Efficacy and safety of non-pharmacological, pharmacological and surgical treatment for hand osteoarthritis: a systematic literature review informing the 2018 update of the EULAR recommendations for the management of hand osteoarthritis

To update the evidence on efficacy and safety of non-pharmacological, pharmacological and surgical interventions for hand osteoarthritis (OA), a systematic literature review was performed up to June 2017, including (randomised) controlled trials or Cochrane systematic reviews. Main efficacy outcomes were pain, function and hand strength. Risk of bias was assessed. Meta-analysis was performed when advisable. Of 7036 records, 127 references were included, of which 50 studies concerned non-pharmacological, 64 pharmacological and 12 surgical interventions. Many studies had high risk of bias, mainly due to inadequate randomisation or blinding. Beneficial non-pharmacological treatments included hand exercise and prolonged thumb base splinting, while single trials showed positive results for joint protection and using assistive devices. Topical and oral non-steroidal anti-inflammatory drugs (NSAIDs) proved equally effective, while topical NSAIDs led to less adverse events. Single trials demonstrated positive results for chondroitin sulfate and intra-articular glucocorticoid injections in interphalangeal joints. Pharmacological treatments for which no clear beneficial effect was shown include paracetamol, intra-articular thumb base injections of glucocorticoids or hyaluronic acid, low-dose oral glucocorticoids, hydroxychloroquine and anti-tumour necrosis factor. No trials compared surgery to sham or non-operative treatment. No surgical intervention for thumb base OA appeared more effective than another, although in general more complex procedures led to more complications. No interventions slowed radiographic progression. In conclusion, an overview of the evidence on efficacy and safety of treatment options for hand OA was presented and informed the task force for the updated European League Against Rheumatism management recommendations for hand OA.

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A Systematic Literature Review of Dorsal Root Ganglion Neurostimulation for the Treatment of Pain

Pain Medicine ◽

10.1093/pm/pnaa005 ◽

2020 ◽

Vol 21 (8) ◽

pp. 1581-1589 ◽

Cited By ~ 2

Author(s):

Timothy R Deer ◽

Corey W Hunter ◽

Pankaj Mehta ◽

Dawood Sayed ◽

Jay S Grider ◽

...

Keyword(s):

Dorsal Root Ganglion ◽

Literature Review ◽

Systematic Literature Review ◽

Dorsal Root ◽

Task Force ◽

Controlled Trial ◽

Risk Of Bias ◽

Level Of Evidence ◽

Bias Assessment ◽

Randomized Controlled

Abstract Objective To conduct a systematic literature review of dorsal root ganglion (DRG) stimulation for pain. Design Grade the evidence for DRG stimulation. Methods An international, interdisciplinary work group conducted a literature search for DRG stimulation. Abstracts were reviewed to select studies for grading. General inclusion criteria were prospective trials (randomized controlled trials and observational studies) that were not part of a larger or previously reported group. Excluded studies were retrospective, too small, or existed only as abstracts. Studies were graded using the modified Interventional Pain Management Techniques–Quality Appraisal of Reliability and Risk of Bias Assessment, the Cochrane Collaborations Risk of Bias assessment, and the US Preventative Services Task Force level-of-evidence criteria. Results DRG stimulation has Level II evidence (moderate) based upon one high-quality pivotal randomized controlled trial and two lower-quality studies. Conclusions Moderate-level evidence supports DRG stimulation for treating chronic focal neuropathic pain and complex regional pain syndrome.

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A Systematic Literature Review of Brain Neurostimulation Therapies for the Treatment of Pain

Pain Medicine ◽

10.1093/pm/pnz371 ◽

2020 ◽

Vol 21 (7) ◽

pp. 1415-1420

Author(s):

Timothy R Deer ◽

Steven Falowski ◽

Jeff E Arle ◽

Jan Vesper ◽

Julie Pilitsis ◽

...

