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id="_NBK577120_"><span itemprop="name">Target for monitoring</span></h1><div class="subtitle">Rheumatoid arthritis in adults: diagnosis and management</div><p><b>Evidence review D</b></p><p><i>NICE Guideline, No. 100</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Guideline Centre (UK)</span>.</p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2018 Jul</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-3003-6</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2018.</div></div><div class="bkr_clear"></div></div><div id="chd1"><h2 id="_chd1_">1. Target for monitoring</h2><div id="chd1.s1"><h3>1.1. Review question: In adults with rheumatoid arthritis, what is the
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best target to use when monitoring disease activity (remission or low
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disease activity)?</h3></div><div id="chd1.s2"><h3>1.2. Introduction</h3><p>Current consensus amongst the rheumatology community is that a
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treat-to-target strategy should be used when treating people with
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rheumatoid arthritis (RA) with DMARDs. A treat-to-target strategy is a
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strategy that defines a treatment target (such as remission or low
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disease activity) and applies tight control (for example, monthly visits
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and respective treatment adjustment) to reach this target. The treatment
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strategy often follows a protocol for treatment adaptions depending on
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the disease activity level and degree of response to treatment.</p><p>The 2009 NICE guideline: Rheumatoid arthritis in adults: management<a class="bibr" href="#ptd.ref9" rid="ptd.ref9"><sup>9</sup></a> suggested a
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treat-to-target approach in the recommendations that said to measure
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inflammatory markers and disease activity monthly “until
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treatment has controlled the disease to a level previously agreed with
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the person with RA”. However, the committee agreed that the
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evidence for a treat-to-target strategy should be reviewed, to make this
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recommendation clearer and more direct if supported by the evidence.</p><p>The committee also agreed that greater clarity was needed on how
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frequently people with rheumatoid arthritis should be monitored, as
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there was currently variation in practice and some uncertainty about how
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frequent monitoring should be in different groups of people with
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rheumatoid arthritis with varying degrees of disease activity. However,
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the frequency of monitoring review excluded an update of the annual
|
|
review recommended in the previous guideline, as it is an essential and
|
|
well-established practice and therefore was not included within the
|
|
scope of this update.</p><p>Three interrelated evidence reviews were conducted to answer the
|
|
following key questions in this area: <ol id="l73"><li id="lt217" class="half_rhythm"><div>Is treat-to-target more effective than usual care?</div></li><li id="lt218" class="half_rhythm"><div>If so, should the treatment target be low disease activity or
|
|
remission?</div></li><li id="lt219" class="half_rhythm"><div>How often should people be monitored, outside of the annual
|
|
review?</div></li></ol></p></div><div id="chd1.s3"><h3>1.3. PICO table</h3><p>For full details, see the review protocol in <a href="#ptd.appa">appendix A</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchd1tab1"><a href="/books/NBK577120/table/chd1.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figchd1tab1" rid-ob="figobchd1tab1"><img class="small-thumb" src="/books/NBK577120/table/chd1.tab1/?report=thumb" src-large="/books/NBK577120/table/chd1.tab1/?report=previmg" alt="Table 1. PICO characteristics of review question." /></a><div class="icnblk_cntnt"><h4 id="chd1.tab1"><a href="/books/NBK577120/table/chd1.tab1/?report=objectonly" target="object" rid-ob="figobchd1tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">PICO characteristics of review question. </p></div></div></div><div id="chd1.s4"><h3>1.4. Methods and process</h3><p>This evidence review was developed using the methods and process
|
|
described in Developing NICE guidelines: the manual.<a class="bibr" href="#ptd.ref1" rid="ptd.ref1"><sup>1</sup></a> Methods specific
|
|
to this review question are described in the review protocol in <a href="#ptd.appa">appendix A</a>.</p><p>Declarations of interest were recorded according to NICE’s 2014
|
|
conflicts of interest policy.</p></div><div id="chd1.s5"><h3>1.5. Clinical evidence</h3><div id="chd1.s5.1"><h4>1.5.1. Included studies</h4><p>A search was conducted for randomised controlled trials and
|
|
systematic reviews of randomised controlled trials comparing
|
|
remission with low disease activity as targets in monitoring RA.</p><p>No relevant clinical studies were identified.</p><p>See also the study selection flow chart in <a href="#ptd.appc">appendix C</a>.</p></div><div id="chd1.s5.2"><h4>1.5.2. Excluded studies</h4><p>See the excluded studies list in <a href="#ptd.appi">appendix I</a>.</p></div><div id="chd1.s5.3"><h4>1.5.3. Summary of clinical studies included in the evidence
|
|
review</h4><p>No relevant clinical studies were identified.</p></div><div id="chd1.s5.4"><h4>1.5.4. Quality assessment of clinical studies included in the evidence
|
|
review</h4><p>No relevant clinical studies were identified.</p></div></div><div id="chd1.s6"><h3>1.6. Economic evidence</h3><div id="chd1.s6.1"><h4>1.6.1. Included studies</h4><p>No relevant health economic studies were identified.</p></div><div id="chd1.s6.2"><h4>1.6.2. Excluded studies</h4><p>No health economic studies that were relevant to this question were
|
|
excluded due to assessment of limited applicability or
|
|
methodological limitations.</p><p>See also the health economic study selection flow chart in <a href="#ptd.appg">appendix G</a>.</p></div><div id="chd1.s6.3"><h4>1.6.3. Unit costs</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchd1tab2"><a href="/books/NBK577120/table/chd1.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figchd1tab2" rid-ob="figobchd1tab2"><img class="small-thumb" src="/books/NBK577120/table/chd1.tab2/?report=thumb" src-large="/books/NBK577120/table/chd1.tab2/?report=previmg" alt="Table 2. UK costs of healthcare professional visits." /></a><div class="icnblk_cntnt"><h4 id="chd1.tab2"><a href="/books/NBK577120/table/chd1.tab2/?report=objectonly" target="object" rid-ob="figobchd1tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">UK costs of healthcare professional visits. </p></div></div></div></div><div id="chd1.s7"><h3>1.7. Resource costs</h3><p>The recommendations made in this review are not expected to have a
|
|
substantial impact on resources.</p></div><div id="chd1.s8"><h3>1.8. Evidence statements</h3><div id="chd1.s8.1"><h4>1.8.1. Clinical evidence statements</h4><p>No relevant clinical studies were identified.</p></div><div id="chd1.s8.2"><h4>1.8.2. Health economic evidence statements</h4><ul id="l78"><li id="lt233" class="half_rhythm"><div>No relevant economic evaluations were identified.</div></li></ul></div></div><div id="chd1.s9"><h3>1.9. The committee’s discussion of the evidence</h3><div id="chd1.s9.1"><h4>1.9.1. Interpreting the evidence</h4><div id="chd1.s9.1.1"><h5>1.9.1.1. The outcomes that matter most</h5><p>The critical outcomes were agreed to be the Disease Activity
|
|
Score (DAS), quality of life and function for all 3 reviews.</p><p>Pain, radiographic progression, fatigue and the number of people
|
|
who withdrew from the trial were agreed to be important outcomes
|
|
for all 3 reviews. The treat-to-target review and the frequency
|
|
of monitoring review also specified the number of people
|
|
achieving remission and low disease activity, using DAS
|
|
thresholds, as important outcomes. The committee agreed that
|
|
data reported in this format are not as informative as
|
|
continuous DAS data but still give an indication of symptom
|
|
relief and disease activity improvement. Disease activity data
|
|
in this dichotomous format were not considered informative for
|
|
the review of whether low disease activity or remission was the
|
|
better target given the question posed by the review.</p><p>In the treat-to-target review, no data were available for the
|
|
outcome of fatigue. For the frequency of monitoring review, no
|
|
data were available for any of the disease activity outcomes,
|
|
quality of life or fatigue.</p><p>No studies were identified for the review of remission compared
|
|
with low disease activity as a treatment target.</p></div><div id="chd1.s9.1.2"><h5>1.9.1.2. The quality of the evidence</h5><div id="chd1.s9.1.2.1"><h5>Treat-to-target versus usual care</h5><p>Five studies were included in the review of treat-to-target
|
|
versus usual care. The quality of the evidence was varied,
|
|
ranging from moderate to very low quality, with the majority
|
|
of the outcomes graded either low or very low quality. A
|
|
lack of blinding was a source of risk of bias in all of the
