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Biologic interventions for fatigue in rheumatoid arthritis

Almeida, Celia, Choy, Ernest Ho Sing, Hewlett, Sarah, Kirwan, John R, Cramp, Fiona, Chalder, Trudie, Pollock, Jon and Christensen, Robin 2016. Biologic interventions for fatigue in rheumatoid arthritis. Cochrane Database of Systematic Reviews 10.1002/14651858.CD008334.pub2

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Background What is rheumatoid arthritis and what are biologics? When you have rheumatoid arthritis, your immune system, which normally fights infection, attacks the lining of your joints, causing swelling, stiffness and pain. The small joints of your hands and feet are usually affected first. There is no cure for rheumatoid arthritis at present, so treatments aim to relieve pain and stiffness and improve your ability to move. Biologics are medications that can reduce joint inflammation, improve symptoms and prevent joint damage. Fatigue is an important symptom in people with rheumatoid arthritis. However, there is no consensus on the most effective management approaches for it. A number of studies have explored the effects of biologic response modifiers (biologics) in the management of rheumatoid arthritis and associated symptoms such as fatigue. We carried out the current review to evaluate the effects of these therapies on fatigue in adults with rheumatoid arthritis. Study characteristics We searched for all research published up to 1 April 2014, finding 32 relevant studies. There were 19 studies on five anti‐TNF biologics (adalimumab, certolizumab, etanercept, golimumab and infliximab) and 12 studies on five non‐anti‐TNF biologics (abatacept, canakinumab, rituximab, tocilizumab and an anti‐interferon gamma monoclonal antibody). Key results Altogether 9,946 participants received biologics and 4,682 participants received standard therapy. All but two of the studies were randomised placebo‐controlled trials, the gold standard in terms of study quality. We compared the effects of biologics versus placebo. In some studies, participants may have been taking standard therapy for rheumatoid arthritis at the start of the trial. In these studies, investigators added either biologics or placebo treatment to standard therapy. Overall, treatment by biologics led to small to moderate reductions (9 units reduction on a 0‐52 scale) in patient‐reported fatigue compared with 3 units in participants treated by placebo. It is unclear whether this improvement is due to a reduction in overall disease activity, a direct effect of the biologics or some other mechanism. Quality of the evidence There may have been some potential bias in the way investigators analysed data, and some studies did not include all randomised individuals, so we judged the quality of the evidence to be only moderate rather than high.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: Q Science > QH Natural history > QH301 Biology
Publisher: Wiley-Blackwell
ISSN: 1469-493X
Last Modified: 18 Jun 2019 13:42

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