Keyword(s):

Literature Review ◽

Systematic Literature Review ◽

Task Force ◽

Work Group ◽

The United States ◽

Risk Of Bias ◽

Current Evidence ◽

Level Of Evidence ◽

Bias Assessment ◽

Moderate Evidence

Abstract Objective To conduct a systematic literature review of brain neurostimulation for pain. Design Grade the evidence for deep brain neurostimulation (DBS). Methods An international, interdisciplinary work group conducted a literature search for brain stimulation. Abstracts were reviewed to select studies for grading. Randomized controlled trials (RCTs) meeting inclusion/exclusion criteria were graded by two independent reviewers. General inclusion criteria were prospective trials (RCTs and observational) that were not part of a larger or previously reported group. Excluded studies were retrospective or existed only as abstracts. Studies were graded using the modified Interventional Pain Management Techniques–Quality Appraisal of Reliability and Risk of Bias Assessment, the Cochrane Collaborations Risk of Bias assessment, and the United States Preventative Services Task Force level-of-evidence criteria. Results Two high-quality RCTs and three observational trials supported DBS, resulting in Level II (moderate) evidence. Conclusion Moderate evidence supports DBS to treat chronic pain. Additional Level I RCTs are needed to further the strength of the evidence in this important area of medicine, but the current evidence suggests that DBS should be considered as an option in treating complex pain cases.

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A Systematic Literature Review of Peripheral Nerve Stimulation Therapies for the Treatment of Pain

Pain Medicine ◽

10.1093/pm/pnaa030 ◽

2020 ◽

Vol 21 (8) ◽

pp. 1590-1603

Author(s):

Timothy R Deer ◽

Michael F Esposito ◽

W Porter McRoberts ◽

Jay S Grider ◽

Dawood Sayed ◽

...

Keyword(s):

Literature Review ◽

Peripheral Nerve ◽

Systematic Literature Review ◽

Nerve Stimulation ◽

Strong Evidence ◽

Task Force ◽

Risk Of Bias ◽

Peripheral Nerve Stimulation ◽

Level Of Evidence ◽

Bias Assessment

Abstract Objective To conduct a systematic literature review of peripheral nerve stimulation (PNS) for pain. Design Grade the evidence for PNS. Methods An international interdisciplinary work group conducted a literature search for PNS. Abstracts were reviewed to select studies for grading. Inclusion/exclusion criteria included prospective randomized controlled trials (RCTs) with meaningful clinical outcomes that were not part of a larger or previously reported group. Excluded studies were retrospective, had less than two months of follow-up, or existed only as abstracts. Full studies were graded by two independent reviewers using the modified Interventional Pain Management Techniques–Quality Appraisal of Reliability and Risk of Bias Assessment, the Cochrane Collaborations Risk of Bias assessment, and the US Preventative Services Task Force level-of-evidence criteria. Results Peripheral nerve stimulation was studied in 14 RCTs for a variety of painful conditions (headache, shoulder, pelvic, back, extremity, and trunk pain). Moderate to strong evidence supported the use of PNS to treat pain. Conclusion Peripheral nerve stimulation has moderate/strong evidence. Additional prospective trials could further refine appropriate populations and pain diagnoses.

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A Systematic Literature Review of Spine Neurostimulation Therapies for the Treatment of Pain

Pain Medicine ◽

10.1093/pm/pnz353 ◽

2020 ◽

Vol 21 (7) ◽

pp. 1421-1432 ◽

Cited By ~ 8

Author(s):

Timothy R Deer ◽

Jay S Grider ◽

Tim J Lamer ◽

Jason E Pope ◽

Steven Falowski ◽

...

Keyword(s):

Literature Review ◽

Complex Regional Pain Syndrome ◽

Systematic Literature Review ◽

Task Force ◽

Pain Syndrome ◽

Risk Of Bias ◽

Intractable Pain ◽

High Quality ◽

Bias Assessment ◽

Failed Back Surgery

Abstract Objective To conduct a systematic literature review of spinal cord stimulation (SCS) for pain. Design Grade the evidence for SCS. Methods An international, interdisciplinary work group conducted literature searches, reviewed abstracts, and selected studies for grading. Inclusion/exclusion criteria included randomized controlled trials (RCTs) of patients with intractable pain of greater than one year’s duration. Full studies were graded by two independent reviewers. Excluded studies were retrospective, had small numbers of subjects, or existed only as abstracts. Studies were graded using the modified Interventional Pain Management Techniques–Quality Appraisal of Reliability and Risk of Bias Assessment, the Cochrane Collaborations Risk of Bias assessment, and the US Preventative Services Task Force level-of-evidence criteria. Results SCS has Level 1 evidence (strong) for axial back/lumbar radiculopathy or neuralgia (five high-quality RCTs) and complex regional pain syndrome (one high-quality RCT). Conclusions High-level evidence supports SCS for treating chronic pain and complex regional pain syndrome. For patients with failed back surgery syndrome, SCS was more effective than reoperation or medical management. New stimulation waveforms and frequencies may provide a greater likelihood of pain relief compared with conventional SCS for patients with axial back pain, with or without radicular pain.