|
|
included studies. Some studies also poorly reported aspects
|
|
of their design such as how they randomised participants,
|
|
concealed allocation, and dealt with missing data, which
|
|
affected the quality rating. For those outcomes where the
|
|
data was reported by only 1 or 2 trials, the confidence
|
|
intervals tended to be wide which meant there was some
|
|
uncertainty about whether the treat-to-target strategy was
|
|
more effective than usual care.</p><p>Importantly, there was substantial inconsistency in the
|
|
magnitude of the benefit of treat-to-target across the
|
|
studies and between different treat-to-target arms within
|
|
studies, which also affected the quality of the evidence for
|
|
most outcomes (DAS, HAQ, remission, low disease activity,
|
|
pain, and study discontinuation). It was not possible to
|
|
conduct formal subgroup analysis to see if this explained
|
|
the heterogeneity, as there were too few studies in each
|
|
subgroup category. However, the committee discussed the
|
|
possible reasons for these differing results. The committee
|
|
noted the great variation in the design of the studies,
|
|
particularly around the disease duration of participants
|
|
(which ranged from less than 1 year in 1 study, to a median
|
|
of 6-7 years in another study), the nature of the target
|
|
used in the intervention arm (whether a DAS-based target was
|
|
used), and whether or not either or both study arms used a
|
|
protocol-driven treatment strategy (some studies did not use
|
|
a protocol in either arm, other studies used a protocol in
|
|
both arms and some studies compared a protocol in the
|
|
intervention arm to usual care without a protocol).</p><p>The committee agreed that it was not possible to establish
|
|
definitively which of these factors (if any) might explain
|
|
the differences in the magnitude of the effect between the
|
|
studies. However, the committee noted that while there was
|
|
some inconsistency in the magnitude of the benefit of
|
|
treat-to-target in improving disease activity, function and
|
|
pain, in general the majority of evidence across outcomes
|
|
favoured treat-to-target over usual care. The few results
|
|
that did suggest a benefit of usual care were generally from
|
|
the non- DAS-based target arms of 2 studies (which used
|
|
targets of zero swollen joint count and matrix
|
|
metalloproteinase 3 levels). The results of the DAS-based
|
|
target arms of those studies favoured the intervention arm,
|
|
consistent with the other study results.</p></div><div id="chd1.s9.1.2.2"><h5>Remission or low disease activity as the target</h5><p>No evidence was identified comparing the targets of remission
|
|
or low disease activity. Recommendations were therefore
|
|
informed by GC consensus opinion.</p></div><div id="chd1.s9.1.2.3"><h5>Frequency of monitoring</h5><p>One study was included in the review of different monitoring
|
|
frequencies. This study compared patient-initiated rapid
|
|
access with traditionally scheduled reviews every 3 to 6
|
|
months. All of the evidence was assessed to be very low
|
|
quality. Lack of blinding, along with relatively high rates
|
|
of missing data and limited information about how this was
|
|
dealt with in the analysis contributed to the risk of bias.
|
|
It was also unclear what was measured at each review and
|
|
whether the minimum requirements as specified in the review
|
|
protocol were satisfied (assessment of the joints for
|
|
swelling and measurement of inflammatory markers), which
|
|
further weakened the evidence. The evidence was also
|
|
assessed to be indirect to that specified in the protocol
|
|
due to the variation in the frequency of reviews in the
|
|
control group, and the population being a mix of people with
|
|
stable and unstable disease.</p><p>No studies were found comparing any other frequencies of
|
|
monitoring.</p><div id="chd1.s9.1.2.3.1"><h5>People at risk of poor outcomes</h5><p>People with a poor prognosis were pre-specified as a
|
|
separate stratum in the protocols for the review of
|
|
remission versus low disease activity as a target and
|
|
the review of frequency of monitoring. People with a
|
|
poor prognosis were considered to be those with one or
|
|
more of the key prognostic factors identified in a
|
|
separate review, which were anti-CCP positive status and
|
|
the presence of erosions at baseline. No evidence was
|
|
found in this subgroup of people for either
|
|
question.</p></div></div></div><div id="chd1.s9.1.3"><h5>1.9.1.3. Benefits and harms</h5><div id="chd1.s9.1.3.1"><h5>Treat-to-target versus usual care</h5><p>The committee agreed that the evidence for the
|
|
treat-to-target versus usual care review suggested that a
|
|
treat-to-target approach was more effective than usual care.
|
|
The committee acknowledged the limitations of the evidence
|
|
base described above, but were persuaded by the consistency
|
|
of the overall findings of a clinically important benefit in
|
|
favour of treat-to-target across almost all of the outcomes.
|
|
The committee acknowledged that the more frequent
|
|
appointments usually required with treat-to-target
|
|
management could, for some people, be difficult to combine
|
|
with full time work, although this would depend on the
|
|
individual. The committee were reassured by the evidence
|
|
that not only did treat-to-target appear to be more
|
|
clinically effective than usual care, study discontinuation
|
|
rates tended to be lower in people receiving treat-to-target
|
|
care, even though the frequency of monitoring in the
|
|
treat-to-target groups was often higher and so the burden on
|
|
people attending the appointments greater.</p><p>In further support of treat-to-target despite the differences
|
|
in the included studies, the committee agreed that one
|
|
included study most closely reflected the treat-to-target
|
|
and usual care approaches used in clinical practice in
|
|
England, whereas some of the other included studies used
|
|
more unusual designs. This study was the only study that
|
|
utilised more frequent monitoring and a protocol-driven
|
|
treatment strategy in the intervention group, compared with
|
|
less frequent visits and treatment at the discretion of
|
|
treating doctor in the usual care group. The committee noted
|
|
that this trial found consistent and substantial benefits of
|
|
treat-to-target approach over usual care, which further
|
|
reinforced their view that treat-to-target was more
|
|
effective than usual care. In addition, the committee noted
|
|
that many of the included studies in the separate evidence
|
|
review of DMARD treatment, which reported positive outcomes
|
|
for people with rheumatoid arthritis, were strategy trials
|
|
that employed a treat-to-target approach. This provided
|
|
further indirect evidence of the importance of
|
|
treating-to-target to achieve good outcomes for people with
|
|
rheumatoid arthritis.</p><p>The committee unanimously agreed that a treat-to-target
|
|
approach to managing rheumatoid arthritis was essential to
|
|
achieving rapid and sustained disease control and was the
|
|
cornerstone of modern rheumatology practice. The lay members
|
|
of the committee strongly emphasised the difference made to
|
|
the lives of people with rheumatoid arthritis when a
|
|
treat-to-target approach is implemented. Without a
|
|
treat-to-target approach, people with rheumatoid arthritis
|
|
risk being left in a moderate disease activity state, and
|
|
these disease levels will have a significant impact on their
|
|
daily life. If implemented appropriately, a treat-to-target
|
|
approach should also avoid many people with rheumatoid
|
|
arthritis having high disease activity levels warranting
|
|
biologic DMARD treatment in the future. Although the quality
|
|
of evidence from this review was not of high quality, the GC
|
|
agreed that the importance of this recommendation in
|
|
clinical practice, combined with this evidence and the
|
|
indirect evidence from other reviews where the strategy was
|
|
employed, all supported a strong recommendation for all
|
|
people with rheumatoid arthritis.</p></div><div id="chd1.s9.1.3.2"><h5>Remission or low disease activity as the target</h5><p>Having agreed that a treat-to-target approach is beneficial,
|
|
the committee discussed what the disease activity target
|
|
should be. The committee discussed the existing
|
|
recommendation, which did not specify a target, and agreed
|
|
that although no evidence was identified for this review, it
|
|
was important to specify a target to ensure that people were
|
|
fully treated and achieved the best possible outcomes and
|
|
understood the goal of the treatment.</p><p>In the absence of available evidence the committee discussed
|
|
which of the 2 targets was most appropriate based on their
|
|
experience and expertise. The committee agreed that the aim
|
|
should always be to control disease activity to the lowest
|
|
possible level, but that this would depend on the individual
|
|
as in some people, treatment will not be able to achieve
|
|
very low targets. The committee decided by consensus that
|
|
remission (for example, DAS28 less than 2.6) is the ideal
|
|
target for most people with rheumatoid arthritis, but for
|
|
people who were unable to achieve this target despite a
|
|
treat-to-target approach with appropriate escalation, low
|
|
disease activity (for example, DAS28 less than 3.2) would be
|
|
acceptable as this is more achievable for some people and
|
|
agreed as a good outcome if remission can’t be
|
|
achieved. The committee noted that remission and low disease
|
|
activity can be measured using various composite scoring
|
|
measures. The committee were of the view that the most
|
|
appropriate measures were validated scoring systems that
|
|
incorporated inflammatory markers and a swollen joint count.
