Rheumatoid arthritis – Related resources

Cochrane reviews

Drug therapy

• Based on the limited data available, moderate-term prednisone treatment of RA appears to be superior to placebo and comparable to treatment with aspirin or chloroquine in improving several rheumatoid arthritis disease activity measures .
• Folate supplementation appears to reduce mucosal and GI side effects during methotrexate therapy for rheumatoid arthritis . Rofecoxib has similar efficacy as naproxen for patients with rheumatoid arthritis, but it causes less ulceration and gastrointestinal bleeding. Rofecoxib is associated with a greater risk of myocardial infarction .
• Celecoxib has similar effect as the traditional NSAIDs for rheumatoid arthritis. It is unclear whether the short-term reduced incidence of upper GI complications are maintained in the long-term .
• Treatment of rheumatoid arthritis patients with weak oral opioids for up to six weeks may offer clinically-relevant improvement in pain, but adverse effects are common and limit the utility of this class of analgesics .
• There is insufficient evidence on the efficacy of tricyclic antidepressants in pain management for patients with rheumatoid arthritis .

Physical therapy and rehabilitation

• Physical activity and psychosocial interventions may decrease self-reported fatigue in adults with rheumatoid arthritis .
• Ultrasound may be effective in increasing grip strength and alleviating symptoms in patients with rheumatoid arthritis .
• Electrical stimulation may have a clinically beneficial effect on grip strength and fatigue resistance for rheumatoid arthritis patients with muscle atrophy of the hand .
• AL-TENS (acupuncture-like TENS) and C-TENS (conventional TENS) may be effective for pain and patient's assessment of change in disease activity in arthritis of hand .
• Acupuncture and electroacupuncture may not be effective for rheumatoid arthritis .
• Laser therapy may be effective for short-term relief of pain and morning stiffness for patients with rheumatoid arthritis .
• There is insufficient evidence to show that balneotherapy is more effective than no treatment, that one type of bath is more effective than another or that one type of bath is more effective than mudpacks, exercise or relaxation therapy .
• Occupational therapy may have a positive effect on functional ability in patients with rheumatoid arthritis .
• The use of an eye drop device compared to a standard bottle appears to improve the ability to squeeze out drops, aim drops, control the number of drops, and to prevent adverse effects in adults with rheumatoid arthritis suffering from persistent dry eyes .

Lifestyle interventions

• Oils containing gamma linolenic acid (evening primrose, borage, or blackcurrant seed oil) might possibly afford some benefit in relieving symptoms for rheumatoid arthritis but the evidence is insufficient .
• Vegetarian and Cretan Mediterranean diets for rheumatoid arthritis may have limited effect on pain but not in physical function and, unintentional weight loss can be considered as an adverse effect .

Other evidence summaries

• Combination therapy appears to be better and not more hazardous than single treatment in induction of remission in early rheumatoid arthritis. The combination strategy as an initial therapy seems to increase the efficacy of the treatment in at least a proportion of patients with early rheumatoid arthritis .
• The delay of a few months from the onset of symptoms to institution of therapy appears to decrease the ability of the traditional single-drug strategy to induce remission in early RA .
• Aggressive combination-DMARD therapy with sulfasalazine, methotrexate, hydroxychloroquine, and prednisolone appears to prevent or retard the development of rheumatoid atlantoaxial disorders .
• Fish oil appears to have a modest effect on tender joint count and morning stiffness in rheumatoid arthritis, and reduces failure of triple disease-modifying antirheumatic drug (DMARD) therapy in patients with recent-onset rheumatoid arthritis.
• Paraffin wax baths may have some effect in improving symptoms in rheumatoid arthritic hands with few side effects .
• Fasting followed by vegetarian diet may improve symptoms in patients with rheumatoid arthritis .

Clinical guidelines

• Rausch Osthoff AK, Niedermann K, Braun J et al. 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Ann Rheum Dis 2018 Jul 11; [Epub ahead of print].
• Geenen R, Overman CL, Christensen R et al. EULAR recommendations for the health professional's approach to pain management in inflammatory arthritis and osteoarthritis. Ann Rheum Dis 2018;77(6):797-807.
• Smolen JS, Landewé R, Bijlsma J et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis 2017;76(6):960-977.
• Agca R, Heslinga SC, Rollefstad S et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis 2017;76(1):17-28.
• Götestam Skorpen C, Hoeltzenbein M, Tincani A et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis 2016;75(5):795-810.
• Buckley L, Guyatt G, Fink HA et al. 2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. Arthritis Care Res (Hoboken) 2017;69(8):1095-1110.
• Singh JA, Saag KG, Bridges SL Jr et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheumatol 2016;68(1):1-26.
• Smolen JS, Breedveld FC, Burmester GR et al. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis 2016;75(1):3-15.
• Singh JA, Furst DE, Bharat A et al. 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res (Hoboken) 2012;64(5):625-39.
• Management of early rheumatoid arthritis. Scottish Intercollegiate Guidelines Network (SIGN). Guideline No. 123

Other Internet resources

• Malottki K, Barton P, Tsourapas A, Uthman AO, Liu Z, Routh K, et al. Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a tumour necrosis factor inhibitor: a systematic review and economic evaluation. Health Technol Assess 2011;15(14) [Tiivistelmä suomeksi]

Literature

• Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet 2010 Sep 25;376(9746):1094-108.
• Aletaha D, Neogi T, Silman AJ et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 2010;62(9):2569-81.