The efficacy of systemic glucocorticosteroids for pain in rheumatoid arthritis: a systematic literature review and meta-analysis
Abstract Objectives Glucocorticosteroids (GCs) are recommended to suppress inflammation in people with active RA. This systematic review and meta-analysis aimed to quantify the effects of systemic GCs on RA pain. Methods A systematic literature review of randomized controlled trials (RCTs) in RA com...
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Veröffentlicht in: | Rheumatology (Oxford, England) England), 2021-12, Vol.61 (1), p.76-89 |
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creator | McWilliams, Daniel F Thankaraj, Divya Jones-Diette, Julie Morgan, Rheinallt Ifesemen, Onosi S Shenker, Nicholas G Walsh, David A |
description | Abstract
Objectives
Glucocorticosteroids (GCs) are recommended to suppress inflammation in people with active RA. This systematic review and meta-analysis aimed to quantify the effects of systemic GCs on RA pain.
Methods
A systematic literature review of randomized controlled trials (RCTs) in RA comparing systemic GCs to inactive treatment. Three databases were and spontaneous pain and evoked pain outcomes were extracted. Standardized mean differences (SMDs) and mean differences were meta-analysed. Heterogeneity (I2, tau statistics) and bias (funnel plot, Egger’s test) were assessed. Subgroup analyses investigated sources of variation. This study was pre-registered (PROSPERO CRD42019111562).
Results
A total of 18 903 titles, 880 abstracts and 226 full texts were assessed. Thirty-three RCTs suitable for the meta-analysis included 3123 participants. Pain scores (spontaneous pain) decreased in participants treated with oral GCs; SMD = −0.65 (15 studies, 95% CI −0.82, −0.49, P 3–6 months and −7 mm (95% CI −13, 0) at >6 months. Similar findings were obtained when evoked pain outcomes were examined. Data from five RCTs suggested improvement also in fatigue during GC treatment.
Conclusion
Oral GCs are analgesic in RA. The benefit is greatest shortly after initiation and GCs might not achieve clinically important pain relief beyond 3 months. Treatments other than anti-inflammatory GCs should be considered to reduce the long-term burden of pain in RA. |
doi_str_mv | 10.1093/rheumatology/keab503 |
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Objectives
Glucocorticosteroids (GCs) are recommended to suppress inflammation in people with active RA. This systematic review and meta-analysis aimed to quantify the effects of systemic GCs on RA pain.
Methods
A systematic literature review of randomized controlled trials (RCTs) in RA comparing systemic GCs to inactive treatment. Three databases were and spontaneous pain and evoked pain outcomes were extracted. Standardized mean differences (SMDs) and mean differences were meta-analysed. Heterogeneity (I2, tau statistics) and bias (funnel plot, Egger’s test) were assessed. Subgroup analyses investigated sources of variation. This study was pre-registered (PROSPERO CRD42019111562).
Results
A total of 18 903 titles, 880 abstracts and 226 full texts were assessed. Thirty-three RCTs suitable for the meta-analysis included 3123 participants. Pain scores (spontaneous pain) decreased in participants treated with oral GCs; SMD = −0.65 (15 studies, 95% CI −0.82, −0.49, P <0.001) with significant heterogeneity (I2 = 56%, P =0.0002). Efficacy displayed time-related decreases after GC initiation. Mean difference visual analogue scale pain was −15 mm (95% CI −20, −9) greater improvement in GC than control at ≤3 months, −8 mm (95% CI −12, −3) at >3–6 months and −7 mm (95% CI −13, 0) at >6 months. Similar findings were obtained when evoked pain outcomes were examined. Data from five RCTs suggested improvement also in fatigue during GC treatment.
