Therapeutic Advances in Musculoskeletal Disease最新文献

{"title":"Distinct characteristics and progression patterns of facet joint structural lesions in radiographic axial spondyloarthritis.","authors":"Simin Liao, Liuquan Cheng, Zheng Zhao, Jian Zhu, Feng Huang","doi":"10.1177/1759720X241281201","DOIUrl":"10.1177/1759720X241281201","url":null,"abstract":"<p><strong>Background: </strong>Both vertebral bodies and posterior elements of the vertebrae (facet joints, FJ) can engage in bone formation in radiographic axial spondyloarthritis (r-axSpA). However, little is known about the specific structural lesions and progression patterns of FJs in r-axSpA.</p><p><strong>Objectives: </strong>To identify specific lesions related to r-axSpA and to investigate the distinct progression patterns by comparing the FJ changes of r-axSpA with that of diffuse idiopathic skeletal hyperostosis (DISH), osteoarthritis (OA), and control group (CG).</p><p><strong>Design: </strong>Single-center, retrospective study. Longitudinal imaging data were retrieved and collected.</p><p><strong>Methods: </strong>Age- and sex-matched patients with complete thoracic and lumbar spine computed tomography (CT) data were included and their bilateral FJs were assessed. FJ changes were divided into erosions, ankylosis, joint-space narrowing, osteophytes, subchondral sclerosis, subchondral cysts, and vacuum phenomena. Average progressed year was defined as \"number of changed vertebrae × interval years\"/number of changed vertebrae.</p><p><strong>Results: </strong>In all, 50 patients in each group were included. Subchondral cysts and vacuum phenomena were not observed. Bilateral FJ ankylosis (FJA)/erosions in the thoracic and lumbar spine, and unilateral ankylosis/erosions in T1-4, T9-12 were significantly more common in r-axSpA. Joint-space narrowing/osteophytes/subchondral sclerosis were significantly more common in DISH and OA. FJ lesions progressed in 56.34% of vertebrae of r-axSpA. The most common pattern was \"FJ normal advanced to ankylosis\" (17.54%) which required 2.63 years. It was followed by \"erosions advanced to ankylosis\" (12.3%) which took 2.05 years, and by \"normal FJ advanced to erosions\" (11.04%) which took 2.29 years, respectively. Degenerative changes could also progress to FJ erosions/ankylosis (24.83%). The majority pattern in DISH/OA was \"FJ changes advanced to subchondral sclerosis/osteophytes/joint-space narrowing.\"</p><p><strong>Conclusion: </strong>Bilateral FJA/erosions are r-axSpA-specific lesions. The specific progression pattern for r-axSpA was \"FJ changes advanced to ankylosis/erosions.\" Repeated CT examination in intervals of at least 2 years will be more appropriate for monitoring FJ progression.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of motor vehicle accidents with profound injuries in patients with ankylosing spondylitis: a nationwide, population-based cohort study.","authors":"Chung-Mao Kao, Wei-Li Ho, Yi-Ming Chen, Tsu-Yi Hsieh, Wen-Nan Huang, Yi-Hsing Chen, Hsin-Hua Chen","doi":"10.1177/1759720X241273039","DOIUrl":"10.1177/1759720X241273039","url":null,"abstract":"<p><strong>Background: </strong>Patients with ankylosing spondylitis (AS) suffer from impaired physical activity and are prone to motor vehicle accidents (MVA), but definite instruction regarding the relationship between disease evolvement and MVA and potential risk factors is lacking.</p><p><strong>Objectives: </strong>To explore the risk factors and their impact on recorded MVA with profound injuries in AS patients with prescriptions.</p><p><strong>Design: </strong>Nationwide, population-based, matched retrospective cohort study.</p><p><strong>Methods: </strong>Using Taiwanese administrative healthcare databases, with available claims data from 2003 to 2013, we selected 30,911 newly diagnosed adult AS patients with concurrent prescriptions from 2006 to 2012 as AS patients, along with 309,110 non-AS individuals as the control group, matched in gender, age at index date and year of the index date. The risk of recorded MVA with profound injuries was compared between the two groups in terms of incidence rate ratio (IRR) and log-rank test <i>p</i>-value. Using Cox regression analysis, we studied associations between the risk and AS diagnosis.</p><p><strong>Results: </strong>The risk of recorded MVA with profound injuries in AS patients was significantly higher than in non-AS individuals, specifically 2 years after AS diagnosis (IRR, 2.00; 95% confidence interval (CI), 1.42-2.81). For patients with follow-up periods >2 years, the adjusted risk was positively associated with suburban residence (adjusted hazard ratio (aHR), 2.18; 95% CI, 1.55-3.06), rural residence (aHR, 1.89; 95% CI, 1.27-2.80), lower insured income (aHR, 1.35; 95% CI, 1.01-1.81) and recorded MVA with profound injuries before AS diagnosis (aHR, 6.16; 95% CI, 2.53-14.96). AS diagnosis (aHR, 1.81; 95% CI, 1.27-2.59) and frequency of ambulatory visits (aHR, 1.01; 95% CI, 1.004--1.02) were specific associated factors for them compared with those with follow-up periods ⩽2 years.