Related Experiment Video
Updated: Feb 8, 2026
Author Spotlight: Evaluating the Adjuvant Efficacy and Safety of Angong Niuhuang Pill in Viral Encephalitis Treatment
Published on: April 19, 2024
Conventional and biologic disease-modifying anti-rheumatic drugs for osteoarthritis: a meta-analysis of randomized
Monica S M Persson1, Aliya Sarmanova1, Michael Doherty1
1Academic Rheumatology, Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK.
Objectives:
The role of inflammation in OA is controversial and it is unclear whether suppressing inflammation with conventional or biologic DMARDs is effective. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to compare DMARDs with placebo in participants with symptomatic OA.
Methods:
Databases (Medline, Embase, Allied and Complementary Medicine Database, Web of Science and Cochrane Library), conference abstracts and ClinicalTrials.gov were searched to end of November 2017 for placebo-controlled RCTs of DMARDs, including biologics, in symptomatic OA. Pain data at treatment peak time point were extracted and combined using a random-effects meta-analysis. Markers of inflammation and adverse events were extracted and reviewed. Risk of bias assessment was conducted using Cochrane's tool.
Results:
Eleven RCTs (1205 participants) were meta-analysed, including six for conventional DMARDs (757 participants) and five for biologics (448 participants). Overall, DMARDs were statistically superior to placebo [effect size (ES) = 0.18, 95% CI: 0.03, 0.34], although the difference was not clinically significant (0.5 ES threshold). Furthermore, no statistically significant differences were observed in sub-analysis of high-quality trials (ES = 0.11, 95% CI : -0.06, 0.28), biologics (ES = 0.16, 95% CI: -0.02, 0.34) or conventional DMARDs (ES = 0.24, 95% CI: -0.05, 0.54). No difference was found between erosive vs non-erosive hand OA, hand vs knee OA or anti-IL1 vs anti-TNF biologics.
Conclusion:
DMARDs did not offer clinically significant pain relief above placebo in OA. This poor efficacy indicates that inflammation may not be a prime driver for OA pain.
Insights
Disease-modifying antirheumatic drugs (DMARDs) did not provide significant pain relief for osteoarthritis (OA) patients compared to placebo. These findings suggest inflammation may not be the primary cause of OA pain.
Area of Science:
- Rheumatology
- Immunology
Background:
- The role of inflammation in osteoarthritis (OA) pathogenesis remains debated.
- The efficacy of disease-modifying antirheumatic drugs (DMARDs), including biologics, in managing OA symptoms is not well-established.
Purpose of the Study:
- To systematically review and meta-analyze randomized controlled trials (RCTs).
- To compare the effectiveness of DMARDs versus placebo in symptomatic OA patients regarding pain relief.
Main Methods:
- A comprehensive search of multiple databases and clinical trial registries was performed for placebo-controlled RCTs.
- Pain data were extracted and analyzed using random-effects meta-analysis; inflammation markers and adverse events were also reviewed.
- Risk of bias was assessed using Cochrane's tool.
Main Results:
- Eleven RCTs involving 1205 participants were analyzed.
- DMARDs showed a statistically significant but not clinically significant improvement in pain over placebo (ES = 0.18).
- No significant differences in pain relief were found in sub-analyses of high-quality trials, biologics, or conventional DMARDs.
Conclusions:
- DMARDs do not provide clinically meaningful pain relief in osteoarthritis patients.
- The limited efficacy suggests that inflammation may not be a primary driver of OA pain.
Related Concept Videos
01:24Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF
01:23Rheumatic Heart Disease I: Introduction
01:20Rheumatic Heart Disease IV: Nursing Management
01:21Rheumatic Heart Disease III: Medical Management
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
01:28Biological Methods for Microbial Control