Emery P, Seto Y
Academic Unit of Musculoskeletal Disease, Department of Rheumatology, 1st Floor, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom.
Clin Exp Rheumatol. 2003 Sep-Oct;21(5 Suppl 31):S191-4.
Recent advances in the management and treatment of rheumatoid arthritis (RA) have provided evidence for the importance of early diagnosis and treatment of the disease. Biological therapy with monoclonal antibodies, including anti-tumor necrosis factor (TNF) agents have shown major efficacy in terms of disease activity and outcome of inflammatory arthritis in trials. Interest has focused on the treatment of early rheumatoid arthritis with anti-TNF agents to induce long-term impact on outcome. A major study of etanercept versus methotrexate (MTX) showed some benefit at one year for the etanercept group, but long-term data have shown greater benefit. Two double-blind placebo-controlled studies of infliximab in patients with early RA yielded promising data, showing the possibility of a true 'window of opportunity' with long-term benefit from a short term treatment period. Aggressive treatment by anti-TNF agents as well as combination therapies of disease modifying anti-rheumatic drugs (DMARDs) in patients with very early disease would be a logical approach to be investigated in the future.
类风湿关节炎（RA）管理与治疗方面的最新进展为该疾病早期诊断和治疗的重要性提供了证据。包括抗肿瘤坏死因子（TNF）药物在内的单克隆抗体生物疗法在试验中已显示出对炎症性关节炎的疾病活动度和转归具有显著疗效。人们的兴趣集中在用抗TNF药物治疗早期类风湿关节炎以对转归产生长期影响。一项关于依那西普与甲氨蝶呤（MTX）对比的主要研究显示，依那西普组在一年时具有一定益处，但长期数据显示其益处更大。两项关于英夫利昔单抗治疗早期RA患者的双盲安慰剂对照研究得出了有前景的数据，表明存在真正的“机会窗口”，即短期治疗期可带来长期益处。对于极早期疾病患者，采用抗TNF药物积极治疗以及联合使用改善病情抗风湿药（DMARDs）将是未来值得研究的合理方法。
