Raza Karim, Buckley Caitriona E, Salmon Mike, Buckley Christopher D
Rheumatology Research Group, Division of Immunity and Infection, Institute of Biomedical Research, MRC Centre for Immune Regulation, University of Birmingham, Birmingham B15 2TT, UK.
Best Pract Res Clin Rheumatol. 2006 Oct;20(5):849-63. doi: 10.1016/j.berh.2006.05.005.
Rheumatoid arthritis (RA) is common and leads to joint damage due to persistent synovitis. The persistence of inflammation is maintained by hyperplastic stromal tissue, which drives the accumulation of leukocytes in the synovium. Aggressive treatment after the first 3-4 months of symptoms, with either disease modifying anti-rheumatic drugs or anti-tumor necrosis factor (TNF)-alpha therapy, reduces the rate of disease progression. However, it rarely switches off disease such that remission can be maintained without the continued need for immunosuppressive therapy. There is increasing evidence that the first few months after symptom onset represent a pathologically distinct phase of disease. This very early phase may translate into a therapeutic window of opportunity during which it may be possible to permanently switch off the disease process. The rationale for, and approaches to, treatment within this very early window are discussed.
类风湿性关节炎（RA）很常见，会因持续性滑膜炎导致关节损伤。炎症的持续由增生性基质组织维持，该组织促使白细胞在滑膜中积聚。在出现症状的最初3 - 4个月后，使用改善病情抗风湿药或抗肿瘤坏死因子（TNF）-α疗法进行积极治疗，可降低疾病进展速度。然而，这种治疗很少能使疾病完全缓解，以至于无需持续进行免疫抑制治疗就能维持病情缓解。越来越多的证据表明，症状出现后的最初几个月代表疾病在病理上的一个不同阶段。这个极早期阶段可能转化为一个治疗机会窗口，在此期间有可能永久阻断疾病进程。本文将讨论在这个极早期窗口内进行治疗的基本原理和方法。