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P656 Epidemiology and outcomes associated with local surgical and intersphincteric ligation procedures for complex cryptoglandular fistulas: A systematic literature review

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.776 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S584-S585

Author(s):

K Iglay ◽

D Bennett ◽

M Kappelman ◽

C Karki ◽

S Cook

Keyword(s):

Literature Review ◽

Systematic Literature Review ◽

Faecal Incontinence ◽

Functional Disability ◽

Risk Of Bias ◽

Anorectal Abscess ◽

Failure Rates ◽

Eligibility Criteria ◽

Surgical Interventions ◽

Post Operative Pain

Abstract Background Studies suggest that complex cryptoglandular fistulas (CCF) are difficult to treat, resulting in higher intervention failure rates and functional disability. This systematic literature review (SLR) assessed the epidemiology of cryptoglandular fistula and outcomes associated with local, surgical and intersphincteric ligation procedures for treatment of CCF. Methods PubMed and Embase were searched to identify articles published in the past 5 years (2015–2020) relating to incidence or prevalence of cryptoglandular fistula and outcomes of surgical interventions for CCF (PROSPERO registration number CRD42020177732). Outcomes of interest included fistula closure/healing, recurrence, surgery failure, post-operative pain and faecal incontinence. The interventions included anal flap procedures, fistulectomy, fistulotomy, primary sphincteroplasty, modified Park’s technique, LIFT or BIOLIFT, and TROPIS. Two trained reviewers used pre-specified eligibility criteria to identify studies for inclusion and evaluate risk of bias using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool for observational studies. Data were extracted for a range of variables, including study type and design, population, outcomes and limitations. Results In total, 148 studies were identified that met a priori eligibility criteria for all cryptoglandular fistulas and all intervention types. Of these, two reported incidence or prevalence of cryptoglandular fistulas and 18 reported outcomes for the interventions of interest in CCF. Prevalence of cryptoglandular fistulas was reported as 1.35 per 10 000 patients without Crohn’s disease, and 52.6% of patients without IBD were found to progress from anorectal abscess to fistula over 12 months. Studies examining the clinical outcomes reported primary healing rates of 57.4–100.0%, recurrence rates of 4.9–61.0% and failure rates of 2.8–18.0% of patients. Only five studies reported post-operative pain as a clinical outcome. Overall, these studies suggest patients experience no or minimal longer-term post-operative pain. In studies reporting post-operative faecal incontinence following anal mucosal flap procedures, observed incontinence rates were low, as measured using Wexner or Miller scoring. None of the studies involving fistulectomy measured faecal incontinence. Conclusion This SLR provides a summary of outcomes from a selected group of surgical interventions for CCF. Healing rates vary according to surgery type; however, differences in study design and heterogenous definitions prevent direct comparison. Overall, the published literature indicates low to modest rates of CCF recurrence and limited data on faecal incontinence and longer-term post-operative pain. Sponsor: Takeda Pharmaceuticals USA, Inc.

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Immunomodulatory therapies for SARS-CoV-2 infection: a systematic literature review to inform EULAR points to consider

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-219725 ◽

2021 ◽

pp. annrheumdis-2020-219725

Author(s):

Alessia Alunno ◽

Aurélie Najm ◽

Xavier Mariette ◽

Gabriele De Marco ◽

Jenny Emmel ◽

...