Conclusion
Oral GCs are analgesic in RA. The benefit is greatest shortly after initiation and GCs might not achieve clinically important pain relief beyond 3 months. Treatments other than anti-inflammatory GCs should be considered to reduce the long-term burden of pain in RA.</description><identifier>ISSN: 1462-0324</identifier><identifier>EISSN: 1462-0332</identifier><identifier>DOI: 10.1093/rheumatology/keab503</identifier><identifier>PMID: 34213524</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Arthritis, Rheumatoid - complications ; Arthritis, Rheumatoid - drug therapy ; Fatigue ; Glucocorticoids - administration & dosage ; Humans ; Pain - drug therapy ; Pain - etiology ; Systematic Review and Meta Analysis</subject><ispartof>Rheumatology (Oxford, England), 2021-12, Vol.61 (1), p.76-89</ispartof><rights>The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. 2021</rights><rights>The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3994-ad58d6c2129df112b525d3cf9ea3a2ceb146d07bef1e816a6dc7b6c65fe559d93</citedby><cites>FETCH-LOGICAL-c3994-ad58d6c2129df112b525d3cf9ea3a2ceb146d07bef1e816a6dc7b6c65fe559d93</cites><orcidid>0000-0002-0581-1895 ; 0000-0002-9852-5811</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,1584,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34213524$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McWilliams, Daniel F</creatorcontrib><creatorcontrib>Thankaraj, Divya</creatorcontrib><creatorcontrib>Jones-Diette, Julie</creatorcontrib><creatorcontrib>Morgan, Rheinallt</creatorcontrib><creatorcontrib>Ifesemen, Onosi S</creatorcontrib><creatorcontrib>Shenker, Nicholas G</creatorcontrib><creatorcontrib>Walsh, David A</creatorcontrib><title>The efficacy of systemic glucocorticosteroids for pain in rheumatoid arthritis: a systematic literature review and meta-analysis</title><title>Rheumatology (Oxford, England)</title><addtitle>Rheumatology (Oxford)</addtitle><description>Abstract
Objectives
Glucocorticosteroids (GCs) are recommended to suppress inflammation in people with active RA. This systematic review and meta-analysis aimed to quantify the effects of systemic GCs on RA pain.
Methods
A systematic literature review of randomized controlled trials (RCTs) in RA comparing systemic GCs to inactive treatment. Three databases were and spontaneous pain and evoked pain outcomes were extracted. Standardized mean differences (SMDs) and mean differences were meta-analysed. Heterogeneity (I2, tau statistics) and bias (funnel plot, Egger’s test) were assessed. Subgroup analyses investigated sources of variation. This study was pre-registered (PROSPERO CRD42019111562).
Results
A total of 18 903 titles, 880 abstracts and 226 full texts were assessed. Thirty-three RCTs suitable for the meta-analysis included 3123 participants. Pain scores (spontaneous pain) decreased in participants treated with oral GCs; SMD = −0.65 (15 studies, 95% CI −0.82, −0.49, P <0.001) with significant heterogeneity (I2 = 56%, P =0.0002). Efficacy displayed time-related decreases after GC initiation. Mean difference visual analogue scale pain was −15 mm (95% CI −20, −9) greater improvement in GC than control at ≤3 months, −8 mm (95% CI −12, −3) at >3–6 months and −7 mm (95% CI −13, 0) at >6 months. Similar findings were obtained when evoked pain outcomes were examined. Data from five RCTs suggested improvement also in fatigue during GC treatment.
Conclusion
Oral GCs are analgesic in RA. The benefit is greatest shortly after initiation and GCs might not achieve clinically important pain relief beyond 3 months. Treatments other than anti-inflammatory GCs should be considered to reduce the long-term burden of pain in RA.</description><subject>Arthritis, Rheumatoid - complications</subject><subject>Arthritis, Rheumatoid - drug therapy</subject><subject>Fatigue</subject><subject>Glucocorticoids - administration & dosage</subject><subject>Humans</subject><subject>Pain - drug therapy</subject><subject>Pain - etiology</subject><subject>Systematic Review and Meta Analysis</subject><issn>1462-0324</issn><issn>1462-0332</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><sourceid>EIF</sourceid><recordid>eNqNkU2LFDEQhoMo7rr6D0Ry9NJOPnu6PQiy-AULXtZzqE4qM9HuzpikV_rmTzcys8N6EwpSJO_7VIWXkJecveGsl5u0x2WCEse4Wzc_EAbN5CNyyVUrGialeHzuhbogz3L-zhjTXHZPyYVUgkst1CX5fbtHit4HC3al0dO85oJTsHQ3LjbamEqwsV6lGFymPiZ6gDDTWvcLBEchlX0KJeS3FE4EqD46hmqEsiSkCe8C_qIwOzphgQZmGNcc8nPyxMOY8cXpvCLfPn64vf7c3Hz99OX6_U1jZd-rBpzuXGsFF73znItBC-2k9T2CBGFxqH91bDug59jxFlpnt0NrW-1R69718oq8O3IPyzChsziXBKM5pDBBWk2EYP59mcPe7OKd6bZKdJJVwOsTIMWfC-ZippAtjiPMGJdshFadYp1o2ypVR6lNMeeE_jyGM_M3PPMwPHMKr9pePVzxbLpPqwo2R0FcDv-H_AOb8bFa</recordid><startdate>20211224</startdate><enddate>20211224</enddate><creator>McWilliams, Daniel