</p><p><strong>Conclusion: </strong>For adult AS patients in Taiwan, factors such as AS disease evolution and frequent ambulatory visits for disease control in the second year of the disease course may significantly increase the risk of recorded MVA with profound injuries beyond 2 years after AS diagnosis.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone marrow edema in children: chronic nonbacterial osteomyelitis and its mimickers","authors":"Chiara Giraudo, Giulia Fichera, Anna Michielin, Francesco Zulian, Roberto Stramare, Winston J. Rennie","doi":"10.1177/1759720x241278438","DOIUrl":"https://doi.org/10.1177/1759720x241278438","url":null,"abstract":"Bone marrow is a highly cellular tissue undergoing significant developmental and physiologic changes with age. Indeed, with maturation from pediatric to the adult age there is a progressive, centrifugal conversion from red to yellow bone marrow. Histological characteristics of bone marrow are reflected in MR image signal. MR is therefore extremely sensitive in detecting pathological changes which are mostly characterized by increased free water causing high signal intensity on T2. Among the numerous diseases causing bone marrow edema in children chronic nonbacterial osteomyelitis (CNO) certainly has to be mentioned. This idiopathic inflammatory disorder is characterized by nonspecific migrating symptoms like skeletal pain with phases of exacerbations and relapses with alternating acute and chronic MR signs and it is often a diagnosis of exclusion. Hence, with bone marrow edema, various features at imaging should be considered to differentiate malignancies such as osseous lymphoma, osteosarcoma, and Ewing’s sarcoma as well as benign lesions like osteomyelitis, post-traumatic, or post-treatment bone marrow edema. The aim of this review is to recall the main characteristics of CNO and provide an overview of its main mimickers highlighting similarities and differences.","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142269496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monotherapy or combination therapy in PsA: current aspects","authors":"Elpida Skouvaklidou, Paraskevi Avgerou, Konstantinos D. Vassilakis, George E. Fragoulis, Nikolaos Kougkas","doi":"10.1177/1759720x241274055","DOIUrl":"https://doi.org/10.1177/1759720x241274055","url":null,"abstract":"Psoriatic arthritis (PsA) is an immune-mediated inflammatory disease with heterogeneity regarding its clinical features, mainly affecting the skin and the musculoskeletal system; additionally, extra-musculoskeletal manifestations and comorbidities are common, adding complexity to its treatment. In the last decades, a plethora of therapeutic options have been available, including conventional synthetic disease-modifying anti-rheumatic drugs (DMARDs), biological DMARDs (bDMARDs), and targeted synthetic DMARDs (tsDMARDs), and many recommendations have been published regarding the proper use of them in patients with PsA. In rheumatoid arthritis, the combination of conventional with bDMARDs or tsDMARDs is a common and recommended practice, whereas in PsA there is scarce data about the benefit of this combination. This review summarizes all the available data from randomized clinical trials, observational studies, and registries about the value of this therapeutic strategy.","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142258728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knee osteoarthritis: disease burden, available treatments, and emerging options","authors":"Michael Langworthy, Vinod Dasa, Andrew I. Spitzer","doi":"10.1177/1759720x241273009","DOIUrl":"https://doi.org/10.1177/1759720x241273009","url":null,"abstract":"Osteoarthritis (OA) is a prevalent condition that affects nearly 528 million people worldwide, including 23% of the global population aged ⩾40, and is characterized by progressive damage to articular cartilage, which often leads to substantial pain, stiffness, and reduced mobility for affected patients. Pain related to OA is a barrier to maintaining physical activity and a leading cause of disability, accounting for 2.4% of all years lived with disability globally, reducing the ability to work in 66% of US patients with OA and increasing absenteeism in 21% of US patients with OA. The joint most commonly involved in OA is the knee, which is affected