy Fleischmann Journal: Rheumatol Ther Date: 2021-11-23