The Study Of Rheumatoid Arthritis
Question:
Answer:
Introduction
Rheumatoid arthritis is a progressive anti-inflammatory autoimmune disease and occurs mostly in older adults. The inflammation of the joint causes swelling and pain. According to the data of World Health Organization, more than 13 million people only in America is suffering from this disorder and due to its autoimmune nature, it is not possible to invent one intervention that can improve the health of affected patient
- Problem: according of the Australian ministry of Health and Welfare , more than 9% of total Australian population is suffering from rheumatoid arthritis and within that maximum (10.2%) are aged person (from 50 to 75). It was further responsible for 6410 deaths in Australia in the year 2014.
- Solution: one approach to deal with rheumatoid arthritis is to Use DMARDs drugs over NSAIDs drugs in the treatment of RA.
- Aim: this study aims to compare the effectiveness of DMARDsas a complete intervention to treat RA in aged people in Australia.
PICO question
Define your PICO |
|
Population |
Older people in Australia |
Intervention |
Use of DMARDs drugs in the treatment of RA. |
Comparison/Control |
Patients having RA, taking DMARD medicine such as Methotrexate and those who are not being treated with the drug |
Outcome |
Improvement in pain and swelling and less usage of other interventions . |
Write your research question below in the PICO format |
|
In rheumatoid arthritis situation, Are DMARDs compared toNSAIDs are useful in improving the condition in aged peoplewith less or no side effects? P: older adults of Australia I: DMARDS (eg:Methotrexate) C:NSAIDs (eg:Ibuprofen) O: improved rheumatoid arthritis |
Search Strategy
2 main databases, PubMed and CINAHL were brainstormed through for searching the relevant journal articles. PubMed was searched using the MESH terms- Methotrexate, Rheumatoid arthritis/ old aged women, Rheumatoid arthritis/ DMARDs. The other Key words used were Rheumatoid arthritis in women, NSAIDs in RA, harmful effects of NSAIDs, DMARDs. The limiters used were full text peer reviewed journals within the years 2012-2018.
Best Practice
Best Practice |
Level of Evidence and Type of Study |
Citation in CDUAPA 6th format |
Solomon, D. H., Ayanian, J. Z., Yelin, E., Shaykevich, T., Brookhart, M. A., & Katz, J. N. (2012). Use of Disease-Modifying Medications for Rheumatoid Arthritis by Race and Ethnicity in the National Ambulatory Medical Care Survey. Arthritis Care & Research, 64(2), 184–189. https://doi.org/10.1002/acr.20674 |
Level IV Case control study |
(Solomon et al., 2012) |
Cho, S. K., Sung, Y. K., Kim, D., Won, S., Choi, C. B., Kim, T. H., … &Bae, S. C. (2016). Drug retention and safety of TNF inhibitors in elderly patients with rheumatoid arthritis. BMC musculoskeletal disorders, 17(1), 333. https://doi.org/10.1186/s12891-016-1185-6
|
Level I RCT |
(Cho et al., 2016) |
Nash, P., Nayiager, S., Genovese, M. C., Kivitz, A. J., Oelke, K., Ludivico, C., …&Corbo, M. (2013). Immunogenicity, Safety, and Efficacy of Abatacept Administered Subcutaneously With or Without Background Methotrexate in Patients With Rheumatoid Arthritis: Results From a Phase III, International, Multicenter, Parallel?Arm, Open?Label Study. Arthritis care & research, 65(5), 718-728. https://doi.org/10.1002/acr.21876
|
Level I RCT |
(Nash et al., 2013) |
Findings
According to the article by Solomon et al.,(2012), the use of the DMARDs represents the standard therapy for RA, having the ability to reduce pain and disability and the traditional model of RA treatment is the application of NSAIDs and glucocorticoids in the first place. The advantages of using DMARDs over NSAIDs lie with the fact that it helps in the slow progression of the disease and delays the damage of the bone and the cartilage in the joints. The action of the DMARDs might not be as quick as the NSAIDs, but its side effects are less than that of NSAIDs. Often a combination of DMARDs and NSAIDs are taken to reduce the clinical condition of Rheumatoid arthritis. This study studies the use of the DMARDs in patient with RA where 859 patients were analyzed for the application of the DMARDs and it was found that among the 859 visits only 404 participants had an associated DMARD alongside with NSAIDs.
As stated by Cho et al., (2016), the researchers divided 429 RA patients treated with TNF inhibitors into two groups. The group 1 included aged people whereas the group 2 was consist of younger generation. The mean observational period was 24 months, with 23.8 ± 25.8 months in the elderly group and 23.3 ± 23.2 months in the younger group.In this situation, the older adults were provided with DMARD drugs and it was found that in the combination they are able to improve patient condition. However stopping any one intervention can generate adverse effects in patients. Hence, it was determined that DMARD was able to improve RA patient condition in the presence of TNF1 inhibitors.
According to Nash et al., (2013) administration of the DMARDs such as methotrexate along with the medications like infliximab or golimumab is prescribed for RA for maintaining the clinical efficacy. As per an open label study, RA patients were classified to get Subcutanousabacept with or without methotrexate. The paper could not validate the efficacy of DMARDs as Sc was not found to responsible for eliciting immunogenicity related to the loss of efficacy with or without Methotrexate.
References
Cho, S. K., Sung, Y. K., Kim, D., Won, S., Choi, C. B., Kim, T. H., … &Bae, S. C. (2016). Drug retention and safety of TNF inhibitors in elderly patients with rheumatoid arthritis. BMC musculoskeletal disorders, 17(1), 333. https://doi.org/10.1186/s12891-016-1185-6
Nash, P., Nayiager, S., Genovese, M. C., Kivitz, A. J., Oelke, K., Ludivico, C., …&Corbo, M. (2013). Immunogenicity, Safety, and Efficacy of Abatacept Administered Subcutaneously With or Without Background Methotrexate in Patients With Rheumatoid Arthritis: Results From a Phase III, International, Multicenter, Parallel?Arm, Open?Label Study. Arthritis care & research, 65(5), 718-728. https://doi.org/10.1002/acr.21876
Solomon, D. H., Ayanian, J. Z., Yelin, E., Shaykevich, T., Brookhart, M. A., & Katz, J. N. (2012). Use of Disease-Modifying Medications for Rheumatoid Arthritis by Race and Ethnicity in the National Ambulatory Medical Care Survey. Arthritis Care & Research, 64(2), 184–189. https://doi.org/10.1002/acr.20674
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