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Quality of life in patients with rheumatoid arthritis

Which Drugs Might Make a Difference?

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Abstract

Rheumatoid arthritis (RA) is a chronic, disabling, inflammatory polyarthritis that affects patient well-being and QOL. Many disease-modifying antirheumatic drugs (DMARDs) are available for treating RA but patients are often refractory to treatment. The goal of treatment is to improve both general health and health-related QOL. Generic and disease-specific instruments exist to measure QOL. Using these instruments, one can determine if QOL improves with treatment. If the minimal clinically important difference (MCID) for the instrument is known, one can determine if the change is clinically significant.

The literature was reviewed in a systematic manner to determine which drugs could affect QOL in patients with refractory RA. Refractory RA is poorly defined but we used the definition of failing at least two DMARDs. Methotrexate, leflunomide, cyclosporin, glucocorticoids, etanercept and infliximab clinically and statistically significantly improved QOL in patients with RA. Gold and epoetin-α (erythropoietin) statistically improved QOL in patients with RA but the clinical significance of the improvements could not be determined. These studies were either in non-refractory populations or the refractoriness could not be determined. Further study is required to determine the response of QOL to treatment in patients with refractory RA and instruments with known MCIDs should be used so that the clinical significance of the improvement can be determined.

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Acknowledgements

The authors would like to thank Jessie McGowan for her assistance with the literature search for this article. Dr Tugwell is a paid consultant for and has received grants from a variety of pharmaceutical companies. There was no specific funding for this study.

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Authors and Affiliations

  1. Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada

    Barbara Blumenauer, Ann Cranney &  Peter Tugwell

  2. Clinical Epidemiology Unit, University of Ottawa, Ottawa, Ontario, Canada

    Jennifer Clinch

Authors
  1. Barbara Blumenauer
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  2. Ann Cranney
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  3. Jennifer Clinch
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  4. Peter Tugwell
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Corresponding author

Correspondence to Peter Tugwell.

Appendices

Appendices: Search Strategy 1

  1. 1.

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  2. 2.

    exp Quality of Life/

  3. 3.

    health status indicators/

  4. 4.

    or/1-3

  5. 5.

    clinical trial.pt.

  6. 6.

    randomized controlled trial.pt.

  7. 7.

    tu.fs.

  8. 8.

    dt.fs.

  9. 9.

    random$.tw.

  10. 10.

    (double adj blind$).tw.

  11. 11.

    placebo$.tw.

  12. 12.

    or/5–11

  13. 13.

    exp Methotrexate/tu [Therapeutic Use]

  14. 14.

    leflunomide.tw.

  15. 15.

    exp Auranofin/tu [Therapeutic Use]

  16. 16.

    exp Hydroxychloroquine/tu [Therapeutic Use]

  17. 17.

    exp Glucocorticoids/tu [Therapeutic Use]

  18. 18.

    exp Cyclosporine/tu [Therapeutic Use]

  19. 19.

    exp Azathioprine/tu [Therapeutic Use]

  20. 20.

    exp Sulfasalazine/tu [Therapeutic Use]

  21. 21.

    exp Cyclophosphamide/tu [Therapeutic Use]

  22. 22.

    exp Penicillamine/tu [Therapeutic Use]

  23. 23.

    exp Anti-Inflammatory Agents, Non-Steroidal/tu [Therapeutic Use]

  24. 24.

    or/13–23

  25. 25.

    4 and 12 and 13

Search Strategy 2

  1. 1.

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  2. 2.

    (rheumat$ adj2 arthritis).tw.

  3. 3.

    stills diseas$.tw.

  4. 4.

    caplans syndrome$.tw.

  5. 5.

    feltys syndrome$.tw.

  6. 6.

    rheumatoid nodule$.tw.

  7. 7.

    sjogrens syndrome$.tw.

  8. 8.

    ankylosing spondylitis.tw.

  9. 9.

    rheumat$.tw.

  10. 10.

    or/1–9

  11. 11.

    (quality adj3 life).tw.

  12. 12.

    exp Quality of Life/

  13. 13.

    health status indicators/

  14. 14.

    or/11–13

  15. 15.

    10 and 14

  16. 16.

    clinical trial.pt.

  17. 17.

    randomized controlled trial.pt.

  18. 18.

    tu.fs.

  19. 19.

    dt.fs.

  20. 20.

    random$.tw.

  21. 21.

    (double adj blind$).tw.

  22. 22.

    placebo$.tw.

  23. 23.

    or/16–22

  24. 24.

    15 and 23

  25. 25.

    15 and 17

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Blumenauer, B., Cranney, A., Clinch, J. et al. Quality of life in patients with rheumatoid arthritis. Pharmacoeconomic 21, 927–940 (2003). https://doi.org/10.2165/00019053-200321130-00002

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  • DOI: https://doi.org/10.2165/00019053-200321130-00002

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