in about 60%–85% of all OA cases. The aging population and longer life expectancy, coupled with earlier and younger diagnoses, translate into a growing cohort of symptomatic patients in need of alternatives to surgery. Despite the large number of patients with knee OA (OAK) worldwide, the high degree of variability in patient presentation can lead to challenges in diagnosis and treatment. Multiple society guidelines recommend therapies for OAK, but departures from guidelines by healthcare professionals in clinical settings reflect a discordance between evidence-based treatment algorithms and routine clinical practice. Furthermore, disease-modifying pharmacotherapies are limited, and treatment for OAK often focuses solely on symptom relief, rather than underlying causes. In this narrative review, we summarize the patient journey, analyze current disease burden and nonsurgical therapy recommendations for OAK, and highlight emerging and promising therapies—such as cryoneurolysis, long-acting corticosteroids, and gene therapies—for this debilitating condition.","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142258729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular comorbidities in psoriatic arthritis: state of the art","authors":"Mrinalini Dey, Elena Nikiphorou","doi":"10.1177/1759720x241274537","DOIUrl":"https://doi.org/10.1177/1759720x241274537","url":null,"abstract":"Psoriatic arthritis (PsA) is a complex multi-system immune-mediated condition, characterised by a high comorbidity burden, one of the most prevalent of which is cardiovascular disease (CVD), affecting up to 80% of patients. This narrative review explores the current understanding of cardiovascular comorbidities in PsA, focusing on mechanistic pathways, risk assessment, and the impact of treatment choices on cardiovascular health. Here, we outline the role of inflammatory cytokines, immune system dysregulation, and genetic predispositions in PsA, not only as drivers of musculoskeletal manifestations but also atherosclerosis and endothelial dysfunction, giving rise to cardiovascular pathology. Given these insights, accurately assessing and predicting cardiovascular risk in PsA patients is a critical challenge. This review evaluates traditional risk calculators as well as innovative biomarkers and imaging techniques, emphasising their utility and limitations in capturing the true cardiovascular risk profile of PsA patients. There are multiple complexities surrounding the treatment of PsA in the context of concurrent CVD, and therapeutic choices must carefully balance efficacy in managing PsA symptoms with the potential cardiovascular implications. A multidisciplinary approach, integrating dermatological, rheumatological, and cardiological perspectives, amongst others, to optimise patient outcomes, is key. Overall, a heightened clinical awareness and research focus on cardiovascular comorbidities in PsA is warranted, aiming to refine risk assessment strategies and therapeutic interventions that holistically address the multifaceted needs of patients with PsA.","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142258730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The socioeconomic status of patients with ankylosing spondylitis and its association with the burden of the disease and permanent disability: a cross-sectional cluster analysis.","authors":"Desirée Ruiz-Vilchez, Lourdes Ladehesa-Pineda, María Ángeles Puche-Larrubia, María Carmen Ábalos-Aguilera, Pilar Font-Ugalde, Alejandro Escudero-Contreras, Eduardo Collantes-Estévez, Clementina López-Medina","doi":"10.1177/1759720X241272947","DOIUrl":"10.1177/1759720X241272947","url":null,"abstract":"<p><strong>Background: </strong>Few studies have been conducted to investigate the socioeconomic profiles of patients with ankylosing spondylitis (AS) and their associations with disease severity and disability.</p><p><strong>Objectives: </strong>The objectives of this study were to identify clusters of patients with AS according to their socioeconomic characteristics and to evaluate the associations between these clusters and the severity of the disease and permanent disability.</p><p><strong>Design: </strong>This was a cross-sectional and multicentre study.</p><p><strong>Methods: </strong>Patients with AS from the REGISPONSER study were included in this analysis. A cluster analysis was conducted using information on sociodemographic (age, sex, race, marital status, education) and socioeconomic (employment, profession, housing conditions and social level) characteristics. Disease burden and permanent disability were compared between the different clusters using logistic regression adjusted for disease duration and disease activity.