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Varios medicamentos pueden aliviar los síntomas de la artritis reumatoide después del fracaso de un medicamento antirreumático modificador de la enfermedad (FAME) biológico o sintético dirigido (b/sd) (un tipo de medicamento que detiene o frena el avance de la enfermedad).
No tenemos seguridad sobre cómo se comparan estos medicamentos con el placebo (tratamiento simulado) o entre sí en cuanto a los efectos no deseados.
Necesitamos más estudios que comparen los medicamentos entre sí para tener una idea más clara de cuál es el mejor. Las decisiones de tratamiento deben considerar los factores de salud y preferencias individuales.
La artritis reumatoide es una enfermedad en la que el sistema inmunitario del cuerpo, que normalmente combate las infecciones, ataca por error las articulaciones. Esto causa dolor, inflamación y rigidez en las articulaciones, así como discapacidad. La artritis reumatoide es una afección a largo plazo, pero los tratamientos pueden ayudar a controlar los síntomas y frenar el daño.
La artritis reumatoide habitualmente se trata con medicamentos antirreumáticos modificadores de la enfermedad (FAME), que funcionan para controlar la inflamación responsable de los síntomas y también para prevenir el daño articular. Hay varios tipos de FAME. Los FAME sintéticos dirigidos (sd) actúan sobre células o proteínas específicas. Los FAME biológicos (b) también se dirigen a células o proteínas específicas, pero están hechos de material que proviene de organismos vivos. Por último, los FAME sintéticos convencionales afectan a todo el sistema inmunitario en lugar de dirigirse a partes específicas del mismo.
Queríamos evaluar la efectividad de los FAME en adultos con artritis reumatoide en quienes el tratamiento con un FAME b/sd no había funcionado. Esta es una revisión sistemática continua (“living systematic review”) , lo que significa que se actualizará regularmente. Dado que este campo de la medicina está en constante evolución, queremos que esta revisión refleje la evidencia más actualizada.
Buscamos estudios que analizaran la efectividad de los FAME en adultos con artritis reumatoide a quienes no les había funcionado el tratamiento con un FAME b/sd.
Evaluamos en qué medida los FAME disponibles reducían los síntomas de la artritis reumatoide, incluidos el dolor, la inflamación articular y los problemas de movilidad articular. Medimos estos resultados mediante la respuesta ACR50 que indica una mejoría del 50% según los criterios establecidos por el American College of Rheumatology. Una respuesta ACR50 significa que la medicación para la artritis reumatoide es efectiva y que los síntomas han mejorado al menos un 50%. También analizamos cualquier efecto no deseado que pudiera causar que una persona interrumpiera el uso de la medicación.
Comparamos y resumimos los resultados de los estudios, y calificamos la confianza en la evidencia en función de factores como su metodología y su tamaño.
Encontramos 19 estudios con 4779 personas con artritis reumatoide que previamente habían recibido un inhibidor del factor de necrosis tumoral (un tipo de FAME biológico [FAME b]), pero no había mejorado sus síntomas. La mayoría de las personas en estos estudios eran mujeres, con una media de edad de 49 a 58 años, y con una duración media de la artritis reumatoide de entre 6 y 14 años. Los estudios se realizaron en distintos lugares del mundo, lo que incluyó Norteamérica, Europa y Asia. Nueve estudios fueron financiados por compañías farmacéuticas, mientras que los otros 10 recibieron subvenciones nacionales de investigación.
Varios medicamentos redujeron los síntomas de la artritis reumatoide en pacientes en los que había fracasado el tratamiento con un FAME b/sd:
un inhibidor del factor de necrosis tumoral distinto (2 estudios; 343 personas);
sarilumab (1 estudio, 365 personas);
tocilizumab 4 mg/kg (1 estudio, 319 personas);
tocilizumab 8 mg/kg (1 estudio, 328 personas);
abatacept intravenoso (por vena) (2 estudios, 665 personas);
rituximab (1 estudio, 499 personas);
upadacitinib (1 estudio, 333 personas);
tofacitinib (1 estudio, 263 personas);
una dosis mayor de baricitinib (1 estudio, 353 personas).
No sabemos con certeza cómo se comparan estos medicamentos con el placebo (tratamiento simulado) o entre sí en cuanto a los efectos no deseados, ya que la evidencia para este desenlace fue, en general, de calidad baja.
