ORCID Profile
0000-0003-1142-1460
Current Organisation
University of Nottingham
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Publisher: BMJ
Date: 06-08-2013
Publisher: BMJ
Date: 02-03-2016
DOI: 10.1136/ANNRHEUMDIS-2014-206914
Abstract: We conducted a systematic literature review to assess the adverse event (AE) profile of paracetamol. We searched Medline and Embase from database inception to 1 May 2013. We screened for observational studies in English, which reported mortality, cardiovascular, gastrointestinal (GI) or renal AEs in the general adult population at standard analgesic doses of paracetamol. Study quality was assessed using Grading of Recommendations Assessment, Development and Evaluation. Pooled or adjusted summary statistics were presented for each outcome. Of 1888 studies retrieved, 8 met inclusion criteria, and all were cohort studies. Comparing paracetamol use versus no use, of two studies reporting mortality one showed a dose–response and reported an increased relative rate of mortality from 0.95 (0.92 to 0.98) to 1.63 (1.58 to 1.68). Of four studies reporting cardiovascular AEs, all showed a dose–response with one reporting an increased risk ratio of all cardiovascular AEs from 1.19 (0.81 to 1.75) to 1.68 (1.10 to 2.57). One study reporting GI AEs reported a dose–response with increased relative rate of GI AEs or bleeds from 1.11 (1.04 to 1.18) to 1.49 (1.34 to 1.66). Of four studies reporting renal AEs, three reported a dose–response with one reporting an increasing OR of ≥30% decrease in estimated glomerular filtration rate from 1.40 (0.79 to 2.48) to 2.19 (1.4 to 3.43). Given the observational nature of the data, channelling bias may have had an important impact. However, the dose–response seen for most endpoints suggests a considerable degree of paracetamol toxicity especially at the upper end of standard analgesic doses.
Publisher: Elsevier BV
Date: 06-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2011
DOI: 10.1016/J.PAIN.2011.09.019
Abstract: A systematic review and meta-analysis of population-based epidemiological studies was undertaken to determine the prevalence of foot and ankle pain in middle and old age. Searches were conducted in the following electronic databases from inception to October 2010: PubMed, EMBASE, AMED, CINAHL, Cochrane, PEDro, and SportDiscus. Full-text English language articles were included if they used population s le frames, cross-sectional design or analysis, and reported prevalence estimates for foot and/or ankle pain in adults aged 45 years and over. Thirty-four articles from 31 studies involving 75,505 participants provided 529 prevalence estimates based on different case definitions and population strata. Random-effects meta-analyses of studies with comparable case definitions provided pooled prevalence estimates, for frequent foot pain of 24% (95% confidence interval 22-25% n=3 I(2)=46%) and for frequent ankle pain of 15% (95% confidence interval 13-16% n=2 I(2)=0). Small s le sizes and low response rates in some studies, together with heterogeneous case definitions, limit confident conclusions on the distribution, subtypes, and impact of foot/ankle pain. Narrative synthesis of evidence from existing studies suggested preponderance in females, an age-related increase in prevalence in women but not men, that the toes/forefoot were the most common anatomical sites of pain, and that moderate disability in an aspect of daily life was reported by two-thirds of cases. This review provides estimates of the community burden of foot and ankle pain in middle and old age. By outlining the scale of this clinical problem, these findings can be used to inform health care planning and provision.
Publisher: BMJ
Date: 16-02-2016
DOI: 10.1136/ANNRHEUMDIS-2015-208823
Abstract: It is thought that the clinical trial benefits of oral non-steroidal anti-inflammatory drugs (NSAIDs) may relate to flare designs. The aim of this study was to examine the difference in NSAID (including cyclooxygenase-2 (COX-2) inhibitors) response in osteoarthritis (OA) trials based on different designs. Systematic review was undertaken of the databases MEDLINE, EMBASE, AMED, CINAHL and the Cochrane library till February 2015. Randomised controlled trials assessing pain, function and/or stiffness following commencement of NSAIDs in flare and non-flare designs were eligible. Trials were assessed using the Cochrane Risk of Bias tool. Meta-analyses were conducted to assess the effect sizes (ES) of NSAIDs for OA with flare versus non-flare trial designs. Fifty-seven studies including 33 263 participants assessing 26 NSAIDs were included. Twenty-two (39%) were flare design, 24 (42%) were non-flare designs, 11 (19%) were possible flare designs. On meta-analysis, there was no statistically significant difference in ES of NSAIDs versus placebo between flare and non-flare trial designs for absolute pain and function or stiffness at immediate-term (1 week), short-term (2–4 week) or longer-term (12–13 week) follow-up periods (p .05). However there was a lower ES for mean change in pain in flare and possible flare trials compared with non-flare trials at short-term follow-up (0.36 vs 0.69 p=0.05). Contrary to previous understanding, flare trial designs do not result in an increased treatment effect for NSAIDs in people with OA compared with non-flare design. Whether flare design influences other outcomes such as joint effusion remains unknown.
