Abstract：
In addition to disease-modifying anti-rheumatic drug (DMARD) treatment, exercise is increasingly promoted in patients with rheumatoid arthritis (RA). Although both are known to reduce disease activity, few studies have investigated the combined effects of these interventions on disease activity. The aim of this scoping review was to provide an overview of the reported evidence on whether a combined effect-i.e., a greater reduction in disease activity outcome measures-can be detected in studies where an exercise intervention was performed in addition to the DMARD treatment in patients with RA. This scoping review followed the PRISMA guidelines. A literature search was performed for exercise intervention studies in patients with RA treated with DMARDs. Studies without a non-exercise control group were excluded. Included studies reported on (components of) DAS28 and DMARD use and were assessed for methodological quality using version 1 of the Cochrane risk-of-bias tool for randomized trials. For each study, comparisons between groups (i.e., exercise + medication vs. medication only) were reported on disease activity outcome measures. Study data related to the exercise intervention, medication use, and other relevant factors were extracted to assess what may have influenced disease activity outcomes in the included studies.
A total of 11 studies were included of which 10 between-group studies on DAS28 components were made. The remaining one study focused on within-group comparisons only. Median duration of the exercise intervention studies was 5 months, and the median number of participants was 55. Six out of the 10 between-group studies reported no significant differences between groups in DAS28 components between exercise + medication vs. medication only. Four studies showed significant reductions in disease activity outcomes for the exercise + medication group compared with the medication-only group. Most studies were not adequately designed methodologically in order to investigate for comparisons of DAS28 components and had a high risk of multi-domain bias. Whether the simultaneous application of exercise therapy and DMARD medication in patients with RA has a combined effect on disease outcome remains unknown, due to weak methodological quality of existing studies. Future studies should focus on the combined effects by having disease activity as the primary outcome.
A total of 11 studies were included of which 10 between-group studies on DAS28 components were made. The remaining one study focused on within-group comparisons only. Median duration of the exercise intervention studies was 5 months, and the median number of participants was 55. Six out of the 10 between-group studies reported no significant differences between groups in DAS28 components between exercise + medication vs. medication only. Four studies showed significant reductions in disease activity outcomes for the exercise + medication group compared with the medication-only group. Most studies were not adequately designed methodologically in order to investigate for comparisons of DAS28 components and had a high risk of multi-domain bias. Whether the simultaneous application of exercise therapy and DMARD medication in patients with RA has a combined effect on disease outcome remains unknown, due to weak methodological quality of existing studies. Future studies should focus on the combined effects by having disease activity as the primary outcome.
摘要：
目的：除了改善疾病的抗风湿药（DMARD）治疗外，类风湿关节炎（RA）患者的运动越来越受欢迎。虽然已知两者都能减少疾病活动，很少有研究调查这些干预措施对疾病活动的综合影响。本次范围界定审查的目的是概述报告的证据，说明是否存在综合效应，即在RA患者中除DMARD治疗外还进行了运动干预的研究中,可以检测到疾病活动结局指标的降低幅度更大.此范围审查遵循PRISMA指南。对DMARDs治疗的RA患者的运动干预研究进行了文献检索。没有非运动对照组的研究被排除。纳入的研究报告了DAS28和DMARD的使用（组成部分），并使用第1版Cochrane偏见风险工具进行了方法学质量评估。对于每一项研究，组间比较(即，运动+药物与仅药物治疗)报告疾病活动结果测量。与运动干预相关的研究数据，药物使用,和其他相关因素被提取,以评估纳入研究中可能影响疾病活动性结局的因素.
结果：共纳入11项研究，其中10项关于DAS28组件的组间研究。其余一项研究仅关注组内比较。运动干预研究的中位持续时间为5个月，参与者的中位数是55。10项组间研究中有6项报告说，运动+药物与药物之间的DAS28成分在组间没有显着差异只有药物。四项研究表明，运动+药物治疗组比仅药物治疗组的疾病活动结果显着降低。大多数研究在方法学上没有充分设计，以调查DAS28组件的比较，并且具有多域偏倚的高风险。在RA患者中同时应用运动疗法和DMARD药物是否对疾病结局有共同影响尚不清楚。由于现有研究的方法学质量薄弱。未来的研究应该集中在以疾病活动为主要结果的综合效应上。
结果：共纳入11项研究，其中10项关于DAS28组件的组间研究。其余一项研究仅关注组内比较。运动干预研究的中位持续时间为5个月，参与者的中位数是55。10项组间研究中有6项报告说，运动+药物与药物之间的DAS28成分在组间没有显着差异只有药物。四项研究表明，运动+药物治疗组比仅药物治疗组的疾病活动结果显着降低。大多数研究在方法学上没有充分设计，以调查DAS28组件的比较，并且具有多域偏倚的高风险。在RA患者中同时应用运动疗法和DMARD药物是否对疾病结局有共同影响尚不清楚。由于现有研究的方法学质量薄弱。未来的研究应该集中在以疾病活动为主要结果的综合效应上。
