Lee D M, Weinblatt M E
Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
Lancet. 2001 Sep 15;358(9285):903-11. doi: 10.1016/S0140-6736(01)06075-5.
Rheumatoid arthritis is a systemic inflammatory disorder that mainly affects the diarthrodial joint. It is the most common form of inflammatory arthritis, and has a substantial societal effect in terms of cost, disability, and lost productivity. Although the pathogenesis of rheumatoid arthritis remains incompletely understood, much insight into the cellular and molecular mechanisms involved has been gained in the past decade. On the basis of these insights, new therapies have been developed, and clinical trials have shown the efficacy of aggressive treatment of patients with active disease. In this review, we discuss improvements in our understanding of the pathophysiology of inflammatory synovitis in rheumatoid arthritis, and improvements in therapy for patients with the disorder. The past decade has seen substantial advances in these areas. Future studies will be directed at improving methods for early diagnosis and identification of patients with progressive disease, and at improving methods to identify candidates for subclasses of disease-modifying antirheumatic drugs (DMARDs). Long-term safety and efficacy data for the new DMARD agents and combination regimens will also further delineate efficacy and toxicity and thus the appropriate clinical context for use of these therapeutic approaches. The continuing elucidation of pathophysiological pathways relevant in rheumatoid arthritis, coupled with continuing advances in biotechnology and rational drug design, offer substantial hope for the continued development of increasingly potent and specific pharmacotherapy for treatment of rheumatoid arthritis.
类风湿关节炎是一种主要影响滑膜关节的全身性炎症性疾病。它是炎症性关节炎最常见的形式，在成本、残疾和生产力损失方面具有重大的社会影响。尽管类风湿关节炎的发病机制仍未完全明了，但在过去十年中，我们对其涉及的细胞和分子机制有了很多了解。基于这些认识，已经开发出了新的疗法，临床试验也证明了积极治疗活动性疾病患者的疗效。在这篇综述中，我们讨论了我们对类风湿关节炎炎症性滑膜炎病理生理学理解的进展，以及该疾病患者治疗方法的改进。在过去十年中，这些领域取得了重大进展。未来的研究将致力于改进早期诊断方法和识别进展性疾病患者的方法，以及改进识别疾病改善抗风湿药物（DMARDs）亚类候选药物的方法。新的DMARD药物和联合治疗方案的长期安全性和疗效数据也将进一步明确疗效和毒性，从而确定这些治疗方法的合适临床应用环境。类风湿关节炎相关病理生理途径的不断阐明，再加上生物技术和合理药物设计的持续进步，为类风湿关节炎治疗中越来越有效和特异的药物治疗的持续发展带来了巨大希望。
