Meta-analyses on the effects of Disease Modifying Anti-Rheumatic Drugs on the most relevant Patient-Reported Outcome domains in Rheumatoid Arthritis

Marijke van den Dikkenberg*, Nathalie Luurssen-Masurel, Tjallingius Martijn Kuijper, Marc-Redwart Kok, Johanna Maria Wilhelmina Hazes, Pascal Hendrik Pieter de Jong, Deirisa Lopes-Barreto, Angelique Elisabeth Adriana Maria Weel-Koenders

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)


OBJECTIVE: Whereas in the treatment of rheumatoid arthritis much evidence exists on the effects of current pharmacologic treatment on clinical outcomes, little is known about the effects on patient-reported outcomes. This systematic review aims to evaluate the effects of disease-modifying antirheumatic drugs (DMARDs) on the patient-relevant domains of pain, fatigue, activity limitation, overall emotional and physical health impact, and work/school/housework ability and productivity.

METHODS: A literature search was conducted to identify randomized controlled trials wherein registered DMARDs were compared with placebo or methotrexate and reported the effects on patient-reported outcomes included in the International Consortium of Health Outcomes Measurement standard set for inflammatory arthritis. Random effects meta-analyses using the standardized mean differences of change scores as the effect measure were performed for the domains of pain, fatigue, and activity limitation, comparing DMARDs with placebo and methotrexate. The other 2 domains were presented narratively.

RESULTS: Across the 5 domains, 69 records belonging to 52 studies were identified. All meta-analyses showed a decrease of burden when DMARDs were compared with placebo (standardized mean differences [95% confidence interval] in pain -0.80 [-0.99, -0.61], fatigue -0.48 [-0.64, -0.32], and activity limitation -0.56 [- 0.63, -0.49]) and when compared with methotrexate (-0.55 [-0.70, -0.41), -0.44 [-0.55, -0.33], and - 0.37 [-0.44, -0.30], respectively).

CONCLUSION: DMARDs decrease the burden in all the domains that are relevant to patients. Effect sizes may be influenced by DMARD type. Therefore, in the decision for rheumatoid arthritis treatment, patient-reported outcomes should be taken into account.

Original languageEnglish
Pages (from-to)1659-1672
Number of pages14
JournalArthritis Care and Research
Issue number8
Early online date3 Jun 2022
Publication statusPublished - Aug 2023

Bibliographical note

Funding Information:
We wish to thank two experienced librarians of the Erasmus Medical Center, Dr. Wichor Bramer and Dr. Elise Krabbendam for their help in developing the search strings, performing the search, and processing the identified records in EndNote.

Publisher Copyright:
© 2022 American College of Rheumatology.


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