The PARADOx (Progression Analysis in Rheumatoid Arthritis of raDiographic Outcomes) systematic review: Radiographic Progression and Treatment Tapering in Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a long-term condition where the immune system attacks the joints, leading to swelling and damage over time. Doctors often use X-ray imaging to track how the disease is progressing and to see how well treatments are working. Since RA treatments can be expensive and may have side effects, some patients and doctors consider reducing (tapering) medication once the disease is under control.

The medications that tend to be considered for tapering in rheumatoid arthritis are conventional synthetic Disease-Modifying Anti-rheumatic drugs (csDMARDs) and/or biologic DMARDs (bDMARDs). csDMARDs are traditional synthetic drugs, whereas bDMARDs are made from living organisms or their components (e.g. proteins). Both are types of disease-modifying antirheumatic drugs (DMARDs) which work by reducing inflammation and suppressing the immune system. This helps to prevent further damage to joints and other tissues.

It’s unclear whether tapering affects long-term joint health and disease progression. This study will review and combine data from clinical trials to compare the effects of continuing full treatment versus tapering on joint damage. By analysing individual patient data from relevant studies, we aim to get a more accurate and reliable appreciation of whether tapering RA treatment is associated with poorer outcomes upon X-ray imaging.

类风湿关节炎（Rheumatoid arthritis, RA）是一种慢性自身免疫性疾病，患者的免疫系统会错误攻击自身关节，随病程进展引发关节肿胀与损伤。临床医师常借助X射线成像（X-ray imaging）监测疾病进展、评估治疗方案的疗效。由于RA治疗成本高昂且可能引发不良反应，部分患者与医师会在疾病得到有效控制后考虑实施药物减量（tapering）治疗。

类风湿关节炎患者减量给药所涉及的药物通常为传统合成改善病情抗风湿药（conventional synthetic Disease-Modifying Anti-rheumatic drugs, csDMARDs）和/或生物制剂改善病情抗风湿药（biologic DMARDs, bDMARDs）。其中，csDMARDs为传统合成药物，而bDMARDs则由活生物体或其组分（如蛋白质）制备而成。二者均属于改善病情抗风湿药（disease-modifying antirheumatic drugs, DMARDs），通过抑制炎症反应、调节免疫系统发挥作用，可阻止关节及其他组织发生进一步损伤。

目前学界尚未明确药物减量是否会对患者的长期关节健康与疾病进展产生影响。本研究将对现有临床试验数据进行回顾与整合，对比持续全剂量治疗与减量给药方案对关节损伤的影响差异。通过分析相关研究中的个体患者数据，本研究旨在更精准、可靠地评估RA减量治疗是否与X射线成像下的不良预后存在关联。