Rheumatology International

, Volume 33, Issue 5, pp 1105–1120

Non-biologic disease-modifying antirheumatic drugs (DMARDs) improve pain in inflammatory arthritis (IA): a systematic literature review of randomized controlled trials

  • Amanda J. Steiman
  • Janet E. Pope
  • Heather Thiessen-Philbrook
  • Lihua Li
  • Cheryl Barnabe
  • Fares Kalache
  • Tabitha Kung
  • Louis Bessette
  • Cathy Flanagan
  • Boulos Haraoui
  • Jacqueline Hochman
  • Sharon Leclercq
  • Dianne Mosher
  • Carter Thorne
  • Vivian Bykerk
Review

DOI: 10.1007/s00296-012-2619-6

Cite this article as:
Steiman, A.J., Pope, J.E., Thiessen-Philbrook, H. et al. Rheumatol Int (2013) 33: 1105. doi:10.1007/s00296-012-2619-6

Abstract

Evidence supports early use of non-biologic DMARDs to prevent irreversible damage in inflammatory arthritides, including rheumatoid arthritis (RA), psoriatic arthritis (PsA), and possibly ankylosing spondylitis (AS). However, there is a paucity of data exploring their effects on pain as a primary outcome in these conditions. This systematic literature review investigated the effect of non-biologic DMARDs on pain levels in IA and examined whether disease duration impacted efficacy. We searched Medline, Embase, Cochrane Central, and Cochrane Database of Systematic Reviews, abstracts from the 2008 to 2010 American College of Rheumatology annual congresses, and citation lists of retrieved publications. Only randomized, double-blind controlled trials were analyzed. Quality was assessed with the Risk of Bias tool. Descriptive statistics were used in meta-analysis. 9,860 articles were identified, with 33 eligible for inclusion: 8 in AS, 6 in PsA, 9 in early RA (ERA), and 10 in established RA. In ERA and established RA, all studies of DMARDs (monotherapy and combination therapies) consistently revealed statistically significant reductions in pain except three oral gold studies. In AS, sulfasalazine studies showed significant pain reduction, whereas use of other DMARDs did not. In PsA, 5 of 6 studies reported VAS-pain improvement. From the studies included, we were unable to assess the influence of disease duration on pain outcomes in these rheumatic conditions. DMARDs improve pain in early and established RA. Sulfasalazine may improve pain in AS and PsA. Further study is needed to assess the relationship between disease duration and DMARD efficacy in reducing pain in these conditions.

Keywords

Arthritis Rheumatoid Arthritis Psoriatic Spondylitis Ankylosing Pain Pain measurement Antirheumatic agents 

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Amanda J. Steiman
    • 1
  • Janet E. Pope
    • 2
  • Heather Thiessen-Philbrook
    • 3
  • Lihua Li
    • 4
  • Cheryl Barnabe
    • 5
  • Fares Kalache
    • 6
  • Tabitha Kung
    • 7
  • Louis Bessette
    • 8
  • Cathy Flanagan
    • 9
  • Boulos Haraoui
    • 10
  • Jacqueline Hochman
    • 11
  • Sharon Leclercq
    • 12
  • Dianne Mosher
    • 13
  • Carter Thorne
    • 14
  • Vivian Bykerk
    • 7
    • 15
  1. 1.Division of Rheumatology, Toronto Western HospitalUniversity of Toronto, University Health NetworkTorontoCanada
  2. 2.Division of Rheumatology, St. Joseph’s HospitalWestern UniversityLondonCanada
  3. 3.London Kidney Clinical Research Unit, Division of NephrologyWestern University, London Health Sciences CentreLondonCanada
  4. 4.London Kidney Clinical Research Unit, Division of NephrologyWestern University, London Health Sciences CentreLondonCanada
  5. 5.Division of RheumatologyUniversity of CalgaryCalgaryCanada
  6. 6.Division of Rheumatology, Montreal General HospitalMcGill UniversityMontrealCanada
  7. 7.Division of Rheumatology, Mount Sinai HospitalUniversity of TorontoTorontoCanada
  8. 8.Division of RheumatologyLaval University, CHUQ, CHULQuebec CityCanada
  9. 9.Division of RheumatologyUniversity of British ColumbiaNew WestminsterCanada
  10. 10.Division of Rheumatology, CHUM, Notre-Dame HospitalUniversité de MontréalMontréalCanada
  11. 11.Women’s College Hospital and Research InstituteUniversity of TorontoTorontoCanada
  12. 12.Division of Rheumatology, Rockyview General HospitalUniversity of CalgaryCalgaryCanada
  13. 13.Division of Rheumatology, Department of MedicineUniversity of CalgaryCalgaryCanada
  14. 14.Division of RheumatologyUniversity of TorontoNewmarketCanada
  15. 15.Division of RheumatologyHospital for Special SurgeryNew York CityUSA

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