|
|
Such measures include DAS, DAS28 and SDAI.</p><p>In order to treat-to-target using a target of remission or
|
|
low disease activity, it is essential that a disease
|
|
activity score such as the DAS28 is measured at each visit.
|
|
The committee acknowledged that the DAS28 can be calculated
|
|
using either ESR or CRP (both inflammatory markers), but
|
|
agreed that current consensus is that CRP is subject to less
|
|
variability as it is a direct measure of inflammatory
|
|
protein. Hence, CRP is generally the preferred measure for
|
|
people treated with conventional DMARDs. Therefore, the
|
|
committee agreed to maintain the previous recommendation to
|
|
measure CRP and disease activity using a composite score
|
|
such as DAS28.</p></div><div id="chd1.s9.1.3.3"><h5>Frequency of monitoring</h5><p>The committee discussed how frequently people should be
|
|
monitored (a) while their disease is active as part of a
|
|
treat-to-target approach, (b) after they have achieved the
|
|
treatment target, and (c) once they have maintained disease
|
|
activity below the treatment target for a period of time and
|
|
their disease is considered well-controlled.</p><p>No evidence was identified specifically looking at how often
|
|
people with active disease should be monitored. The
|
|
committee noted that the previous guideline recommended
|
|
monthly monitoring for people with active disease. The
|
|
committee also considered the monitoring regimens in the
|
|
studies included in the treat-to-target review. These varied
|
|
between studies, however, the study considered to be the
|
|
most applicable evidence (discussed above) employed monthly
|
|
monitoring in the treat-to-target arm, compared with three
|
|
monthly in the usual care arm. The committee agreed by
|
|
consensus that monthly review of people with active disease
|
|
remained the most appropriate monitoring frequency as part
|
|
of the treat-to-target approach. Monthly monitoring in
|
|
active disease was considered necessary in order to escalate
|
|
DMARD doses, to consider the need for short-term
|
|
glucocorticoids while waiting for DMARDs to take effect, to
|
|
establish whether people were tolerating the drug and assess
|
|
side effects, and to provide support and encourage
|
|
adherence. Any more frequent was considered to be
|
|
unnecessary from both an effectiveness and resource impact
|
|
perspective, and would increase the burden for people with
|
|
RA.</p><p>The committee discussed how frequently people should be
|
|
monitored once their disease was below the target activity
|
|
level of remission or low disease activity. The committee
|
|
discussed the previous guideline recommendation, which was
|
|
to provide appointments at a frequency and location suitable
|
|
to [the person’s] needs. The committee agreed that
|
|
this should be more specific if possible, to improve
|
|
consistency and avoid under or over monitoring of this group
|
|
of people. It was agreed by consensus that a review
|
|
appointment should be considered 6 months after a person
|
|
achieves the treatment target, to assess whether the disease
|
|
control has been maintained.</p><p>The committee discussed whether people with sustained disease
|
|
levels below the treatment target required regular
|
|
monitoring between annual reviews in the absence of
|
|
worsening symptoms or deterioration (annual reviews were not
|
|
updated in this guideline). The committee considered the
|
|
study included in the frequency of monitoring review to be
|
|
somewhat applicable to this situation, as it enrolled
|
|
participants with long term, established disease. The
|
|
evidence suggested that patient-initiated rapid access
|
|
(median 8 reviews over 6 years) was no less effective than
|
|
traditionally scheduled medical review every 3-6 months
|
|
(median 13 reviews over 6 years) in this group of people
|
|
with rheumatoid arthritis. The committee acknowledged the
|
|
limitations of this evidence (discussed above), but agreed
|
|
it reflected their experience that regular scheduled
|
|
appointments (over and above an annual review) were not
|
|
necessary in people with well-controlled disease.</p><p>Overall, the committee agreed that once people with
|
|
rheumatoid arthritis had achieved the treatment target, and
|
|
this was sustained at a 6 month follow-up appointment, there
|
|
was no need for additional routine appointments to be
|
|
scheduled other than the annual review. However, the
|
|
committee emphasised the importance of all people with
|
|
rheumatoid arthritis having rapid access to specialist care
|
|
for disease flares, and the need for ongoing drug
|
|
monitoring. The committee agreed this was addressed by the
|
|
existing recommendations on rapid access, which had not been
|
|
reviewed in the update, with some amendments to the wording
|
|
to improve clarity.</p><div id="chd1.s9.1.3.3.1"><h5>People at risk of poor outcomes</h5><p>The committee agreed that there was no evidence
|
|
suggesting people with a poor prognosis should be
|
|
managed any differently to the general rheumatoid
|
|
arthritis population, in terms of the treatment target
|
|
or the frequency of monitoring. The committee agreed
|
|
that the standard recommendations regarding
|
|
treatment-to-target with monthly monitoring should
|
|
ensure that people with a poor prognosis receive
|
|
effective treatment of their disease.</p></div></div></div></div><div id="chd1.s9.2"><h4>1.9.2. Cost effectiveness and resource use</h4><p>For the treat-to-target review, 2 economic evaluations were
|
|
identified, comparing a treat-to-target approach to usual care (Nair
|
|
2015, Grigor 2004). Nair 2015 was a cost–utility analysis
|
|
based on a cohort of people with early RA. This evaluation used
|
|
clinical effectiveness data from the CAMERA trial, which was also
|
|
included in the clinical review for treat-to-target. Analysis within
|
|
this study identified treat-to-target to be cost effective, and in
|
|
fact cost saving compared to usual practice (being less costly and
|
|
more effective). The treat-to-target strategy resulted in less
|
|
medical consumption and improved quality of life due to better
|
|
DAS28/HAQ; however, drug costs were higher. The committee noted the
|
|
relatively short time horizon of the study and questioned the
|
|
ability of the study to capture the long-term cost benefits
|
|
associated with the treat-to-target approach. The second analysis
|
|
(Grigor 2004) was a cost–consequences analysis based on the
|
|
TICORA RCT (same paper) which was also included in the clinical
|
|
review. This analysis also found that treat-to-target was less
|
|
costly and more effective than usual care. No analysis of
|
|
uncertainty was conducted however; confidence intervals indicate
|
|
that there is some uncertainty in both the costs and outcomes. The
|
|
committee considered these confidence intervals and concluded that
|
|
at a minimum treat-to-target was likely to be cost neutral.</p><p>Based on the clinical and economic evidence reviewed, the committee
|
|
concluded that treat-to-target appeared to improve outcomes at no
|
|
additional cost. As treat-to-target is already considered current
|
|
practice and was recommended in the previous guideline, it is not
|
|
anticipated that this recommendation will have a substantial
|
|
resource impact.</p><p>No health economic studies were identified regarding the frequency of
|
|
monitoring or the target for monitoring. Unit costs were provided
|
|
for rheumatologist consultations to aid the consideration of cost
|
|
effectiveness. The committee considered the potential economic
|
|
impact of increasing frequency of monitoring from monthly to
|
|
fortnightly and agreed that this would have a substantial impact on
|
|
NHS resources and that there was no clinical evidence to support it.
