Anti-inflammatory drugs and analgesics for managing symptoms in people with cystic fibrosis-related arthritis

 

Abstract

Background

Arthritis remains a relatively infrequent complication of cystic fibrosis, but is a cause of significant morbidity when it does occur. Two distinct types of arthritis are described in cystic fibrosis: cystic fibrosis-related arthropathy (CFA) and hypertrophic pulmonary osteoarthropathy (HPO). Management of arthritis in people with cystic fibrosis is uncertain and complex because of the underlying disease and its intense treatment.

Objectives

To review the effectiveness and safety of pharmacological agents for the symptomatic management of cystic fibrosis-related arthritis in adults and children with cystic fibrosis.

Search methods

We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches, handsearches of relevant journals and abstract books of conference proceedings.

Date of most recent search: 27 November 2009.

Selection criteria

Randomised controlled trials which compared the efficacy and safety of anti-inflammatory and analgesic agents (e.g. non-steroidal anti-inflammatory agents, systemic corticosteroids, intra-articular corticosteroids) with each other, with no treatment or with placebo for CFA and HPO.

Data collection and analysis

No relevant studies were identified.

Main results

No studies were included in this review.

Authors' conclusions

Although it is generally recognised that CFA may be episodic and resolve spontaneously, treatment with analgesics and anti-inflammatory agents may be needed. While this approach may be sufficient to manage symptoms, it is disappointing that no randomised controlled trials to rigorously evaluate these agents were found, nor could the authors identify any quasi-randomised. This systematic review has identified the need for a well-designed adequately-powered randomised controlled trial to assess the efficacy and safety of pharmacological agents for the symptomatic management of cystic fibrosis-related arthritis (CFA and HPO) in adults and children with cystic fibrosis. Studies should also better define the two conditions. A study has recently been conducted in CFA and may help fill this gap when analysed and published.

 

Plain language summary

The use of drugs to manage symptoms in people with arthritis related to cystic fibrosis

Arthritis is not a common complication of cystic fibrosis, but it can be a major complication when it does occur. There are two distinct types of arthritis in cystic fibrosis: cystic fibrosis-related arthropathy (CFA) and hypertrophic pulmonary osteoarthropathy (HPO). The best treatment for these conditions is not clear because of the underlying disease and its intense treatment. We planned to report evidence from clinical trials to evaluate the effectiveness and safety of different anti-inflammatory analgesic drugs compared with placebo, with each other or with no treatment. However, we were disappointed that we could not find any completed randomised controlled trials of these treatments or any evidence from non-randomised controlled trials. One study in CFA has recently finished and may provide some evidence when published. We suggest that there should be a randomised controlled trial to look at the effects and the safety of using anti-inflammatory drugs or painkillers or both to manage the symptoms of cystic fibrosis-related arthritis.

 

摘要

背景

藥物(抗發炎藥或止痛藥)對減緩肺囊性纖維化引起關節炎之療效

關節炎是一個肺囊性纖維化較少發生的併發症，不過當它發生常會造成嚴重的罹病。有兩種不同特徵的關節炎和肺囊性纖維化有關：一種是纖維化相關之關節病變 (CFA)；另一種是增生性肺部骨性關節病變。對於罹患關節炎的肺囊性纖維化患者，治療複雜且不明確，因為本身的疾病和密集的治療。

目標

回顧對於罹患關節炎的肺囊性纖維化患者，成人或小孩，有效又安全的症狀治療方式。

搜尋策略

我們從包含了電子資料庫、人工搜尋期刊以及研討會摘要找出參考文獻的Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register上搜尋。最近的資料是2007年9月。

選擇標準

隨機對照試驗，比較不同抗發炎藥和止痛藥(例如非類固醇抗發炎藥和全身性類固醇、關節內類固醇)或與“不治療”及與安慰劑比較治療CFA和HPO的藥效和安全性。

資料收集與分析

沒有找到符合的研究。

主要結論

這篇回顧沒有納入任何研究。

作者結論

一般認為CFA是偶發性且會自行緩解，但常常還是需要使用止痛藥和消炎藥。雖然這種療法對於減緩症狀可能足夠，但另我們失望的並沒有找到任何隨機分配的臨床試驗來嚴謹地分析這些藥物，就算是半隨機的研究也找不到。這篇回顧指出，我們的確需要隨機分配的臨床試驗，比較不同抗發炎藥和止痛藥(例如非類固醇抗發炎藥和全身性類固醇、關節內類固醇)來治療CFA和HPO無論成人小孩，的藥效和安全性。最好研究可以分出這兩種不同情形。最近開始進行的一篇關於CFA的研究可能可以彌補這個遺憾。

翻譯人

本摘要由臺灣大學附設醫院王帝皓翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

使用藥物來減緩肺囊性纖維化引起關節炎。關節炎是一個肺囊性纖維化較少發生的併發症，不過可能會很嚴重。有兩種不同特徵的關節炎和肺囊性纖維化有關：一種是纖維化相關之關節病變 (CFA)；另一種是增生性肺部骨性關節病變(HPO)。對於罹患關節炎的肺囊性纖維化患者，治療複雜且不明確，因為本身的疾病和密集的治療。我們打算回顧臨床試驗的成果，並報告評估利用不同抗發炎或止痛藥物和安慰劑甚至無治療相比治療的療效和安全性。無論如何，我們非常失望，我們無法找到任何完整的隨機分配臨床試驗；甚至任何其他臨床研究的證據。最近開始進行的一篇關於CFA的研究或許可以有些結果。我們建議應該進行隨機分配的臨床試驗研究，來闡明不同抗發炎藥和止痛藥來治療肺囊性纖維化引起的關節炎的藥效和安全性。