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The author appears to conclude that anti-tumour necrosis factor agents may be more effective for enthesitis in patients with spondyloarthritis, but the evidence was limited and findings should be interpreted with caution. Despite some limitations in the conduct of the review and in view of the limited evidence presented, the author's cautious conclusion seems appropriate.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

Psoriatic arthritis is a condition that leads to pain and stiffness in joints. It can be caused by psoriasis, but sometimes occurs in people who don't have any visible psoriasis-related skin changes. Various treatments can relieve the symptoms and prevent damage to the joints.It is estimated that 20% of people who have psoriasis also develop pain and inflammation in certain joints at some point. The joints start hurting and may feel stiff for a while, particularly in the morning. Movement often makes the stiffness disappear within half an hour. The affected joints may also become swollen, feel warm and sensitive to the touch. If the small joints between the vertebrae (spine bones) are inflamed, it might cause back pain.Psoriatic arthritis can occur in many joints of the body. It often affects the hands, feet, elbows, knees, neck or vertebrae. More than five joints typically become inflamed, including the joints at the end of the fingers and toes. These joints are especially prone to becoming deformed in severe cases. Tendons and tendon sheaths can also become inflamed.Most people who have psoriatic arthritis also have nail psoriasis. This can lead to small dents in the nails, which may become thicker, change color or start peeling off too. Nail psoriasis is difficult to treat and sometimes mistaken for a fungal nail infection.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 18, 2017

Anti-tumour necrosis factor alphas (anti-TNFs) such as infliximab (e.g., Remicade©) are biologics that are proven effective against autoimmune inflammatory diseases. Biologics are large, protein-based agents used to block inflammation for a variety of serious diseases. Infliximab can be used for a variety of chronic inflammatory conditions including rheumatoid arthritis (RA), ankylosing spondylitis (AS), inflammatory bowel disease (IBD) including ulcerative colitis (UC) and Crohn’s disease (CD), psoriatic arthritis (PA), and plaque psoriasis (PP).– More recently, subsequent entry biosimilar drugs for infliximab have been introduced to the market due to the patent expiry of the originator (or innovator) drug. Biosimilar drugs are therapeutically and biologically similar to originators, appearing in general when exclusivity rights are lost. ‘Biosimilar infliximab’ is used interchangeably with subsequent entry infliximab in this review.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: January 18, 2017

Psoriasis is a common, chronic disease, which for many people, is associated with profound functional, psychological and social morbidity and important comorbidities. Effective treatments are available. Some treatments are expensive; all require appropriate monitoring and some may only be accessed in specialist care settings. Evidence indicates that a substantial proportion of people with psoriasis are currently dissatisfied with their treatment.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: October 2012

The objective of this report is to perform a systematic review of the beneficial and harmful effects of ustekinumab 45 mg or 90 mg for the treatment of active psoriatic arthritis in adults, alone or in combination with methotrexate. Ustekinumab is a fully human IgG1 kappa monoclonal antibody that binds to the shared p40 subunit of interleukin (IL)-12 and IL-23 and is administered by subcutaneous injection of 45 mg or 90 mg at weeks 0 and 4 and every 12 weeks thereafter.

Common Drug Review - Canadian Agency for Drugs and Technologies in Health.

Version: November 2016

The study found that biologic disease-modifying antirheumatic drugs (with methotrexate where permitted) are superior to placebo in children with polyarticular course JIA who have had an insufficient response to previous treatment.

Health Technology Assessment - NIHR Journals Library.

Version: April 2016

The study found that tumour necrosis factor inhibitors are clinically effective for treating ankylosing spondylitis and non-radiographic axial spondyloarthritis, although more so in ankylosing spondylitis than in non-radiographic axial spondyloarthritis. Tumour necrosis factor inhibitors may be an effective use of NHS resources depending on which assumptions are considered appropriate when modelling cost-effectiveness.

Health Technology Assessment - NIHR Journals Library.

Version: February 2016

The objective of this systematic review is to examine the beneficial and harmful effects of IV tocilizumab in the treatment of active polyarticular juvenile idiopathic arthritis (pJIA).

Common Drug Review - Canadian Agency for Drugs and Technologies in Health.

Version: August 2014

The calcineurin inhibitors (CNIs) tacrolimus and cyclosporine A (CsA) are effective immunosuppressive agents for renal transplantation, but they must be managed carefully to avoid toxicity. Routine therapeutic monitoring guides dosing, but uncertainty surrounds different monitoring methods and timepoints. Additionally, the effectiveness of strategies to reduce CNI exposure with lower therapeutic levels and other immunosuppressants is unclear. This systematic review evaluates the evidence for three Key Questions. Key Question 1 compares immunoassay analysis with liquid chromatographic or mass spectrometric analytical techniques for therapeutic monitoring of CNIs. Key Question 2 examines CsA monitoring timepoints. Key Question 3 evaluates alternatives to full-dose CNI regimens.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: March 2016

Osteoarthritis refers to a clinical syndrome of joint pain accompanied by varying degrees of functional limitation and reduced quality of life. It is the most common form of arthritis, and one of the leading causes of pain and disability worldwide. The most commonly affected peripheral joints are the knees, hips and small hand joints. Although pain, reduced function and effects on a person’s ability to carry out their day-to-day activities can be important consequences of osteoarthritis, pain in itself is of course a complex biopsychosocial issue, related in part to person expectations and self-efficacy, and associated with changes in mood, sleep and coping abilities. There is often a poor link between changes on an X-ray and symptoms: minimal changes can be associated with a lot of pain and modest structural changes to joints oftencan occur without with minimal accompanying symptoms. Contrary to popular belief, osteoarthritis is not caused by ageing and does not necessarily deteriorate. There are a number of management and treatment options (both pharmacological and non-pharmacological), which this guideline addresses and which offer effective interventions for control of symptoms and improving function.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: February 2014

Etanercept, infliximab and adalimumab are licensed in the UK for the treatment of active and progressive psoriatic arthritis (PsA) in adults who have an inadequate response to standard treatment.

Health Technology Assessment - NIHR Journals Library.

Version: February 2011

This review examined the evidence on ultrasound examinations for assessment of osteoarthritis and found that more work was required to develop standardised definitions of pathology and demonstrate validity of ultrasound. Despite a number of limitations in the review process, this conclusion reflected the heterogeneity and poor quality of the data presented and is likely to be accurate.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Systematic Reviews in PubMed

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