|
|
The committee agreed to keep the previous recommendation of monthly
|
|
monitoring based on the clinical evidence reviewed. The committee
|
|
noted that monthly visits may not have been implemented nationwide
|
|
and this is reflected in a survey of the 2009 guideline
|
|
implementation in the Midlands (25–62% receiving monthly
|
|
monitoring). If this is reflective of practice across the country,
|
|
this recommendation will likely involve a change in practice in many
|
|
clinics around the country and may have a resource impact. Although
|
|
there was no direct health economic evidence for the frequency of
|
|
monitoring, the Grigor 2004 and Nair 2015 treat-to-target economic
|
|
analyses suggested that even with more frequent visits (monthly
|
|
versus every 3 months), a treat-to-target approach was cost saving.
|
|
Finally, the committee noted that these monthly visits are often
|
|
conducted by a nurse specialist rather than a consultant. The unit
|
|
costs of different healthcare professionals were presented to the
|
|
committee and it was noted that the cost of a nurse consultation
|
|
would be less expensive than that of a consultant.</p><p>Regarding the target, aiming for low disease activity or remission is
|
|
considered unlikely to have a resource impact. With either target,
|
|
the individual will require ongoing monitoring and treatment
|
|
adjustment, both of which have cost implications that are unlikely
|
|
to differ depending on the target.</p><p>The committee made a recommendation to consider a review appointment
|
|
within 6 months of stabilising. This recommendation was made based
|
|
on expert opinion and consensus. The committee considered that this
|
|
recommendation might reduce unwarranted variation in follow-up
|
|
across the country as the prior recommendation may have led to
|
|
unnecessary consultations for some or others receiving no
|
|
follow-up.</p></div></div></div><div id="ptd.rl.r1"><h2 id="_ptd_rl_r1_">References</h2><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="ptd.ref1">Barlow
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|
JH,
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Barefoot
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J. Group
|
|
education for people with arthritis. Patient
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|
Education and Counseling. 1996;
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27(3):257–267 [<a href="https://pubmed.ncbi.nlm.nih.gov/8788354" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8788354</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>2.</dt><dd><div class="bk_ref" id="ptd.ref2">Bykerk
|
|
VP,
|
|
Keystone
|
|
EC,
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|
Kuriya
|
|
B,
|
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Larche
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M,
|
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Thorne
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JC,
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|
Haraoui
|
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B. Achieving
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remission in clinical practice: lessons from clinical trial
|
|
data. Clinical and Experimental
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Rheumatology. 2013;
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|
31(4):621–32 [<a href="https://pubmed.ncbi.nlm.nih.gov/23622099" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23622099</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>3.</dt><dd><div class="bk_ref" id="ptd.ref3">Cardiel
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MH. Treat to
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|
target strategy in rheumatoid arthritis: real
|
|
benefits. Reumatologia Clinica.
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|
2013;
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9(2):101–5 [<a href="https://pubmed.ncbi.nlm.nih.gov/22985804" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22985804</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>4.</dt><dd><div class="bk_ref" id="ptd.ref4">Curtis
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|
L,
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|
Burns
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A. Unit costs of
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health and social care 2016.
|
|
Canterbury. Personal
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|
Social Services Research Unit University of Kent,
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|
2016. Available from: <a href="http://www.pssru.ac.uk/project-pages/unit-costs/2016/" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.pssru.ac.uk<wbr style="display:inline-block"></wbr>​/project-pages/unit-costs/2016/</a></div></dd></dl><dl class="bkr_refwrap"><dt>5.</dt><dd><div class="bk_ref" id="ptd.ref5">Department of
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|
Health. NHS reference costs 2015-16.
|
|
2016. Available from: <a href="https://www.gov.uk/government/publications/nhs-reference-costs-collection-guidance-for-2015-to-2016" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.gov.uk/government<wbr style="display:inline-block"></wbr>​/publications<wbr style="display:inline-block"></wbr>​/nhs-reference-costs-collection-guidance-for-2015-to-2016</a>
|
|
Last accessed: 06/10/2017.</div></dd></dl><dl class="bkr_refwrap"><dt>6.</dt><dd><div class="bk_ref" id="ptd.ref6">Edmonds
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|
J.
|
|
Objectives study in RA (OSRA): A RCT defining the
|
|
best clinical target control in RA. American
|
|
College of Rheumatology: Annual Scientific Meeting.
|
|
2007;
|
|
Nov(2151)</div></dd></dl><dl class="bkr_refwrap"><dt>7.</dt><dd><div class="bk_ref" id="ptd.ref7">Hodkinson
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B,
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|
Musenge
|
|
E,
|
|
Tikly
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M. Tight
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|
control of rheumatoid arthritis in a resource-constrained setting: a
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|
randomized controlled study comparing the clinical disease activity
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|
index and simplified disease activity index.
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|
Rheumatology. 2015;
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54(6):1033–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/25431484" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25431484</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>8.</dt><dd><div class="bk_ref" id="ptd.ref8">Jurgens
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|
MS,
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|
Welsing
|
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PM,
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|
Jacobs
|
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JW. Overview
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|
and analysis of treat-to-target trials in rheumatoid arthritis
|
|
reporting on remission. Clinical and
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|
Experimental Rheumatology. 2012;
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30(4 Suppl
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|
73):S56–63 [<a href="https://pubmed.ncbi.nlm.nih.gov/23078808" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23078808</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>9.</dt><dd><div class="bk_ref" id="ptd.ref9">National Collaborating
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|
Centre for Chronic Conditions. Rheumatoid
|
|
arthritis: national clinical guideline for management and treatment
|
|
in adults. NICE clinical guideline
|
|
79. London.
|
|
Royal College of Physicians,
|
|
2009. Available from: <a href="http://guidance.nice.org.uk/CG79" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://guidance<wbr style="display:inline-block"></wbr>​.nice.org.uk/CG79</a> [<a href="https://pubmed.ncbi.nlm.nih.gov/21413195" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21413195</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>10.</dt><dd><div class="bk_ref" id="ptd.ref10">National Institute for
|
|
Health and Care Excellence. Developing NICE
|
|
guidelines: the manual.
|
|
London. National
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|
Institute for Health and Care Excellence,
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2014. Available from: <a href="http://www.nice.org.uk/article/PMG20/chapter/1%20Introduction%20and%20overview" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.nice.org.uk<wbr style="display:inline-block"></wbr>​/article/PMG20/chapter<wbr style="display:inline-block"></wbr>​/1%20Introduction%20and%20overview</a> [<a href="https://pubmed.ncbi.nlm.nih.gov/26677490" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26677490</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>11.</dt><dd><div class="bk_ref" id="ptd.ref11">Pincus
|
|
T,
|
|
Castrejon
|
|
I. Evidence
|
|
that the strategy is more important than the agent to treat
|
|
rheumatoid arthritis. Data from clinical trials of combinations of
|
|
non-biologic DMARDs, with protocol-driven intensification of therapy
|
|
for tight control or treat-to-target.
|
|
Bulletin of the Hospital for Joint Disease
|
|
2013; 71 (Suppl
|
|
1):S33–40 [<a href="https://pubmed.ncbi.nlm.nih.gov/24219039" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24219039</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>12.</dt><dd><div class="bk_ref" id="ptd.ref12">Pope
|
|
JE,
|
|
Haraoui
|
|
B,
|
|
Rampakakis
|
|
E,
|
|
Psaradellis
|
|
E,
|
|
Thorne
|
|
C,
|
|
Sampalis
|
|
JS
|
|
et al. Treating to a target in established active
|
|
rheumatoid arthritis patients receiving a tumor necrosis factor
|
|
inhibitor: results from a real-world cluster-randomized adalimumab
|
|
trial. Arthritis Care &
|
|
Research. 2013;
|
|
65(9):1401–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/23509040" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23509040</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>13.</dt><dd><div class="bk_ref" id="ptd.ref13">Radner
|
|
H,
|
|
Smolen
|
|
JS,
|
|
Aletaha
|
|
D. Remission
|
|
in rheumatoid arthritis: benefit over low disease activity in
|
|
patient-reported outcomes and costs.
|
|
Arthritis Research & Therapy.
