Evidence for Treating Rheumatoid Arthritis to Target: Results of a Systematic Literature Search

Overview

Journal Ann Rheum Dis

Specialty Rheumatology

Date 2010 Mar 19

PMID 20237123

Citations 86

Authors

Monika Schoels

Rachel Knevel

Daniel Aletaha

Johannes W J Bijlsma

Ferdinand C Breedveld

Dimitrios T Boumpas

Gerd Burmester

Bernard Combe

Maurizio Cutolo

Maxime Dougados

Paul Emery

Desiree van der Heijde

Tom W J Huizinga

Joachim Kalden

Edward C Keystone

Tore K Kvien

Emilio Martin-Mola

Carlomaurizio Montecucco

Maarten de Wit

Josef S Smolen

Affiliations

Soon will be listed here.

Abstract

Objectives: To summarise existing evidence on a target oriented approach for rheumatoid arthritis (RA) treatment.

Methods: We conducted a systematic literature search including all clinical trials testing clinical, functional, or structural values of a targeted treatment approach. Our search covered Medline, Embase and Cochrane databases until December 2008 and also conference abstracts (2007, 2008).

Results: The primary search yielded 5881 citations; after the selection process, 76 papers underwent detailed review. Of these, only seven strategic clinical trials were extracted: four studies randomised patients to routine or targeted treatment, two compared two different randomised targets and one compared targeted treatment to a historical control group. Five trials dealt with early RA patients. All identified studies showed significantly better clinical outcomes of targeted approaches than routine approaches. Disability was reported in two studies with no difference between groups. Four studies compared radiographic outcomes, two showing significant benefit of the targeted approach.

Conclusion: Only few studies employed randomised controlled settings to test the value of treatment to a specific target. However, they provided unanimous evidence for benefits of targeted approaches. Nevertheless, more data on radiographic and functional outcomes and on patients with established RA are needed.

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