Nuestra confianza en la evidencia varió de alta a muy baja. Los casos en que la confianza fue limitada, se debieron a que no hubo suficientes estudios para tener certeza acerca de los resultados. Cuando buscamos estudios para incluir en la revisión, encontramos algunas áreas en las que la evidencia disponible no era suficiente. Específicamente, encontramos que hubo menos estudios que compararon directamente los medicamentos entre sí y más estudios que los compararon con placebo. Hacer más estudios que comparen los medicamentos directamente entre sí ayudarían a comprender cuál es mejor.
La evidencia está actualizada hasta el 28 de noviembre de 2025. Como se trata de una revisión continua, actualizaremos esta investigación cada año para garantizar que nuestros resultados reflejen la nueva evidencia.
by Yuta Nemoto, Fumie Otsuka, Shihoko Suzuki, Saori Kataoka, Tomoko Nakanishi, Takuya Ueda, Susumu Ogawa, Sumika Karasawa, Mikiko Shimaoka, Hiroto Narimatsu, Ung-il Chung
BackgroundEsports (competitive and organised video gaming) may enhance physical and cognitive health in older adults. The aim of this study was to examine the feasibility and effects of a multicomponent program incorporating esports on physical and cognitive function in community-dwelling older adults.
MethodsThis parallel, non-randomised controlled trial was conducted in Yokosuka, Kanagawa, Japan. Twenty-six participants who 1) were aged 60 years or older, 2) had no cognitive impairment, 3) had no major health problems, and 4) had no prior experience with digital games were allocated to either the intervention (n = 12) or the control (n = 14) group. Participants in the intervention group attended weekly 90-minute sessions consisting of health education, exercise, and esports for 12 weeks. The feasibility of the program was assessed based on adverse events, participant retention, adherence to the program, engagement in digital games outside the program, enjoyment of the program, and willingness to continue playing esports after the study period. Additionally, psychological status, physical and cognitive function, and body composition were assessed.
ResultsNo adverse events were reported; 10 of the 12 participants attended ≥80% of the sessions, all participants reported enjoying the program, and no participants dropped out during follow-up. Positive psychological status scores increased from before to after each session among participants in the intervention group. Furthermore, adjusted analyses showed more favourable changes in gait speed and balance in the intervention group than in the control group (p < 0.05). However, the effects on physical function remain uncertain because the analyses were exploratory.
ConclusionsThe program showed potential for high retention and adherence among older adults, with no adverse events. Larger-scale trials are needed to confirm the effectiveness of this intervention program, as the analyses in this study were exploratory.
Trial registrationThe study protocol was registered with the UMIN-CTR (ID: UMIN000055350; date of first registration: 27 August 2024).
Virtual reality (VR)-based cognitive–motor training has emerged as a promising nonpharmacological intervention for older adults with mild cognitive impairment (MCI). However, evidence regarding its effectiveness in community-dwelling populations remains inconclusive.
The aim of this study is to evaluate the effectiveness of VR-based cognitive–motor training on cognitive and functional outcomes in community-dwelling older adults with MCI.
A comprehensive literature search was conducted in PubMed, Embase, MEDLINE, CINAHL Complete, PsycINFO, Scopus, and the Cochrane Library from inception to October 15, 2025. The quality of included studies was assessed using the Joanna Briggs Institute critical appraisal tools. Risk of bias was assessed using the revised Cochrane Risk of Bias tool. Meta-analysis was conducted using random-effects models.
A total of 15 studies involving 706 participants were included, with 362 participants receiving VR-based cognitive–motor training and 344 receiving control intervention. Compared with control interventions, VR-based cognitive–motor training was associated with significant improvement in global cognition measured using the Montreal Cognitive Assessment. However, no significant improvement was observed for the Mini-Mental State Examination. Borderline improvement was found for executive function measured by Trail Making Test Part B. No significant effects were observed for instrumental activities of daily living, depressive symptoms, or walking performance. Substantial heterogeneity was observed across studies.
VR-based cognitive–motor training may improve global cognition in community-dwelling older adults with MCI. However, evidence for functional outcomes remains limited, and findings should be interpreted cautiously because of substantial heterogeneity across studies.
VR-based cognitive–motor interventions may provide feasible nonpharmacological approaches for gerontological, community, and rehabilitation nursing practice. Nurses may support implementation through patient and caregiver education, adherence monitoring, and continuity of cognitive care in community settings.
The Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were developed to improve the completeness and transparency of reporting of reliability and agreement of health measurement instruments. However, since their publication in 2011 methodological standards, both for reporting guideline development and reliability, agreement and measurement error studies have advanced, highlighting the need for aligning and updating. In addition, related initiatives like COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) have emerged, offering opportunities to harmonise terminology and promote consistency across diverse types of measurement instruments. This method review aims to (1) systematically identify and synthesise commentaries on and evaluations of the original GRRAS and (2) map recent methodological developments in the planning, conduct and interpretation of reliability, agreement and measurement error studies in health science, psychology and education that should be reflected in the reporting, to inform the development of the GRRAS-COSMIN reporting guidelines.
Two complementary search strategies will be employed. First, forward direct citation tracking of the original GRRAS publications will be conducted in Web of Science. We will include sources providing critique, commentaries or suggestions related to the GRRAS. We will exclude publications that used GRRAS just for structuring their report, withdrawn or retracted articles, textbooks, peer reviews, supplements and conference materials without full-text publications. Included articles will be analysed using descriptive content analysis. Second, we will perform a systematic search in MEDLINE, PsycInfo, Embase, ERIC and CINAHL supplemented by key references identified by or known to the author team. We will include studies, reviews, commentaries, editorials, methodological papers, tutorials and guidance documents that discuss or critically reflect on methodological aspects of the measurement properties reliability and/or agreement/measurement error published between 1 January 2015 and 30 June 2026 in health sciences, psychology or education. Eligibility will be assessed by two independent reviewers and included sources will be analysed using ‘codebook’ thematic analysis. Findings will be presented narratively supplemented by visuals and tables if appropriate.
This study involves publicly available data. No ethical approval is needed. Results will be disseminated through an open-access journal publication following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review Extension and conference presentations.
The Healthy Early Life Moments in Singapore (HELMS) programme was developed by a multidisciplinary team to improve metabolic and mental health outcomes in women/mothers and to promote healthy growth and development in their children. Despite increasing interest in preventive life-course care, evidence on the long-term economic impact of these life-course interventions remains limited. This protocol outlines the economic evaluation of the HELMS integrated lifestyle intervention, supported by a mobile health (mHealth) app, across the reproductive continuum from preconception to postpartum.
The HELMS programme is conducted at KK Women’s and Children’s Hospital, recruiting overweight or obese women and planning to conceive. The economic evaluation comprises a within-trial costing study and a cost-effectiveness analysis. We will develop a Markov model for mothers and children to simulate maternal-child health outcomes over a 10-year horizon from the healthcare provider’s perspective. Primary data will be sourced from the HELMS programme and supplemented by local mother–child cohorts and published literature. The cost analysis will include direct medical, direct non-medical and programme-related costs incurred through the HELMS intervention. We will measure health outcomes in quality-adjusted life-years (QALYs) using the EuroQol-5 Dimension utility scores. We will conduct both deterministic and probabilistic sensitivity analyses to assess model uncertainty. The evaluation will estimate total and incremental costs, QALYs and incremental cost-effectiveness ratios for HELMS versus standard care. We will present cost-effectiveness acceptability curves and perform subgroup analyses to explore heterogeneity by maternal age, ethnicity and body mass index. A willingness-to-pay threshold appropriate for the Singapore context, based on recently published estimates, will be used to determine cost-effectiveness. We will also identify key cost drivers and examine the intervention’s scalability.
The study has been approved by the Centralised Institutional Review Board of SingHealth (2021/2247). Written informed consent will be obtained from all participants. The findings will be published in peer-reviewed journals and disseminated to international and national policy makers.
This study aims to explore lived experiences of women with human papillomavirus (HPV) in the Iranian socio-cultural context, focusing on their understanding of the disease, associated challenges and the impact of these challenges on health-seeking behaviours.
This qualitative study was conducted using Smith’s Interpretative Phenomenological Analysis (IPA) method, employing in-depth semi-structured interviews.
Community-based recruitment in Tehran, Iran, with data collection conducted in 2025.
10 women aged 24–44 years, diagnosed with HPV, were recruited in Tehran through purposive and convenience sampling. Purposive sampling ensured rich experiential data relevant to the research question, while convenience sampling facilitated access to participants willing to discuss a sensitive topic.