|
|
2014;
|
|
16:R56 [<a href="/pmc/articles/PMC3979137/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3979137</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24555808" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24555808</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>14.</dt><dd><div class="bk_ref" id="ptd.ref14">Schoels
|
|
M,
|
|
Knevel
|
|
R,
|
|
Aletaha
|
|
D,
|
|
Bijlsma
|
|
JW,
|
|
Breedveld
|
|
FC,
|
|
Boumpas
|
|
DT
|
|
et al. Evidence for treating rheumatoid arthritis to
|
|
target: results of a systematic literature search.
|
|
Annals of the Rheumatic Diseases.
|
|
2010;
|
|
69(4):638–43 [<a href="/pmc/articles/PMC3015093/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3015093</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20237123" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20237123</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>15.</dt><dd><div class="bk_ref" id="ptd.ref15">Smolen
|
|
JS,
|
|
Breedveld
|
|
FC,
|
|
Burmester
|
|
GR,
|
|
Bykerk
|
|
V,
|
|
Dougados
|
|
M,
|
|
Emery
|
|
P
|
|
et al. Treating rheumatoid arthritis to target: 2014
|
|
update of the recommendations of an international task
|
|
force. Annals of the Rheumatic
|
|
Diseases. 2016;
|
|
75(1):3–15 [<a href="/pmc/articles/PMC4717393/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4717393</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25969430" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25969430</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>16.</dt><dd><div class="bk_ref" id="ptd.ref16">Stoffer
|
|
MA,
|
|
Schoels
|
|
MM,
|
|
Smolen
|
|
JS,
|
|
Aletaha
|
|
D,
|
|
Breedveld
|
|
FC,
|
|
Burmester
|
|
G
|
|
et al. Evidence for treating rheumatoid arthritis to
|
|
target: results of a systematic literature search
|
|
update. Annals of the Rheumatic
|
|
Diseases. 2016;
|
|
75(1):16–22 [<a href="/pmc/articles/PMC4717391/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4717391</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25990290" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25990290</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>17.</dt><dd><div class="bk_ref" id="ptd.ref17">van
|
|
Tuyl
|
|
LH,
|
|
Lems
|
|
WF,
|
|
Voskuyl
|
|
AE,
|
|
Kerstens
|
|
PJ,
|
|
Garnero
|
|
P,
|
|
Dijkmans
|
|
BA
|
|
et al. Tight control and intensified COBRA combination
|
|
treatment in early rheumatoid arthritis: 90% remission in a pilot
|
|
trial. Annals of the Rheumatic
|
|
Diseases. 2008;
|
|
67(11):1574–7 [<a href="https://pubmed.ncbi.nlm.nih.gov/18625629" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18625629</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>18.</dt><dd><div class="bk_ref" id="ptd.ref18">Wells
|
|
G,
|
|
Boers
|
|
M,
|
|
Tugwell
|
|
P, M. D. A. Working
|
|
Group. Low disease activity state in
|
|
rheumatoid arthritis: concepts and derivation of minimal disease
|
|
activity. Clinical and Experimental
|
|
Rheumatology. 2006;
|
|
24(6 Suppl
|
|
43):S-52–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/17083764" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17083764</span></a>]</div></dd></dl></dl></div><div id="appendixes.appgroupd"><h2 id="_appendixes_appgroupd_">Appendices</h2><div id="ptd.appa"><h3>Appendix A. Review protocols</h3><p id="ptd.appa.et1"><a href="/books/NBK577120/bin/ptd-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 3. Review protocol: Which target to monitor in rheumatoid
|
|
arthritis?</a><span class="small"> (PDF, 165K)</span></p><p id="ptd.appa.et2"><a href="/books/NBK577120/bin/ptd-appa-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 4. Health economic review protocol</a><span class="small"> (PDF, 147K)</span></p></div><div id="ptd.appb"><h3>Appendix B. Literature search strategies</h3><p>The literature searches for this review are detailed below and complied
|
|
with the methodology outlined in Developing NICE guidelines: the manual
|
|
2014, updated 2017. <a href="https://www.nice.org.uk/guidance/pmg20/resources/developing-nice-guidelines-the-manual-pdf-72286708700869" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.nice.org.uk/guidance/pmg20/resources/developing-nice-guidelines-the-manual-pdf-72286708700869</a></p><p><i>For more detailed information, please see the Methodology
|
|
Review</i>.</p><div id="ptd.appb.s1"><h4>B.1. Clinical search literature search strategy</h4><p>Searches were constructed using a PICO framework where population (P)
|
|
terms were combined with Intervention (I) and in some cases
|
|
Comparison (C) terms. Outcomes (O) are rarely used in search
|
|
strategies for interventions as these concepts may not be well
|
|
described in title, abstract or indexes and therefore difficult to
|
|
retrieve. Search filters were applied to the search where
|
|
appropriate.</p><p id="ptd.appb.tab1"><a href="/books/NBK577120/table/ptd.appb.tab1/?report=objectonly" target="object" rid-ob="figobptdappbtab1" class="figpopup">Table 5. Database date parameters and filters used</a></p><p id="ptd.appb.tab2"><a href="/books/NBK577120/table/ptd.appb.tab2/?report=objectonly" target="object" rid-ob="figobptdappbtab2" class="figpopup">Medline (Ovid) search terms</a></p><p id="ptd.appb.tab3"><a href="/books/NBK577120/table/ptd.appb.tab3/?report=objectonly" target="object" rid-ob="figobptdappbtab3" class="figpopup">Embase (Ovid) search terms</a></p><p id="ptd.appb.tab4"><a href="/books/NBK577120/table/ptd.appb.tab4/?report=objectonly" target="object" rid-ob="figobptdappbtab4" class="figpopup">Cochrane Library (Wiley) search terms</a></p></div><div id="ptd.appb.s2"><h4>B.2. Health Economics literature search strategy</h4><p>Health economic evidence was identified by conducting a broad search
|
|
relating to rheumatoid arthritis population in NHS Economic
|
|
Evaluation Database (NHS EED – this ceased to be updated
|
|
after March 2015) and the Health Technology Assessment database
|
|
(HTA) with no date restrictions. NHS EED and HTA databases are
|
|
hosted by the Centre for Research and Dissemination (CRD).
