Efficacy and safety of non-pharmacological, pharmacological and surgical treatments for hand osteoarthritis in 2024: a systematic review.

IF 5.1 2区 医学 Q1 RHEUMATOLOGY RMD Open Pub Date : 2025-01-09 DOI:10.1136/rmdopen-2024-004963
Ingvild Kjeken, Daniel Huseby Bordvik, Nina Osteras, Ida K Haugen, Kristine Aasness Fjeldstad, Ingrid Skaalvik, Margreet Kloppenburg, Féline P B Kroon, Anne Therese Tveter, Geir Smedslund
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Abstract

Background: We aimed to update the 2018 systematic literature review on the efficacy and safety of treatments for hand osteoarthritis (OA), which was based on 126 studies.

Methods: We performed a systematic literature search on randomised controlled trials from June 2017 up to 31 December 2023. Risk of bias was assessed using the RoB2 tool. Meta-analyses of previous and new studies regarding the efficacy for pain, function, grip strength and OMERACT/OARSI responders were performed. Certainty of evidence was judged using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) tool.

Results: Sixty-five new studies were included. For non-pharmacological interventions, there was low-certainty evidence for a small long-term effect of hand exercises and a moderate long-term effect of thumb orthoses for pain, and moderate-certainty evidence that assistive devices had a moderate long-term effect on function. Concerning pharmacological interventions, there was low-certainty evidence for a moderate short-term effect of oral non-steroidal anti-inflammatory drugs (NSAIDs) on pain, high- and moderate-certainty evidence for a small short-term effect of topical NSAIDs and oral glucocorticoids on function, respectively, and low-certainty evidence that oral glucocorticoids had a small short-term effect on function. Further, there was low-certainty evidence that methotrexate had a small long-term effect on pain. The heterogeneity of studies did not allow for any meta-analyses on surgery.

Conclusion: The results largely support current treatment recommendations. However, there is a lack of interventions that efficiently improve grip strength, and the evidence for most current treatments is still limited. To better understand action mechanism of different treatments, future trials should include hand OA subtyping and be powered for subgroup analyses.

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2024年手骨关节炎的非药物、药物和手术治疗的疗效和安全性:系统综述。
背景:我们旨在更新基于126项研究的2018年关于手骨关节炎(OA)治疗的有效性和安全性的系统文献综述。方法:我们对2017年6月至2023年12月31日的随机对照试验进行了系统的文献检索。使用RoB2工具评估偏倚风险。对先前和新的关于疼痛、功能、握力和OMERACT/OARSI应答者疗效的研究进行meta分析。使用GRADE(建议评估、发展和评价分级)工具来判断证据的确定性。结果:纳入65项新研究。对于非药物干预,有低确定性的证据表明手部锻炼有小的长期效果,拇指矫形器对疼痛有中等的长期效果,中等确定性的证据表明辅助装置对功能有中等的长期影响。在药理学干预方面,有低确定性证据表明口服非甾体抗炎药(NSAIDs)对疼痛有中等短期影响,有高和中等确定性证据表明外用非甾体抗炎药和口服糖皮质激素分别对功能有较小的短期影响,有低确定性证据表明口服糖皮质激素对功能有较小的短期影响。此外,有低确定性的证据表明甲氨蝶呤对疼痛的长期影响很小。研究的异质性不允许对手术进行任何荟萃分析。结论:结果在很大程度上支持目前的治疗建议。然而,缺乏有效提高握力的干预措施,而且目前大多数治疗方法的证据仍然有限。为了更好地了解不同治疗的作用机制,未来的试验应该包括手OA亚型,并为亚组分析提供动力。
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来源期刊
RMD Open
RMD Open RHEUMATOLOGY-
CiteScore
7.30
自引率
6.50%
发文量
205
审稿时长
14 weeks
期刊介绍: RMD Open publishes high quality peer-reviewed original research covering the full spectrum of musculoskeletal disorders, rheumatism and connective tissue diseases, including osteoporosis, spine and rehabilitation. Clinical and epidemiological research, basic and translational medicine, interesting clinical cases, and smaller studies that add to the literature are all considered.
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