Schumacher H R, Pessler F, Chen L X
Department of Rheumatology, University of Pennsylvania Hospital, 3rd Ravdin Building, 34th and Spruce Street, Philadelphia, Pennsylvania, USA.
Clin Exp Rheumatol. 2003 Sep-Oct;21(5 Suppl 31):S15-9.
Early diagnosis is being appropriately emphasized in RA, as early DMARD treatment can be very effective. ACR criteria are useful but may not perform as well in early disease. These criteria depend on clinical examination, which is subject to over- and under-interpretation. Ultrasound and MRI may offer advantages. Laboratory tests and synovial fluid analyses may contribute, but are often not definitive. All of these data, synovial biopsies and a variety of other features can guide prognosis as well as diagnosis. Consideration of the whole patient, including education levels and coping strategies, can help. Aggressive management is proposed for most patients once the diagnosis is firm. Strategies are needed to arrange that patients are seen at a very early stage by rheumatologists knowledgeable in the treatment of early arthritis. Early diagnosis is receiving increasing emphasis in RA, with the recognition that erosive irreversible disease can occur in the first months and that a variety of treatments can clearly prevent or slow disease progression (1, 2). Most studies addressing early RA use the American Rheumatism Association (ARA), now the American College of Rheumatology (ACR), criteria (3) for purposes of uniformity although these criteria have been shown to be less valid in early disease (4). Early DMARD treatment can make a difference, but there are a number of unanswered or partially answered questions about diagnosis that remain to be addressed. We review this area, focusing on work from our own research and how this has guided our thinking.
在类风湿关节炎（RA）中，早期诊断正得到适当的重视，因为早期使用改善病情抗风湿药（DMARD）治疗可能非常有效。美国风湿病学会（ACR）标准很有用，但在疾病早期可能效果不佳。这些标准依赖于临床检查，而临床检查可能存在过度解读和解读不足的情况。超声和磁共振成像（MRI）可能具有优势。实验室检查和滑液分析可能有帮助，但往往不具有决定性。所有这些数据、滑膜活检以及各种其他特征都可以指导预后和诊断。考虑患者的整体情况，包括教育水平和应对策略，可能会有所帮助。一旦诊断明确，建议对大多数患者进行积极治疗。需要制定策略，以便让熟悉早期关节炎治疗的风湿病专家在疾病早期就对患者进行诊治。随着人们认识到在发病的头几个月就可能出现侵蚀性不可逆疾病，并且多种治疗方法可以明显预防或减缓疾病进展（1,2），早期诊断在RA中越来越受到重视。尽管这些标准在早期疾病中已被证明有效性较低（4），但为了保持一致性，大多数关于早期RA的研究仍使用美国风湿病协会（ARA），即现在的美国风湿病学会（ACR）的标准（3）。早期使用DMARD治疗可能会产生不同的结果，但关于诊断仍有许多未得到解答或部分得到解答的问题有待解决。我们将回顾这一领域，重点关注我们自己的研究工作以及它如何指导了我们的思考。