|
|
Additional searches were run on Medline and Embase for health
|
|
economics studies.</p><p id="ptd.appb.tab5"><a href="/books/NBK577120/table/ptd.appb.tab5/?report=objectonly" target="object" rid-ob="figobptdappbtab5" class="figpopup">Table 6. Database date parameters and filters used</a></p><p id="ptd.appb.tab6"><a href="/books/NBK577120/table/ptd.appb.tab6/?report=objectonly" target="object" rid-ob="figobptdappbtab6" class="figpopup">Medline (Ovid) search terms</a></p><p id="ptd.appb.tab7"><a href="/books/NBK577120/table/ptd.appb.tab7/?report=objectonly" target="object" rid-ob="figobptdappbtab7" class="figpopup">Embase (Ovid) search terms</a></p><p id="ptd.appb.tab8"><a href="/books/NBK577120/table/ptd.appb.tab8/?report=objectonly" target="object" rid-ob="figobptdappbtab8" class="figpopup">NHS EED and HTA (CRD) search terms</a></p></div></div><div id="ptd.appc"><h3>Appendix C. Clinical evidence selection</h3><p id="ptd.appc.fig1"><a href="/books/NBK577120/figure/ptd.appc.fig1/?report=objectonly" target="object" rid-ob="figobptdappcfig1" class="figpopup">Figure 1. Flow chart of clinical study selection for the review of
|
|
‘Which target to monitor in rheumatoid
|
|
arthritis?’</a></p></div><div id="ptd.appd"><h3>Appendix D. Clinical evidence tables</h3><p>No relevant clinical studies were identified.</p></div><div id="ptd.appe"><h3>Appendix E. Forest plots</h3><p>No relevant clinical studies were identified.</p></div><div id="ptd.appf"><h3>Appendix F. GRADE tables</h3><p>No relevant clinical studies were identified.</p></div><div id="ptd.appg"><h3>Appendix G. Health economic evidence selection</h3><p id="ptd.appg.fig2"><a href="/books/NBK577120/figure/ptd.appg.fig2/?report=objectonly" target="object" rid-ob="figobptdappgfig2" class="figpopup">Figure 2. Flow chart of economic study selection for the
|
|
guideline</a></p></div><div id="ptd.apph"><h3>Appendix H. Health economic evidence tables</h3><p>No relevant economic studies were identified.</p></div><div id="ptd.appi"><h3>Appendix I. Excluded studies</h3><div id="ptd.appi.s1"><h4>I.1. Excluded clinical studies</h4><p id="ptd.appi.tab1"><a href="/books/NBK577120/table/ptd.appi.tab1/?report=objectonly" target="object" rid-ob="figobptdappitab1" class="figpopup">Table 7. Studies excluded from the clinical review</a></p></div><div id="ptd.appi.s2"><h4>I.2. Excluded health economic studies</h4><p id="ptd.appi.tab2"><a href="/books/NBK577120/table/ptd.appi.tab2/?report=objectonly" target="object" rid-ob="figobptdappitab2" class="figpopup">Table 8. Studies excluded from the health economic review</a></p></div></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Intervention evidence review</p><p>Developed by the National Guideline Centre, hosted by the Royal College of
|
|
Physicians</p></div><div><p>The recommendations in this guideline represent the view of NICE, arrived at after
|
|
careful consideration of the evidence available. When exercising their judgement,
|
|
professionals are expected to take this guideline fully into account, alongside the
|
|
individual needs, preferences and values of their patients or service users. The
|
|
recommendations in this guideline are not mandatory and the guideline does not
|
|
override the responsibility of healthcare professionals to make decisions
|
|
appropriate to the circumstances of the individual patient, in consultation with the
|
|
patient and, where appropriate, their carer or guardian.</p><p>Local commissioners and providers have a responsibility to enable the guideline to be
|
|
applied when individual health professionals and their patients or service users
|
|
wish to use it. They should do so in the context of local and national priorities
|
|
for funding and developing services, and in light of their duties to have due regard
|
|
to the need to eliminate unlawful discrimination, to advance equality of opportunity
|
|
and to reduce health inequalities. Nothing in this guideline should be interpreted
|
|
in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in
|
|
other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and
|
|
<a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland
|
|
Executive</a>. All NICE guidance is subject to regular review and may be
|
|
updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2018.</div><div class="small"><span class="label">Bookshelf ID: NBK577120</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/35129925" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">35129925</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobchd1tab1"><div id="chd1.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">PICO characteristics of review question</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577120/table/chd1.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd1.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_chd1.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_chd1.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adults with RA, with at
|
|
least moderate disease activity (equivalent to DAS28
|
|
≥ 3.2).</p>
|
|
<p>Studies in adults with poor
|
|
prognostic factors will be reviewed
|
|
separately.</p>
|
|
</td></tr><tr><th id="hd_b_chd1.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention(s)</th><td headers="hd_b_chd1.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Monitoring a composite
|
|
measure of disease activity with a target of
|
|
<b>disease remission</b></p>
|
|
<p>The following
|
|
composite measures will be considered: <ul id="l74"><li id="lt220" class="half_rhythm"><div>Disease activity score 28 (DAS28). DAS28
|
|
< 2.6 = remission</div></li><li id="lt221" class="half_rhythm"><div>Original disease activity score (DAS). DAS
|
|
< 1.6 = remission</div></li><li id="lt222" class="half_rhythm"><div>Simplified disease activity index (SDAI). SDAI
|
|
≤ 3.3 = remission</div></li></ul> The different disease activity measures will
|
|
be pooled in the analysis.</p>
|
|
</td></tr><tr><th id="hd_b_chd1.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison(s)</th><td headers="hd_b_chd1.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Monitoring a composite
|
|
measure of disease activity with a target of
|
|
<b>low disease activity</b></p>
|
|
<p>The
|
|
following composite measures will be considered:
|
|
<ul id="l75"><li id="lt223" class="half_rhythm"><div>Disease activity score (DAS28; all versions).
|
|
DAS28 < 3.2 = low disease activity</div></li><li id="lt224" class="half_rhythm"><div>Original disease activity score (DAS; all
|
|
versions). DAS < 2.4 = low disease
|
|
activity</div></li><li id="lt225" class="half_rhythm"><div>Simplified disease activity index (SDAI). SDAI
|
|
≤ 11.0 = low disease activity</div></li></ul> The different disease activity measures will
|
|
be pooled in the analysis.</p>
|
|
</td></tr><tr><th id="hd_b_chd1.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_chd1.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CRITICAL <ul id="l76"><li id="lt226" class="half_rhythm"><div>Disease Activity Score (continuous) at 12
|
|
months</div></li><li id="lt227" class="half_rhythm"><div>Quality of life (continuous) at 12 months</div></li><li id="lt228" class="half_rhythm"><div>Function (continuous) at 12 months</div></li></ul> IMPORTANT <ul id="l77"><li id="lt229" class="half_rhythm"><div>Fatigue (continuous) at 12 months</div></li><li id="lt230" class="half_rhythm"><div>Pain (continuous) at 12 months</div></li><li id="lt231" class="half_rhythm"><div>Radiological progression (continuous) at 12
|
|
months</div></li><li id="lt232" class="half_rhythm"><div>Withdrawal/adherence (dichotomous) at longest
|
|
reported time point</div></li></ul></td></tr><tr><th id="hd_b_chd1.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_chd1.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RCT</p>
|
|
<p>Systematic review
|
|
of RCTs</p>
|
|
</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchd1tab2"><div id="chd1.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">UK costs of healthcare professional visits</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577120/table/chd1.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chd1.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_chd1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Type of appointment</th><th id="hd_h_chd1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unit cost</th><th id="hd_h_chd1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Source</th></tr></thead><tbody><tr><td headers="hd_h_chd1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">GP appointment lasting
|
|
9.22 minutes</td><td headers="hd_h_chd1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£36</td><td headers="hd_h_chd1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PSSRU Unit costs 2016<a class="bibr" href="#ptd.ref4" rid="ptd.ref4"><sup>4</sup></a></td></tr><tr><td headers="hd_h_chd1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-admitted face to face
|
|
outpatient follow-up attendance, rheumatology
|
|
(consultant led)</td><td headers="hd_h_chd1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£137</td><td headers="hd_h_chd1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NHS reference costs
|
|
2015-2016<a class="bibr" href="#ptd.ref5" rid="ptd.ref5"><sup>5</sup></a></td></tr><tr><td headers="hd_h_chd1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-admitted face to face
|
|
outpatient follow-up attendance, rheumatology
|
|
(non-consultant led)</td><td headers="hd_h_chd1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£87</td><td headers="hd_h_chd1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NHS reference costs
|
|
2015-2016<a class="bibr" href="#ptd.ref5" rid="ptd.ref5"><sup>5</sup></a></td></tr><tr><td headers="hd_h_chd1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hospital based nurse, band
|
|
6, specialist nurse (per working hour/per hour of
|
|
patient contact)</td><td headers="hd_h_chd1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£44/£108</td><td headers="hd_h_chd1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PSSRU Unit costs 2016<a class="bibr" href="#ptd.ref4" rid="ptd.ref4"><sup>4</sup></a></td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobptdappbtab1"><div id="ptd.appb.tab1" class="table"><h3><span class="label">Table 5</span><span class="title">Database date parameters and filters used</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577120/table/ptd.appb.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ptd.appb.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_ptd.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Database</th><th id="hd_h_ptd.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dates searched</th><th id="hd_h_ptd.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Search filter used</th></tr></thead><tbody><tr><td headers="hd_h_ptd.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medline (Ovid)</td><td headers="hd_h_ptd.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1946 – 09 October
|
|
2017</td><td headers="hd_h_ptd.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Exclusions</p>
|
|
<p>Randomised controlled
|
|
trials</p>
|
|
<p>Systematic review studies</p>
|
|
</td></tr><tr><td headers="hd_h_ptd.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Embase (Ovid)</td><td headers="hd_h_ptd.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1974 – 09 October
|
|
2017</td><td headers="hd_h_ptd.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Exclusions</p>
|
|
<p>Randomised controlled
|
|
trials</p>
|
|
<p>Systematic review studies</p>
|
|
</td></tr><tr><td headers="hd_h_ptd.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The Cochrane Library
|
|
(Wiley)</td><td headers="hd_h_ptd.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Cochrane Reviews to
|
|
2017</p>
|
|
<p>Issue 10 of 12</p>
|
|
<p>CENTRAL to 2017
|
|
Issue 9 of 12</p>
|
|
<p>DARE, and NHSEED to
|
|
2015</p>
|
|
<p>Issue 2 of 4</p>
|
|
<p>HTA to 2016 Issue 4
|
|
of 4</p>
|
|
</td><td headers="hd_h_ptd.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobptdappbtab2"><div id="ptd.appb.tab2" class="table"><h3><span class="title">Medline (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577120/table/ptd.appb.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ptd.appb.tab2_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Arthritis,
|
|
Rheumatoid/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid adj2
|
|
(arthritis or arthrosis)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(caplan* adj2
|
|
syndrome).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(felty* adj2
|
|
syndrome).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid adj2
|
|
factor).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((inflammatory or
|
|
idiopathic) adj2 arthritis).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">“inflammatory
|
|
polyarthritis”.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-7</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 8 to English
|
|
language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">news/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp historical
|
|
article/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anecdotes as Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">comment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or
|
|
comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/10-17</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled
|
|
trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18 not 19</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animals/ not humans/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Animals, Laboratory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp animal
|
|
experiment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp animal model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodentia/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or
|
|
mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/20-26</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 not 27</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(tight* adj
|
|
control*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">t2t.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((mission or aiming or aim
|
|
or aimed or aims or achiev* or sustain* or reach*)
|
|
adj2 remission).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((treat* or therap*) adj2
|
|
(target* or goal*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(symptom* adj2 (reduc* or
|
|
improv* or control*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">low disease
|
|
activity.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(abrogat* adj2
|
|
inflammat*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">optimi*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/29-36</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28 and 37</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled
|
|
trial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">controlled clinical