None. This was an exploratory qualitative study.
Four main themes emerged from this IPA study: (1) the heavy burden of social stigma (unequal moral landscapes, forced loneliness, body shame and loss of femininity); (2) a challenging therapeutic journey (unknown territory, verbal violence and a ray of hope); (3) persistent worries (living with uncertain tomorrow, fear of cancer and broken trust); and (4) from wound to wisdom (becoming an agent again and not being alone in the experience).
This qualitative exploration indicates that for women in the Iranian sociocultural context, the impact of HPV may extend into psychosocial domains, involving gendered stigma and identity concerns that can influence health-seeking behaviours. These experiences appear to be shaped by local perceptions of femininity and social norms. While many participants faced significant difficulties, some also reported instances of personal growth and strengthened social support. These insights point to the potential benefit of integrating psychological support into HPV care and enhancing healthcare provider training to address the psychosocial needs of patients.
Not applicable (qualitative study).
by Edidiong Orok, Oluwaseun Olumoko, Inimuvie Ekada, Amos Oladunni
Inappropriate use of antimalarial medications can accelerate the development of antimicrobial resistance (AMR), undermining treatment efficacy and public health goals. Artemether-lumefantrine (A/L) is the first-line treatment for uncomplicated malaria in Nigeria, yet its misuse persists, particularly among young adults. This study assessed knowledge gaps in A/L use among university students in Southwestern Nigeria to identify opportunities for targeted intervention. A cross-sectional online survey was conducted among undergraduate students from three universities in Southwestern Nigeria. Respondents’ knowledge of A/L was categorized as good (≥70%), fair (50–69%), or poor (by Makiko Sasaki, Mamoru Tanaka, Akihiro Nomoto, Ryusei Yamasaki, Tomokazu Yoshimura, Shigenobu Yano, Yasunari Sasaki, Yuki Kojima, Taketo Suzuki, Hirotada Nishie, Keiji Ozeki, Takaya Shimura, Eiji Kubota, Hiromi Kataoka
Photodynamic therapy (PDT) is an anti-cancer therapy that employs a photosensitizer (PS) and an optimal wavelength of light, causing a photochemical reaction that releases reactive oxygen species, thereby inducing cancer cell death via oxidative stress. Because light irradiation is limited to the tumor site, PDT has minimal adverse effects. The cancer cell selectivity of the PS is important for reducing damage to the normal mucosa caused by scattered light. Antibody-drug conjugates (ADC) are novel anti-cancer therapies that combine a monoclonal tumor-surface-receptor-targeting antibody with a drug bonded through chemical linkers. ADCs enable the targeted delivery of a variety of drugs to cancer cells while minimizing their delivery to healthy tissues. One such tumor surface receptor is the human epidermal growth factor receptor 2 (HER2), which is of interest in the treatment of many cancers, including gastrointestinal cancer. To improve tumor selectivity and minimize damage to the mucosa surrounding the tumor in PDT, we established a novel PS glucose-linked chlorin e6-conjugated trastuzumab (G-Ce6-trastuzumab) that is conjugated to existing PS glucose-linked chlorin e6 (G-Ce6) and evaluated its anti-cancer effect compared to G-Ce6. The effect of PDT was evaluated using HER2-high-expression cells NCI-N87 and HER2-low-expression cells MKN-45. G-Ce6-trastuzumab is internalized by the intracellular organelles in cancer cells. Evaluation of cell death using the WST-8 assay also demonstrated a significantly higher cytotoxic effect of G-Ce6-trastuzumab in HER2-high-expression cells compared with conventional PS G-Ce6. Thereby, G-Ce6-trastuzumab may be an excellent novel PS for PDT because of its strong selectivity for HER2-high-expression cells.Keloids are chronic fibroproliferative skin disorders with high recurrence rates and limited treatment options, yet reliable diagnostic biomarkers are lacking. Current classification systems rely heavily on clinical observation, underscoring the need for objective, noninvasive tools. In this exploratory study, serum-based 1H nuclear magnetic resonance (NMR) measurement combined with short-time Fourier transform (STFT) for time-frequency analysis was performed, followed by principal component analysis (PCA), to investigate potential patient subgroups. Serum samples from 29 patients were analysed and PC1 scores suggested two potential patient subgroups. Retrospective analysis showed that these subgroups differed primarily in keloid aetiology: one group predominantly included cases arising from unclear or minimal causes (e.g., acne, folliculitis), whereas the other comprised cases following clear traumatic events (e.g., surgery). Although most clinical variables showed no significant differences, significant differences in aetiology and Japan Scar Workshop Scar Scale (JSS) scores support the biological relevance of this separation of subgroups. These findings suggest that the time-frequency features of NMR signals from serum samples capture systemic characteristics associated with keloid pathophysiology. If validated in larger cohorts, this approach may serve as a noninvasive adjunct to clinical assessment and lay the foundation for objective patient stratification and precision-guided treatment strategies.