</p><p><strong>Results: </strong>A total of 866 patients with AS were included. Two clusters were identified according to socioeconomic characteristics: Cluster 1 (<i>n</i> = 476), with a predominantly low socioeconomic profile, and Cluster 2 (<i>n</i> = 390), with a predominantly high socioeconomic profile. After adjusting for disease duration, patients in Cluster 1 had a longer diagnosis delay, greater body mass index and greater structural damage than those in Cluster 2. Access to biologic disease-modifying anti-rheumatic drugs (bDMARDs) was similar for both groups. However, patients in Cluster 1 had a greater prevalence of permanent disability than those in Cluster 2 after adjusting for disease duration and disease activity (30.8% vs 13.2%, odds ratio 2.58 (95% confidence interval 1.76-3.83)).</p><p><strong>Conclusion: </strong>This study suggests that the socioeconomic status of patients with AS may have implications for disease severity and permanent disability, despite the similar use of bDMARDs.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11378180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meibomian gland dropout of upper eyelids as a novel biomarker for early diagnosis of primary Sjögren's syndrome: a pilot study.","authors":"Jing Wu, Yongying Liang, Fanjun Shi, Xianghong Tu, Jingfa Zhang, Qinghua Qiu","doi":"10.1177/1759720X241274726","DOIUrl":"10.1177/1759720X241274726","url":null,"abstract":"<p><strong>Background: </strong>Early diagnosis of primary Sjögren's syndrome (pSS) remains difficult due to its insidious onset.</p><p><strong>Objectives: </strong>To identify whether meibomian gland dropout (MGD) is a sensitive and noninvasive predictor of pSS by studying its association with histopathology in labial salivary gland biopsy in patients with clinically suspected pSS.</p><p><strong>Design: </strong>Prospective, randomized, multicenter, comparative effectiveness study.</p><p><strong>Methods: </strong>The study was conducted from July 2022 to July 2023. In all, 56 eligible participants with clinically suspected pSS were recruited from three combined ophthalmology medicine/rheumatology SS clinics. All participants with suspected pSS were evaluated and diagnosed by ophthalmology and rheumatology consultants and underwent infrared imaging of the meibomian glands using Keratograph 5M and histopathological evaluation of labial salivary gland biopsies. The length, width, and tortuosity of the meibomian glands were measured; the dropout rate in the nasal, temporal, and total eyelids was analyzed; and the dropout score was calculated using meibography grading scales.</p><p><strong>Results: </strong>Among the 56 participants, 34 were identified with pSS, and 22 were diagnosed with non-SS dry eye (NSSDE) and served as the control group. We recorded significant differences in the temporal and total MGD rates of the upper eyelids between the pSS and NSSDE groups (all <i>p</i> < 0.01). Improved prediction accuracy was achieved with the temporal and total MGD rates in the upper eyelids, with area under the curve values of 0.94 and 0.91, and optimal cutoff points of 0.78 and 0.75, respectively.</p><p><strong>Conclusion: </strong>MGD in the upper eyelids, especially in the temporal portion, is strongly associated with the histopathological outcome of labial salivary gland biopsy in pSS and is proposed as a highly predictive and noninvasive biomarker for the early diagnosis of pSS.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: ChiCTR2000038911.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11369872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Switching related to inefficacy in biologics and targeted synthetic therapies for psoriatic arthritis: a comparative real-life study.","authors":"Dalifer Freites-Nuñez, Leticia Leon, Esther Toledano, Gloria Candelas, Cristina Martinez, Maria Rodriguez-Laguna, Daniel Rubio, Benjamin Fernandez-Gutierrez, Lydia Abasolo","doi":"10.1177/1759720X241273083","DOIUrl":"10.1177/1759720X241273083","url":null,"abstract":"<p><strong>Background: </strong>Switching between therapies is a recommended strategy for psoriatic arthritis (PsA) patients who experience treatment failure; however, studies including real-life data are scarce.</p><p><strong>Objectives: </strong>To assess the incidence rate (IR) of switching between biologics and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) due to inefficacy in PsA, and to compare the risk of switching due to inefficacy across different b/tsDMARDs groups.</p><p><strong>Design: </strong>A longitudinal retrospective study, spanning from 2007 to 2022, was conducted on patients with PsA treated with b/tsDMARDs at an outpatient rheumatology clinic.