|
|
trial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomi#ed.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">placebo.ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">drug therapy.fs.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomly.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">trial.ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">groups.ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/39-46</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Clinical Trials as
|
|
topic.sh.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">trial.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/39-42,44,48-49</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meta-Analysis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meta-Analysis as
|
|
Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(meta analy* or metanaly*
|
|
or metaanaly* or meta regression).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((systematic* or
|
|
evidence*) adj3 (review* or overview*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(reference list* or
|
|
bibliograph* or hand search* or manual search* or
|
|
relevant journals).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search strategy or search
|
|
criteria or systematic search or study selection or
|
|
data extraction).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">57.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search* adj4
|
|
literature).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">58.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(medline or pubmed or
|
|
cochrane or embase or psychlit or psyclit or
|
|
psychinfo or psycinfo or cinahl or science citation
|
|
index or bids or cancerlit).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cochrane.jw.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">60.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((multiple treatment* or
|
|
indirect or mixed) adj2 comparison*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">61.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/51-60</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">62.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38 and (50 or 61)</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobptdappbtab3"><div id="ptd.appb.tab3" class="table"><h3><span class="title">Embase (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577120/table/ptd.appb.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ptd.appb.tab3_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp *rheumatoid
|
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arthritis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid adj2
|
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(arthritis or arthrosis)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(caplan* adj2
|
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syndrome).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(felty* adj2
|
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syndrome).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid adj2
|
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factor).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((inflammatory or
|
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idiopathic) adj2 arthritis).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">“inflammatory
|
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polyarthritis”.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-7</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 8 to English
|
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language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter.pt. or letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">note.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/ or case
|
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study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or
|
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comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/10-14</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled
|
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trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15 not 16</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal/ not human/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">nonhuman/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal
|
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Experiment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Experimental
|
|
Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodent/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or
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|
mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/17-24</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 not 25</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(tight* adj
|
|
control*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">t2t.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((mission or aiming or aim
|
|
or aimed or aims or achiev* or sustain* or reach*)
|
|
adj2 remission).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((treat* or therap*) adj2
|
|
(target* or goal*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(symptom* adj2 (reduc* or
|
|
improv* or control*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">low disease
|
|
activity.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(abrogat* adj2
|
|
inflammat*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">optimi*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/27-34</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26 and 35</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">factorial*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(crossover* or cross
|
|
over*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((doubl* or singl*) adj
|
|
blind*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(assign* or allocat* or
|
|
volunteer* or placebo*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">crossover procedure/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">single blind
|
|
procedure/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled
|
|
trial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">double blind
|
|
procedure/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/37-45</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">systematic review/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">meta-analysis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(meta analy* or metanaly*
|
|
or metaanaly* or meta regression).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((systematic or evidence)
|
|
adj3 (review* or overview*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(reference list* or
|
|
bibliograph* or hand search* or manual search* or
|
|
relevant journals).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search strategy or search
|
|
criteria or systematic search or study selection or
|
|
data extraction).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search* adj4
|
|
literature).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(medline or pubmed or
|
|
cochrane or embase or psychlit or psyclit or
|
|
psychinfo or psycinfo or cinahl or science citation
|
|
index or bids or cancerlit).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cochrane.jw.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((multiple treatment* or
|
|
indirect or mixed) adj2 comparison*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">57.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/47-56</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">58.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36 and (46 or 57)</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobptdappbtab4"><div id="ptd.appb.tab4" class="table"><h3><span class="title">Cochrane Library (Wiley) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577120/table/ptd.appb.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ptd.appb.tab4_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">[mh “Arthritis,
|
|
Rheumatoid”]</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid near/2
|
|
(arthritis or arthrosis)):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(caplan* near/2
|
|
syndrome):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(felty* near/2
|
|
syndrome):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid near/2
|
|
factor):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((inflammatory or
|
|
idiopathic) near/2 arthritis):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">inflammatory
|
|
polyarthritis:ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(or #1-#7)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(tight* next
|
|
control*):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">t2t:ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((mission or aiming or aim
|
|
or aimed or aims or achiev* or sustain* or reach*)
|
|
near/2 remission):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((treat* or therap*)
|
|
near/2 (target* or goal*)):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(symptom* near/2 (reduc*
|
|
or improv* or control*)):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">low disease
|
|
activity:ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(abrogat* near/2
|
|
inflammat*):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">optimi*:ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(or #9-#16)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#8 and #17</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobptdappbtab5"><div id="ptd.appb.tab5" class="table"><h3><span class="label">Table 6</span><span class="title">Database date parameters and filters used</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577120/table/ptd.appb.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ptd.appb.tab5_lrgtbl__"><table><thead><tr><th id="hd_h_ptd.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Database</th><th id="hd_h_ptd.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dates searched</th><th id="hd_h_ptd.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Search filter used</th></tr></thead><tbody><tr><td headers="hd_h_ptd.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medline</td><td headers="hd_h_ptd.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2014 – 06 October
|
|
2017</td><td headers="hd_h_ptd.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Exclusions</p>
|
|
<p>Health
|
|
economics studies</p>
|
|
</td></tr><tr><td headers="hd_h_ptd.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Embase</td><td headers="hd_h_ptd.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2014 – 06 October
|
|
2017</td><td headers="hd_h_ptd.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Exclusions</p>
|
|
<p>Health
|
|
economics studies</p>
|
|
</td></tr><tr><td headers="hd_h_ptd.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Centre for Research and
|
|
Dissemination (CRD)</td><td headers="hd_h_ptd.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HTA - 2001 – 06
|
|
October 2017</p>
|
|
<p>NHSEED - 2001 – 31 March
|
|
2015</p>
|
|
</td><td headers="hd_h_ptd.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobptdappbtab6"><div id="ptd.appb.tab6" class="table"><h3><span class="title">Medline (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577120/table/ptd.appb.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ptd.appb.tab6_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Arthritis,
|
|
Rheumatoid/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid adj2
|
|
(arthritis or arthrosis)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(caplan* adj2
|
|
syndrome).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(felty* adj2
|
|
syndrome).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid adj2
|
|
factor).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((inflammatory or
|
|
idiopathic) adj2 arthritis).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">“inflammatory
|
|
polyarthritis”.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-7</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 8 to English
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language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">news/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp historical
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article/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anecdotes as Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">comment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or
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comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/10-17</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled
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trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18 not 19</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animals/ not humans/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Animals, Laboratory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp animal
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experiment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp animal model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodentia/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or
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mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/20-26</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 not 27</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Value of life/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “Costs and Cost
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Analysis”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Economics,
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Hospital/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Economics,
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Medical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics, Nursing/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics,
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Pharmaceutical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “Fees and
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Charges”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Budgets/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cost*.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(economic* or
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pharmaco?economic*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(price* or
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pricing*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cost* adj2 (effective* or
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utilit* or benefit* or minimi* or unit* or estimat*
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or variable*)).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(financ* or fee or