Keyword(s):

Literature Review ◽

Systematic Literature Review ◽

Intravenous Immunoglobulins ◽

Risk Of Bias ◽

Disease Stage ◽

Efficacy And Safety ◽

Immunomodulatory Treatment ◽

Immunomodulatory Agents ◽

Randomised Controlled ◽

Immunomodulatory Therapies

ObjectiveTo summarise the available information on efficacy and safety of immunomodulatory agents in SARS-CoV-2 infection.MethodsAs part of a European League Against Rheumatism (EULAR) taskforce, a systematic literature search was conducted from January 2019 to 11 December 2020. Two reviewers independently identified eligible studies according to the Population, Intervention, Comparator and Outcome framework and extracted data on efficacy and safety of immunomodulatory agents used therapeutically in SARS-CoV-2 infection at any stage. The risk of bias was assessed with validated tools.ResultsOf the 60 372 records, 401 articles were eligible for inclusion. Studies were at variable risk of bias. Randomised controlled trials (RCTs) were available for the following drugs: hydroxychloroquine (n=12), glucocorticoids (n=6), tocilizumab (n=4), convalescent plasma (n=4), interferon beta (n=2), intravenous immunoglobulins (IVIg) (n=2) and n=1 each for anakinra, baricitinib, colchicine, leflunomide, ruxolitinib, interferon kappa and vilobelimab. Glucocorticoids were able to reduce mortality in specific subsets of patients, while conflicting data were available about tocilizumab. Hydroxychloroquine was not beneficial at any disease stage, one RCT with anakinra was negative, one RCT with baricitinib+remdesivir was positive, and individual trials on some other compounds provided interesting, although preliminary, results.ConclusionAlthough there is emerging evidence about immunomodulatory therapies for the management of COVID-19, conclusive data are scarce with some conflicting data. Since glucocorticoids seem to improve survival in some subsets of patients, RCTs comparing glucocorticoids alone versus glucocorticoids plus anticytokine/immunomodulatory treatment are warranted. This systematic literature review informed the initiative to formulate EULAR ‘points to consider’ on COVID-19 pathophysiology and immunomodulatory treatment from the rheumatology perspective.

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Efficacy and safety of gout flare prophylaxis and therapy use in people with chronic kidney disease: a Gout, Hyperuricemia and Crystal-Associated Disease Network (G-CAN)-initiated literature review

Arthritis Research & Therapy ◽

10.1186/s13075-021-02416-y ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Huai Leng Pisaniello ◽

Mark C. Fisher ◽

Hamish Farquhar ◽

Ana Beatriz Vargas-Santos ◽

Catherine L. Hill ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Renal Function ◽

Kidney Disease ◽

Literature Review ◽

Interleukin 1 ◽

Treatment Options ◽

Cochrane Library ◽

Efficacy And Safety ◽

Clinical Trial Results ◽

Gout Flare

AbstractGout flare prophylaxis and therapy use in people with underlying chronic kidney disease (CKD) is challenging, given limited treatment options and risk of worsening renal function with inappropriate treatment dosing. This literature review aimed to describe the current literature on the efficacy and safety of gout flare prophylaxis and therapy use in people with CKD stages 3–5. A literature search via PubMed, the Cochrane Library, and EMBASE was performed from 1 January 1959 to 31 January 2018. Inclusion criteria were studies with people with gout and renal impairment (i.e. estimated glomerular filtration rate (eGFR) or creatinine clearance (CrCl) < 60 ml/min/1.73 m2), and with exposure to colchicine, interleukin-1 inhibitors, non-steroidal anti-inflammatory drugs (NSAIDs), and glucocorticoids. All study designs were included. A total of 33 studies with efficacy and/or safety analysis stratified by renal function were reviewed—colchicine (n = 20), anakinra (n = 7), canakinumab (n = 1), NSAIDs (n = 3), and glucocorticoids (n = 2). A total of 58 studies reported these primary outcomes without renal function stratification—colchicine (n = 29), anakinra (n = 10), canakinumab (n = 6), rilonacept (n = 2), NSAIDs (n = 1), and glucocorticoids (n = 10). Most clinical trials excluded study participants with severe CKD (i.e. eGFR or CrCl of < 30 mL/min/1.73 m2). Information on the efficacy and safety outcomes of gout flare prophylaxis and therapy use stratified by renal function is lacking. Clinical trial results cannot be extrapolated for those with advanced CKD. Where possible, current and future gout flare studies should include patients with CKD and with study outcomes reported based on renal function and using standardised gout flare definition.

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