To elucidate the essential strategies used by home-visit nurses to support the independence of individuals with dementia who live alone.
Qualitative interview study employing the Interpretive Description methodology.
Purposive sampling was conducted across three home-visit nursing offices in Tokyo. Individual semi-structured interviews were conducted with 14 home-visit nurses between June and August 2022. The interviews explored the strategies the participants employed while caring for individuals with dementia living alone. The transcribed data were analysed using reflexive thematic analysis.
Four strategies were identified: Strategy 1. Cultivating a relationship of trust to manage client refusal, Strategy 2. Fostering a balance between client and practical realities, Strategy 3. Optimising limited support resources and Strategy 4. Educating and advocating for a lack of understanding among supporters.
Home-visit nurses incorporate their standard practices into four strategies at both the direct care and support network levels to support independent living of individuals with dementia living alone. These strategies address the challenge of balancing autonomy with safety and health protection, which is a key consideration in supporting this population.
The findings provide guidance for home-visit nursing practice and inform the development of educational programmes to enhance their training.
This study advances understanding of how home-visit nurses navigate the challenges of autonomy, safety and health for people with dementia living alone, offering insights to inform future research and educational initiatives.
This study adhered to the Consolidated Criteria for Reporting Qualitative Research.
This study did not include patient or public involvement in its design, conduct, or reporting.
by Mario Alejandro Mercado Mendoza, Armando Sánchez Vargas, Pierre Mokondoko
Landslides threaten sustainable development through economic and human losses. This study integrates machine learning methods to construct susceptibility maps, including topographic-hydrological indicators, to improve the inclusion of earthflow landslides. Furthermore, we aim to find relationships between landslide susceptibility and social lag using Copula models and SHAP values. Results reveal differentiated dependence across different partitions. Specifically, we found regime-specific co-occurrences of high social lag and high landslide susceptibility areas in steep, deprived areas, contrasting resilient affluent zones. Educational deprivation emerges as the top vulnerability factor, followed by healthcare access, overcrowding, and housing deficits. Highlighting spatial inequities, the analysis advocates targeted interventions blending slope stabilization and social policies.This study aims to identify the impact of climate change anxiety and asthma control on asthmatics' quality of life and examine the moderating role of climate change anxiety in this linkage.
A multi-national cross-sectional study was conducted in four Arabian countries on 1266 asthmatics selected by convenience sampling. Data were collected from November 2023 to February 2024 using a climate anxiety scale, mini-asthma quality of life questionnaire, and an asthma control questionnaire.
Climate anxiety was higher among middle-aged participants, as well as those with longer disease durations and previous hospitalisations. Climate anxiety showed strong negative correlations with asthma control (r = −0.704, p ≤ 0.05) and asthma quality of life (r = − 0.638, p ≤ 0.05). Climate anxiety and asthma control are powerful predictors of quality of life among asthmatics. Climate anxiety moderates the relationship between asthma control and quality of life, making it less positive (B = −0.094, p > 0.001). Covariates such as gender, age, comorbidities, employment status, disease duration, and previous hospitalisation showed significant associations with asthma quality of life.
Assessment and mitigation of climate anxiety among asthmatics is a key strategy for controlling asthma and improving the quality of life. So, nurses must incorporate climate anxiety assessment into the care plan for asthmatics.
Climate change is a global concern, and insights into how climate-related psychological stressors exacerbate asthma symptoms and overall health outcomes are necessary. The findings provide actionable data for healthcare professionals to underscore the need for integrated healthcare approaches considering environmental and psychological factors.
This study adheres to strengthening the reporting of observational studies in epidemiology (STROBE) statement.
Clients with asthma across multiple nationalities actively contributed to our paper.
FreshRSS 