BMC Rheumatology最新文献

Objective: To compare the clinical efficacy and safety of biological disease-modifying antirheumatic drugs (DMARDs) and Janus kinase(JAK) inhibitors in patients with early rheumatoid arthritis (RA).

Methods: A systematic search was conducted of PubMed, Web of Science, Cochrane Library, and EMBASE databases (up to February 2025), supplemented by searches of clinical trial registries. Eligible randomised controlled trials enrolled adults with early RA (< 2 years) treated with biological DMARDs/JAK inhibitors versus conventional synthetic DMARDs. Statistical analyses were conducted using Stata software (version 16.0).

Results: 21 eligible trials involving nine interventions and 8,361 participants were included in this meta-analysis. Multiple biological DMARDs demonstrated superior therapeutic efficacy compared to methotrexate. Adalimumab + methotrexate showed the most pronounced effect on DAS28 remission (OR 2.90[95% CI 1.94-4.33]; SUCRA 83.7%), while tocilizumab + methotrexate exhibited the highest efficacy in achieving ACR70 response (OR 4.41[95% CI 2.29-8.49]; SUCRA 94.7%). Regarding safety, only tocilizumab + methotrexate demonstrated a higher incidence of adverse events(OR 5.11[95% CI 2.03-12.86]; SUCRA 0.6%). No safety risks were identified for other interventions. Due to the limited number of eligible clinical trials, the optimal treatment strategy remains inconclusive.

Conclusion: For patients with early RA and high disease activity, combination therapy with certain biological DMARDs demonstrated superior clinical efficacy compared to methotrexate. No noteworthy safety risks have been observed. More high-quality trials should be conducted to evaluate treatment strategies for individuals with early RA comprehensively.

Clinical trial number: Not applicable.

Background: Systemic lupus erythematosus (SLE), an autoimmune disease, damages multiple organs. Studies showed higher all-cause mortality in SLE patients compared to the general population. However, it remains unclear whether the persistent immunodeficiency and organ damage exacerbate the prognosis of intensive care for patients with comorbid SLE.

Methods: A cohort of 50,920 critically ill patients from 2008 to 2019 in USA was obtained from the MIMIC IV database. Matching was employed to create control groups, mitigating the influence of known confounders. Wilcoxon test and Pearson's Chi-squared Test were utilized to compare quantitative and categorical variables between groups, respectively. Log-rank test was used to compare survival differences. Univariate and multivariate Cox regression analyses were conducted to explore influencing factors. Mediation analysis was employed to investigate the mediating role of influencing factors.

Results: Patients with comorbid SLE showed notably lower 180-day survival than controls (HR = 1.485, P = 0.015). While hemoglobin, platelets, white blood cells, creatinine, urine output, SOFA performed significance in univariate Cox regression analysis, only creatinine and urine output remained significant in multivariate analysis. Mediation analysis revealed the significant mediating effect of renal function (represented by creatinine). SLE patients treated with glucocorticoids did not exhibit a significant decrease in survival compared to controls (HR = 1.482, P = 0.095), whereas those without glucocorticoids showed a significant decrease (HR = 1.660, P = 0.027).

Conclusion: SLE diminishes survival among critically ill patients by affecting renal function, while glucocorticoids can partially mitigate the decline in survival.