Arndt U, Rittmeister M, Möller B
Rheumazentrum Rhein-Main, Medizinische Klinik III, Johann-Wolfgang-Goethe-Universität, Frankfurt/M.
Orthopade. 2003 Dec;32(12):1095-103. doi: 10.1007/s00132-003-0560-9.
Nowadays undisputed is the effectiveness of early and long-standing DMARD therapy in the presence of active rheumatoid arthritis on disease progression and avoidance of structural joint changes. "Early" is defined as immediate initiation of drug therapy after diagnosis of rheumatoid arthritis. "Long-term" refers to a mostly life-long therapy, which even in the case of remission should be continued for at least 1 year. Clinical and laboratory routine controls during DMARD therapy are absolutely necessary. "DMARDs" summarize disease-modifying antirheumatic drugs such as methotrexate, sulfasalazine, leflunomide, hydroxychloroquine, aurum but also the TNF-blockers infliximab and etanercept. In cases of disease remission with combination drug therapy, corticosteroids and NSAID should be discontinued in a timely manner ahead of DMARDs to ensure that the reduction of clinical symptoms is not steroid controlled. DMARD therapy should end at least 6 months prior to conception.
目前，早期和长期使用改善病情抗风湿药物（DMARD）治疗对活动性类风湿关节炎疾病进展及避免关节结构改变的有效性已无可争议。“早期”定义为类风湿关节炎诊断后立即开始药物治疗。“长期”指大多为终身治疗，即使在病情缓解情况下也应持续至少1年。DMARD治疗期间进行临床和实验室常规检查绝对必要。“DMARDs”涵盖改善病情抗风湿药物，如甲氨蝶呤、柳氮磺胺吡啶、来氟米特、羟氯喹、金制剂，还有肿瘤坏死因子阻滞剂英夫利昔单抗和依那西普。在联合药物治疗病情缓解的情况下，应在停用DMARDs之前及时停用皮质类固醇和非甾体抗炎药，以确保临床症状的减轻不是由类固醇控制的。DMARD治疗应在受孕前至少6个月结束。
