Pincus T
Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232.
J Autoimmun. 1992 Apr;5 Suppl A:209-26. doi: 10.1016/0896-8411(92)90036-p.
A case for early intervention in rheumatoid arthritis is presented on the basis of the following observations: (1) established rheumatoid arthritis of 5 years duration or more is a progressive disease in most patients; (2) most patients with rheumatoid arthritis already have evidence of permanent radiographic damage within the first 2 years of disease; (3) the morbidity and mortality of rheumatoid arthritis are predicted by baseline data indicating more severe clinical status, rather than drug toxicity or causes 'unrelated' to rheumatoid arthritis; (4) currently used therapies, even those documented to be effective in randomized controlled trials, are not effective in most patients over periods of 2 years or longer. It is not known whether earlier intervention will result in better outcomes. However, these phenomena suggest a need for studies to evaluate early aggressive intervention in rheumatoid arthritis.
基于以下观察结果，提出了对类风湿关节炎进行早期干预的理由：（1）病程达5年或更长时间的确诊类风湿关节炎在大多数患者中是一种进行性疾病；（2）大多数类风湿关节炎患者在疾病的头2年内就已经有永久性放射学损伤的证据；（3）类风湿关节炎的发病率和死亡率由表明临床状况更严重的基线数据预测，而非药物毒性或与类风湿关节炎“无关”的病因；（4）目前使用的疗法，即使那些在随机对照试验中被证明有效的疗法，在大多数患者中超过2年或更长时间也无效。尚不清楚早期干预是否会带来更好的结果。然而，这些现象表明需要开展研究来评估对类风湿关节炎进行早期积极干预的效果。
