Disease-modifying antirheumatic drugs (DMARDs)根据一项新的荟萃分析，骨关节炎并不是手部或膝关节关节炎(OA)的有效治疗方法。The drugs are commonly used to treatrheumatoid arthritis (RA)and other forms ofinflammatory arthritis, but researchers in the United Kingdom (UK) found they were no better than placebo for OA pain. Their findings appeared in June 2018 inRheumatology.
DMARDs aren’t pain medications. They’re meant to slow the disease and prevent further damage to joints and organs by suppressing inflammation. When DMARDs work, pain usually improves as inflammation gets under control.
There are three types of DMARDs. One group includestraditional (also called conventional) drugslike methotrexate (Rheumatrex, Trexall) and hydroxychloroquine (Plaquenil). These are relatively inexpensive and are often the first medications tried for inflammatory autoimmune diseases such as RA.
The second group includesbiologic DMARDS. These target molecules or pathways that trigger or perpetuate inflammation.
The third group is made up of so-called targeted DMARDs (namely, tofacitinib, baricitinib and apremilast), which are too new to have been included in this meta-analysis.
Historically, DMARDs haven’t been used for OA, which was long believed to result from wear and tear on cartilage, not inflammation. But many scientists now agree that OA has an inflammatory component, so researchers have been testing DMARDs for OA in clinical trials. Trial results have been mixed, however, and haven’t settled the question of what role inflammation plays in the disease.
That led researchers at the Arthritis UK Pain Centre at the University of Nottingham to undertake the first meta-analysis on the topic. For it, they analyzed 11 randomized, controlled clinical trials that used conventional or biologic DMARDs to treatOA painin more than 1,200 patients.
尽管在试验进行的方式、参与者数量和试验质量方面存在显著差异，但最终结果显示，安慰剂与传统或生物DMARD在缓解疼痛方面没有差异。
The authors say this doesn’t necessarily mean that inflammation doesn’t contribute to the development and progression of OA. Inflammation may play a role but isn’t the main driver of the disease. Or DMARDs might not target the right inflammatory pathways.
Another possibility is that the poor quality of some of the trials may have led to biased results. But lead study author Monica Persson, PhD, a researcher, says that’s not the case.
“Five of the 11 trials … may be considered high-quality trials,” she writes, noting that if only those five trials are considered, their conclusions are the same as for all 11.
She also points out that differences among the studies are more likely due to the type of DMARD (conventional vs. biologic), the joint affected and the subtype of OA rather than problems with the trials themselves.
Andrew Laster, MD, a rheumatologist with Arthritis & Osteoporosis Consultants of the Carolinas in Charlotte, North Carolina, isn’t so sure. Although he says the researchers’ conclusions are of interest because of the ongoing debate about the role of inflammation in OA, he cautions not to “put too much weight on this one meta-analysis because of a number of limitations in the analysis that the authors readily acknowledge,” including the varying quality of the studies.
David Pisetsky, MD, a professor of rheumatology and immunology at Duke University in Durham, North Carolina, agrees that it’s natural to want to know if existing therapies like DMARDs are effective for OA. But he points out that the study results are consistent with what doctors have seen with their own patients.
“The question is whether any of the newer [targeted DMARDs] would do better,” he says.
Currently, there are no disease-modifying drugs approved for treating OA. But your own body may be able to help. Many studies have shown thatexerciseandweight lossnot only relieve OA pain, they also have the potential to stop further structural damage to the joint, although it can’t repair or undo it.
一项大型研究发现，体重下降10%就可以改善运动能力，超重或肥胖的骨性关节炎患者的疼痛减轻50%。Afollow-up studyshowed that doubling the amount of weight loss cut pain and improved function by another 25 percent – all without drugs or surgery.
Author: Linda Rath
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- More Weight Loss is Better for Knee OA