F</creator><creator>Thankaraj, Divya</creator><creator>Jones-Diette, Julie</creator><creator>Morgan, Rheinallt</creator><creator>Ifesemen, Onosi S</creator><creator>Shenker, Nicholas G</creator><creator>Walsh, David A</creator><general>Oxford University Press</general><scope>TOX</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-0581-1895</orcidid><orcidid>https://orcid.org/0000-0002-9852-5811</orcidid></search><sort><creationdate>20211224</creationdate><title>The efficacy of systemic glucocorticosteroids for pain in rheumatoid arthritis: a systematic literature review and meta-analysis</title><author>McWilliams, Daniel F ; Thankaraj, Divya ; Jones-Diette, Julie ; Morgan, Rheinallt ; Ifesemen, Onosi S ; Shenker, Nicholas G ; Walsh, David A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3994-ad58d6c2129df112b525d3cf9ea3a2ceb146d07bef1e816a6dc7b6c65fe559d93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Arthritis, Rheumatoid - complications</topic><topic>Arthritis, Rheumatoid - drug therapy</topic><topic>Fatigue</topic><topic>Glucocorticoids - administration & dosage</topic><topic>Humans</topic><topic>Pain - drug therapy</topic><topic>Pain - etiology</topic><topic>Systematic Review and Meta Analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McWilliams, Daniel F</creatorcontrib><creatorcontrib>Thankaraj, Divya</creatorcontrib><creatorcontrib>Jones-Diette, Julie</creatorcontrib><creatorcontrib>Morgan, Rheinallt</creatorcontrib><creatorcontrib>Ifesemen, Onosi S</creatorcontrib><creatorcontrib>Shenker, Nicholas G</creatorcontrib><creatorcontrib>Walsh, David A</creatorcontrib><collection>Oxford Journals Open Access Collection</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Rheumatology (Oxford, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McWilliams, Daniel F</au><au>Thankaraj, Divya</au><au>Jones-Diette, Julie</au><au>Morgan, Rheinallt</au><au>Ifesemen, Onosi S</au><au>Shenker, Nicholas G</au><au>Walsh, David A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The efficacy of systemic glucocorticosteroids for pain in rheumatoid arthritis: a systematic literature review and meta-analysis</atitle><jtitle>Rheumatology (Oxford, England)</jtitle><addtitle>Rheumatology (Oxford)</addtitle><date>2021-12-24</date><risdate>2021</risdate><volume>61</volume><issue>1</issue><spage>76</spage><epage>89</epage><pages>76-89</pages><issn>1462-0324</issn><eissn>1462-0332</eissn><abstract>Abstract
Objectives
Glucocorticosteroids (GCs) are recommended to suppress inflammation in people with active RA. This systematic review and meta-analysis aimed to quantify the effects of systemic GCs on RA pain.
Methods
A systematic literature review of randomized controlled trials (RCTs) in RA comparing systemic GCs to inactive treatment. Three databases were and spontaneous pain and evoked pain outcomes were extracted. Standardized mean differences (SMDs) and mean differences were meta-analysed. Heterogeneity (I2, tau statistics) and bias (funnel plot, Egger’s test) were assessed. Subgroup analyses investigated sources of variation. This study was pre-registered (PROSPERO CRD42019111562).
Results
A total of 18 903 titles, 880 abstracts and 226 full texts were assessed. Thirty-three RCTs suitable for the meta-analysis included 3123 participants. Pain scores (spontaneous pain) decreased in participants treated with oral GCs; SMD = −0.65 (15 studies, 95% CI −0.82, −0.49, P <0.001) with significant heterogeneity (I2 = 56%, P =0.0002). Efficacy displayed time-related decreases after GC initiation. Mean difference visual analogue scale pain was −15 mm (95% CI −20, −9) greater improvement in GC than control at ≤3 months, −8 mm (95% CI −12, −3) at >3–6 months and −7 mm (95% CI −13, 0) at >6 months. Similar findings were obtained when evoked pain outcomes were examined. Data from five RCTs suggested improvement also in fatigue during GC treatment.
Conclusion
Oral GCs are analgesic in RA. The benefit is greatest shortly after initiation and GCs might not achieve clinically important pain relief beyond 3 months. Treatments other than anti-inflammatory GCs should be considered to reduce the long-term burden of pain in RA.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>34213524</pmid><doi>10.1093/rheumatology/keab503</doi><tpages>14</tpages><orcidid>https://orcid.org/0000-0002-0581-1895</orcidid><orcidid>https://orcid.org/0000-0002-9852-5811</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Arthritis, Rheumatoid - complications Arthritis, Rheumatoid - drug therapy Fatigue Glucocorticoids - administration & dosage Humans Pain - drug therapy Pain - etiology Systematic Review and Meta Analysis |
title | The efficacy of systemic glucocorticosteroids for pain in rheumatoid arthritis: a systematic literature review and meta-analysis |
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