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Abstract：
OBJECTIVE: To provide an evidence base for clinical practice guidelines (CPG) for the management of rheumatoid arthritis (RA) in older adults.
METHODS: PubMed, Cochrane library, and Japan Centra Revuo Medicina databases were searched for articles published between 1990 and 2019. Quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system, with some modifications.
RESULTS: Among 702 identified articles, there were 5 post-hoc analyses of randomized controlled trials and 10 observational studies. Meta-analysis of the former yielded a mean difference of the van der Heijde-modified total Sharp score of -2.79 (95% confidence interval [CI] - 3.74 to -1.84) for treatment with tumor necrosis factor inhibitors. The risk ratio (RR) for the American College of Rheumatology 50% response rate, and for serious adverse events was 2.83 (95%CI 1.90-4.21) and 1.32 (95%CI 0.53-3.31), respectively, for Janus kinase inhibitors. Meta-analysis of the observational studies yielded an RR for disease activity score-28 remission and serious infections of 0.76 (95%CI 0.64-0.91) and 1.92 (95%CI 1.31-2.81) for older-versus-younger patients receiving biological disease-modifying antirheumatic drugs, respectively.
CONCLUSIONS: This systematic review provides the necessary evidence for developing CPG for the management of RA in older adults.
METHODS: PubMed, Cochrane library, and Japan Centra Revuo Medicina databases were searched for articles published between 1990 and 2019. Quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system, with some modifications.
RESULTS: Among 702 identified articles, there were 5 post-hoc analyses of randomized controlled trials and 10 observational studies. Meta-analysis of the former yielded a mean difference of the van der Heijde-modified total Sharp score of -2.79 (95% confidence interval [CI] - 3.74 to -1.84) for treatment with tumor necrosis factor inhibitors. The risk ratio (RR) for the American College of Rheumatology 50% response rate, and for serious adverse events was 2.83 (95%CI 1.90-4.21) and 1.32 (95%CI 0.53-3.31), respectively, for Janus kinase inhibitors. Meta-analysis of the observational studies yielded an RR for disease activity score-28 remission and serious infections of 0.76 (95%CI 0.64-0.91) and 1.92 (95%CI 1.31-2.81) for older-versus-younger patients receiving biological disease-modifying antirheumatic drugs, respectively.
CONCLUSIONS: This systematic review provides the necessary evidence for developing CPG for the management of RA in older adults.
摘要：
目的：为老年人类风湿性关节炎(RA)的临床治疗指南提供依据。
方法：PubMed，科克伦图书馆,并在日本CentraRevuoMedicina数据库中搜索了1990年至2019年之间发表的文章。使用建议分级评估来评估证据的质量，开发和评估系统，有一些修改。
结果：在702篇确定的文章中，有5项随机对照试验和10项观察性研究的事后分析.前者的荟萃分析得出，使用肿瘤坏死因子抑制剂治疗的vanderHeijde改良的Sharp总评分的平均差为-2.79（95％置信区间[CI]-3.74至-1.84）。美国风湿病学会50%反应率的风险比(RR)，严重不良事件为2.83（95CI1.90-4.21）和1.32（95CI0.53-3.31），分别,用于Janus激酶抑制剂。观察性研究的荟萃分析得出，对于接受生物疾病缓解抗风湿药物的老年患者和年轻患者，疾病活动评分-28缓解和严重感染的RR为0.76（95CI0.64-0.91）和1.92（95CI1.31-2.81）。分别。
结论：本系统综述为发展CPG治疗老年人RA提供了必要的证据。
方法：PubMed，科克伦图书馆,并在日本CentraRevuoMedicina数据库中搜索了1990年至2019年之间发表的文章。使用建议分级评估来评估证据的质量，开发和评估系统，有一些修改。
结果：在702篇确定的文章中，有5项随机对照试验和10项观察性研究的事后分析.前者的荟萃分析得出，使用肿瘤坏死因子抑制剂治疗的vanderHeijde改良的Sharp总评分的平均差为-2.79（95％置信区间[CI]-3.74至-1.84）。美国风湿病学会50%反应率的风险比(RR)，严重不良事件为2.83（95CI1.90-4.21）和1.32（95CI0.53-3.31），分别,用于Janus激酶抑制剂。观察性研究的荟萃分析得出，对于接受生物疾病缓解抗风湿药物的老年患者和年轻患者，疾病活动评分-28缓解和严重感染的RR为0.76（95CI0.64-0.91）和1.92（95CI1.31-2.81）。分别。
结论：本系统综述为发展CPG治疗老年人RA提供了必要的证据。