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fees).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(value adj2 (money or
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monetary)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/29-44</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp models, economic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*Models, Theoretical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*Models,
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Organizational/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">markov chains/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">monte carlo method/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Decision Theory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(markov* or monte
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carlo).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">econom* model*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(decision* adj2 (tree* or
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analy* or model*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/46-54</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28 and (45 or 55)</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobptdappbtab7"><div id="ptd.appb.tab7" class="table"><h3><span class="title">Embase (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577120/table/ptd.appb.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ptd.appb.tab7_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp *rheumatoid
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arthritis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid adj2
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(arthritis or arthrosis)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(caplan* adj2
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syndrome).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(felty* adj2
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syndrome).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rheumatoid adj2
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factor).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((inflammatory or
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idiopathic) adj2 arthritis).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">“inflammatory
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polyarthritis”.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-7</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 8 to English
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language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter.pt. or letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">note.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/ or case
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study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or
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comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/10-14</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled
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trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15 not 16</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal/ not human/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">nonhuman/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal
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Experiment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Experimental
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Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodent/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or
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mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/17-24</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 not 25</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">statistical model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp economic aspect/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27 and 28</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*theoretical model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*nonbiological model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">stochastic model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">decision theory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">decision tree/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">monte carlo method/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(markov* or monte
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carlo).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">econom* model*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(decision* adj2 (tree* or
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analy* or model*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/29-38</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*health economics/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp *economic
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evaluation/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp *health care
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cost/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp *fee/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">funding/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cost*.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(economic* or
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pharmaco?economic*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(price* or
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pricing*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cost* adj2 (effective* or
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utilit* or benefit* or minimi* or unit* or estimat*
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or variable*)).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(financ* or fee or
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fees).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(value adj2 (money or
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monetary)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/40-52</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26 and (39 or 53)</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobptdappbtab8"><div id="ptd.appb.tab8" class="table"><h3><span class="title">NHS EED and HTA (CRD) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577120/table/ptd.appb.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ptd.appb.tab8_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR Arthritis,
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Rheumatoid EXPLODE ALL TREES</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((rheumatoid adj2
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(arthritis or arthrosis)))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((caplan* adj2
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syndrome))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((felty* adj2
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syndrome))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((rheumatoid adj2
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factor))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(((inflammatory or
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idiopathic) adj2 arthritis))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(“inflammatory
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polyarthritis”)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1 OR #2 OR #3 OR #4 OR #5
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OR #6 OR #7</td></tr></tbody></table></div></div></article><article data-type="fig" id="figobptdappcfig1"><div id="ptd.appc.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%201.%20Flow%20chart%20of%20clinical%20study%20selection%20for%20the%20review%20of%20%02018Which%20target%20to%20monitor%20in%20rheumatoid%20arthritis%3F%02019.&p=BOOKS&id=577120_ptdappcf1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577120/bin/ptdappcf1.jpg" alt="Figure 1. Flow chart of clinical study selection for the review of ‘Which target to monitor in rheumatoid arthritis?’." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 1</span><span class="title">Flow chart of clinical study selection for the review of
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‘Which target to monitor in rheumatoid
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arthritis?’</span></h3></div></article><article data-type="fig" id="figobptdappgfig2"><div id="ptd.appg.fig2" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%202.%20Flow%20chart%20of%20economic%20study%20selection%20for%20the%20guideline.&p=BOOKS&id=577120_ptdappgf2.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577120/bin/ptdappgf2.jpg" alt="Figure 2. Flow chart of economic study selection for the guideline." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 2</span><span class="title">Flow chart of economic study selection for the
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guideline</span></h3><div class="caption"><p>* Non-relevant population, intervention, comparison, design or
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setting; non-English language</p></div></div></article><article data-type="table-wrap" id="figobptdappitab1"><div id="ptd.appi.tab1" class="table"><h3><span class="label">Table 7</span><span class="title">Studies excluded from the clinical review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577120/table/ptd.appi.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ptd.appi.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_ptd.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_ptd.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Exclusion reason</th></tr></thead><tbody><tr><td headers="hd_h_ptd.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bykerk 2013<a class="bibr" href="#ptd.ref2" rid="ptd.ref2"><sup>2</sup></a></td><td headers="hd_h_ptd.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review: methods
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are not adequate/unclear</td></tr><tr><td headers="hd_h_ptd.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cardiel 2013<a class="bibr" href="#ptd.ref3" rid="ptd.ref3"><sup>3</sup></a></td><td headers="hd_h_ptd.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review: methods
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are not adequate/unclear</td></tr><tr><td headers="hd_h_ptd.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Edmonds 2007<a class="bibr" href="#ptd.ref6" rid="ptd.ref6"><sup>6</sup></a></td><td headers="hd_h_ptd.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison.
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conference abstract</td></tr><tr><td headers="hd_h_ptd.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hodkinson 2015<a class="bibr" href="#ptd.ref7" rid="ptd.ref7"><sup>7</sup></a></td><td headers="hd_h_ptd.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect interventions.
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Inappropriate comparison</td></tr><tr><td headers="hd_h_ptd.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Jurgens 2012<a class="bibr" href="#ptd.ref8" rid="ptd.ref8"><sup>8</sup></a></td><td headers="hd_h_ptd.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review: methods
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are not adequate/unclear</td></tr><tr><td headers="hd_h_ptd.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pincus 2013<a class="bibr" href="#ptd.ref11" rid="ptd.ref11"><sup>11</sup></a></td><td headers="hd_h_ptd.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review:
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literature search not sufficiently rigorous</td></tr><tr><td headers="hd_h_ptd.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pope 2013<a class="bibr" href="#ptd.ref12" rid="ptd.ref12"><sup>12</sup></a></td><td headers="hd_h_ptd.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate
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comparison</td></tr><tr><td headers="hd_h_ptd.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Radner 2014<a class="bibr" href="#ptd.ref13" rid="ptd.ref13"><sup>13</sup></a></td><td headers="hd_h_ptd.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study
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design</td></tr><tr><td headers="hd_h_ptd.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Schoels 2010<a class="bibr" href="#ptd.ref14" rid="ptd.ref14"><sup>14</sup></a></td><td headers="hd_h_ptd.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review: methods
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are not adequate/unclear</td></tr><tr><td headers="hd_h_ptd.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Smolen 2016<a class="bibr" href="#ptd.ref15" rid="ptd.ref15"><sup>15</sup></a></td><td headers="hd_h_ptd.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review: methods
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are not adequate/unclear</td></tr><tr><td headers="hd_h_ptd.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Stoffer 2016<a class="bibr" href="#ptd.ref16" rid="ptd.ref16"><sup>16</sup></a></td><td headers="hd_h_ptd.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review: methods
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are not adequate/unclear</td></tr><tr><td headers="hd_h_ptd.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">van Tuyl 2008<a class="bibr" href="#ptd.ref17" rid="ptd.ref17"><sup>17</sup></a></td><td headers="hd_h_ptd.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate
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comparison</td></tr><tr><td headers="hd_h_ptd.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wells 2006<a class="bibr" href="#ptd.ref18" rid="ptd.ref18"><sup>18</sup></a></td><td headers="hd_h_ptd.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design.
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Inappropriate comparison</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobptdappitab2"><div id="ptd.appi.tab2" class="table"><h3><span class="label">Table 8</span><span class="title">Studies excluded from the health economic review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577120/table/ptd.appi.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ptd.appi.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_ptd.appi.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference</th><th id="hd_h_ptd.appi.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reason for exclusion</th></tr></thead><tbody><tr><td headers="hd_h_ptd.appi.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ptd.appi.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr></tbody></table></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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