The use of drugs to slow or stop progression of arthritis related to CF.

Thornton J, Rangaraj S

Published Online:

November 10, 2010

Arthritis is not a common complication of cystic fibrosis but it can cause major problems when it does occur. There are two distinct types of arthritis in cystic fibrosis: cystic fibrosis-related arthropathy and hypertrophic pulmonary osteoarthropathy. The best treatment for these conditions is not clear because of the underlying disease and its intense treatment. Anti-inflammatory and analgesic drugs treat the symptoms of arthritis but only disease modifying anti-rheumatic drugs (DMARDs) can stop or slow progression of the disease. We planned to report evidence from clinical trials to evaluate the effectiveness of different DMARDs 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. We suggest that there should be a randomised controlled trial to look at the effects and the safety of using DMARDs to slow or stop the progression of arthritis.

Abstract (click to read)

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 and hypertrophic osteoarthropathy. Management of arthritis in people with cystic fibrosis is uncertain and complex because of the underlying disease and its treatment.

Objectives:

To review the effectiveness and safety of disease-modifying anti-rheumatic drugs (DMARDs) for the management of arthritis related to cystic fibrosis in adults and children.

Search strategy:

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

Date of most recent search: 10 September 2010.

Selection criteria:

Randomised controlled trials which compared the efficacy and safety of DMARDs (e.g. methotrexate, gold, sulfasalazine, penicillamine, leflunomide, hydroxychloroquine and newer agents such as biologic disease modifying agents and monoclonal antibodies) with each other, with no treatment or with placebo for cystic fibrosis-related arthropathy or hypertrophic osteoarthropathy.

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 cystic fibrosis-related arthritis can be episodic and resolve spontaneously, treatment with analgesics and anti-inflammatory agents may be needed. But when episodic symptoms progress to persistent disease, DMARDs may be needed to limit the course of the disease. It is disappointing that no randomised controlled trials to rigorously evaluate DMARDs could be found. This systematic review has identified the need for a well-designed adequately powered randomised controlled trial to assess the efficacy and safety of DMARDs for the management of cystic fibrosis-related arthropathy and hypertrophic osteoarthropathy in adults and children with cystic fibrosis. However, given the infrequency of cystic fibrosis-related arthritis and the range of symptoms and severity, randomised controlled trials may not be feasible and well-designed non-randomised observational studies may be more appropriate. Studies should also better define the two conditions.

This record should be cited as:

Thornton J, Rangaraj S. Disease modifying anti-rheumatic drugs in people with cystic fibrosis-related arthritis. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD007336. DOI: 10.1002/14651858.CD007336.pub2

Assessed as up to date:

September 14, 2010

Find the research

Get full text at The Cochrane Library

Primary Review Group:

Cystic Fibrosis and Genetic Disorders Group

Health topics:

Genetic disorders > Cystic fibrosis > Systems outside lung & gastrointestinal tract

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

The use of drugs to slow or stop progression of arthritis related to CF.

More like this

Copyright © 2012 - The Cochrane Collaboration