Publisher: Wiley
Date: 10-09-2013
Publisher: Oxford University Press (OUP)
Date: 04-02-2014
DOI: 10.1093/RHEUMATOLOGY/KET418
Abstract: Vitamin D receptor (VDR) gene polymorphisms may be associated with the risk of OA, however, evidence for this is controversial. This meta-analysis aims to confirm whether VDR gene polymorphisms are associated with OA. Meta-analyses on the association between OA and VDR ApaI, BsmI, TaqI and FokI polymorphisms were conducted using allele and homozygote contrast and contrasts in the recessive and dominant models. Stratification analyses by different demographic regions (Europe vs Asian) were also performed and pooled odds ratios (ORs) were obtained using the random effects model if the results were heterogeneous. A total of 13 relevant studies involving OA patients (n = 2104) and controls (n = 2939) were included in the analysis. There were significant associations between VDR ApaI polymorphisms and OA in the Asian population (A vs a: OR= 1.16, 95% CI 1.02, 1.32, P = 0.025 AA vs Aa/aa: OR= 1.36, 95% CI 1.04, 1.77, P = 0.025 AA vs aa: OR= 1.35, 95% CI 1.00, 1.80, P = 0.047), but not in the whole population. There was also a statistically significant association between FokI polymorphism and OA (FF vs Ff/ff: OR= 0.65, 95% CI 0.44, 0.95, P = 0.024) however, this result was derived from only two studies. No significant associations were found between VDR TaqI and BsmI polymorphisms and OA. There are modest but statistically significant associations between VDR ApaI polymorphisms and the susceptibility of OA in the Asian population.
Publisher: BMJ
Date: 07-12-2117
DOI: 10.1136/ANNRHEUMDIS-2016-210815
Abstract: The increased information provided by modern imaging has led to its more extensive use. Our aim was to develop evidence-based recommendations for the use of imaging in the clinical management of the most common arthropathy, osteoarthritis (OA). A task force (including rheumatologists, radiologists, methodologists, primary care doctors and patients) from nine countries defined 10 questions on the role of imaging in OA to support a systematic literature review (SLR). Joints of interest were the knee, hip, hand and foot imaging modalities included conventional radiography (CR), MRI, ultrasonography, CT and nuclear medicine. PubMed and EMBASE were searched. The evidence was presented to the task force who subsequently developed the recommendations. The strength of agreement for each recommendation was assessed. 17 011 references were identified from which 390 studies were included in the SLR. Seven recommendations were produced, covering the lack of need for diagnostic imaging in patients with typical symptoms the role of imaging in differential diagnosis the lack of benefit in monitoring when no therapeutic modification is related, though consideration is required when unexpected clinical deterioration occurs CR as the first-choice imaging modality consideration of how to correctly acquire images and the role of imaging in guiding local injections. Recommendations for future research were also developed based on gaps in evidence, such as the use of imaging in identifying therapeutic targets, and demonstrating the added value of imaging. These evidence-based recommendations and related research agenda provide the basis for sensible use of imaging in routine clinical assessment of people with OA.
Publisher: BMJ
Date: 25-05-2011
Publisher: Elsevier BV
Date: 08-2011
Publisher: BMJ
Date: 20-12-2013
DOI: 10.1136/ANNRHEUMDIS-2013-204494
Abstract: There is emerging evidence that the development and progression of osteoarthritis (OA) is associated with inflammation. C reactive protein (CRP), a systemic marker for inflammation, may be elevated in OA patients but the evidence is conflicting. To systematically review the literature for the relationship between serum CRP levels measured by a high sensitivity method (high sensitive CRP (hs-CRP)) and OA, as well as the correlation between circulating CRP levels and OA phenotypes. MEDLINE, EMBASE and CINAHL databases were systematically searched from January 1992 to December 2012. Studies were included when they met the inclusion criteria and data from studies were extracted. Two independent reviewers assessed study quality using a modified Newcastle-Ottawa Quality Assessment Scale. Meta-analyses were performed to pool available data from included studies. 32 studies met the inclusion criteria. Serum hs-CRP levels in OA were modestly but statistically significantly higher than controls (mean difference=1.19 mg/L, 95% CI 0.64 to 1.73, p<0.001) with significant heterogeneity between studies. Levels were significantly associated with pain (r=0.14, 95% CI 0.09 to 0.20, p<0.001) and decreased physical function (r=0.25, 95% CI 0.13 to 0.39, p<0.001). No significant associations were found between hs-CRP levels and radiographic OA. Low-grade systemic inflammation may play a greater role in symptoms rather than radiographic changes in OA.
Publisher: Elsevier BV
Date: 05-2011
Publisher: BMJ
Date: 29-01-2014
Publisher: BMJ
Date: 13-07-2013
Publisher: Elsevier BV
Date: 05-2011
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Weiya Zhang.