</p><p><strong>Methods: </strong>The primary outcome was switching between b/tsDMARDs due to inefficacy. The independent variable was the exposure to b/tsDMARDs during follow-up. As covariates, clinical, treatment-related, and sociodemographic variables were considered. Survival techniques were run to estimate the IR of switching due to inefficacy per 100 patients*year and confidence interval at 95% (95% CI). Cox multivariate regression analyses were run to assess the risk of b/tsDMARDs switching due to inefficacy, expressed as hazard ratio (HR) and 95% CI.</p><p><strong>Results: </strong>In all, 141 patients were included, with 893.09 patients*year follow-ups. 52.48% of them were females in their fifties. In total, 262 courses of treatment were recorded. During the study period, 56 patients presented 121 switches and 103 related to inefficacy (IR: 11.53 (9.51-13.98)). Tumor necrosis factor-alpha inhibitors (TNFi) showed the lowest IR. In the bivariate analysis, all b/tsDMARDs had more risk of switching compared to TNFi (HR: anti-lL-17 vs TNFi: 2.26 (1.17-4.36); others vs TNFi: 3.21 (1.59-6.45)); however, this statistical significance was no longer present in the multivariate analysis once adjustments were made for the covariates. Still, the final model achieved statistical significance in the following variables: gender, clinical symptoms, prescription year, therapy courses, glucocorticoids, and sulfasalazine.</p><p><strong>Conclusion: </strong>In this study, we did not find differences in the rate of switching due to inefficacy among different groups of b/tsDMARDs. Other concomitant treatments, sociodemographic, and clinical variables were identified as risk factors for switching due to inefficacy.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11366104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of acupuncture versus placebo on clinical status and potential specific effects in Fibromyalgia: an umbrella review of 11 meta-analyses.","authors":"Felipe Araya-Quintanilla, Robinson Ramirez-Vélez, Guillermo Mendez-Rebolledo, Iván Cuyul-Vásquez, Alexis Arce-Álvarez, Yasmin Ezzatvar, Héctor Gutiérrez-Espinoza","doi":"10.1177/1759720X241271775","DOIUrl":"10.1177/1759720X241271775","url":null,"abstract":"<p><strong>Background: </strong>The use of acupuncture is related to patients' expectations, and the therapeutic interaction effect remains a topic of debate in the literature. Accordingly, it is still unclear whether acupuncture can generate positive clinical effects in patients with fibromyalgia (FM).</p><p><strong>Objective: </strong>To determine the effectiveness of acupuncture versus placebo for clinical outcomes and determine the overall effect not attributed to specific effects in patients with FM.</p><p><strong>Design: </strong>Umbrella review of systematic reviews (SRs) and meta-analyses.</p><p><strong>Data sources and methods: </strong>An electronic search was performed in MEDLINE (via PubMed), Web of Science, CENTRAL, EMBASE, LILACS, CINAHL, PEDro, and SPORTDiscus databases from inception until December 2023. We selected studies with a clinical diagnosis of FM and that analyzed the effectiveness of acupuncture compared with a placebo. Pain intensity, functional status, fatigue, sleep quality, and depression symptoms were assessed. Effect sizes were calculated as the mean difference (MD) or standard mean difference (SMD). The quality of intervention reporting was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.</p><p><strong>Results: </strong>Eleven SRs with 8399 participants were included. Compared with placebo, acupuncture was associated with reductions in pain intensity (MD = -1.13 cm, 95% CI -2.09 to -0.17, <i>p</i> < 0.001), physical function (SMD = -0.63, 95% CI -1.67 to 0.41, <i>p</i> = 0.06), sleep quality (SMD = -0.25, 95% CI -1.39 to 0.88, <i>p</i> = 0.06), and fatigue (SMD = 0.20, 95% CI = 0.17 to 0.22, <i>p</i> < 0.001). The proportion not attributable to specific effects (PCE) of acupuncture was 58% for pain intensity (PCE = 0.58, 95% CI 0.45 to 0.71), 57% for physical function (PCE = 0.57, 95% CI -0.07 to 1.20), and 69% for fatigue (PCE = 0.69, 95% CI 0.18 to 1.21).</p><p><strong>Conclusion: </strong>Acupuncture showed a statistically significant difference in decreased pain intensity and fatigue in women with FM. However, the certainty of evidence was low to very low; its effects are not clinically important, and more than 50% of the overall treatment effects were not attributed to the specific effects of acupuncture.</p><p><strong>Prospero registration number: </strong>CRD42023487315.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11334136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}