Keystone Edward C
University of Toronto, Canada.
Nat Clin Pract Rheumatol. 2006 Nov;2(11):594-601. doi: 10.1038/ncprheum0340.
Recent data have shown that disability and joint destruction in rheumatoid arthritis (RA) occur early on in the course of the disease and progress rapidly. It has been shown that in the early stages of RA, disability is attributed to increased disease activity, whereas later in the course of the disease, disability results from irreversible joint damage. These findings support the need to develop treatment strategies that will rapidly bring the disease under control, with the ultimate goal of alleviating symptoms and halting progressive joint damage. A number of such strategies have been evaluated, including the early administration of a biologic agent alone or in combination with high-dose methotrexate. Other, more recent treatment strategies include the tight control of disease activity by targeting specific outcomes necessary for decision making; the use of biologic agents for the treatment of moderate disease; and the induction of remission with a biologic agent early in the course of disease, followed by maintenance therapy using a conventional disease-modifying antirheumatic drug. The substantial positive effect these strategies have on patient outcomes supports the concept that the optimal management of RA involves aggressive early therapy combined with close monitoring of disease progression and modification of ineffective therapeutic strategies.
近期数据表明，类风湿关节炎（RA）中的残疾和关节破坏在疾病进程早期就会出现，且进展迅速。研究表明，在RA的早期阶段，残疾归因于疾病活动度增加，而在疾病后期，残疾则是由不可逆的关节损伤导致。这些发现支持了制定治疗策略的必要性，这些策略应能迅速控制疾病，最终目标是缓解症状并阻止关节进行性损伤。已经评估了许多此类策略，包括单独早期使用生物制剂或与高剂量甲氨蝶呤联合使用。其他更新的治疗策略包括通过针对决策所需的特定结果来严格控制疾病活动度；使用生物制剂治疗中度疾病；在疾病进程早期用生物制剂诱导缓解，随后使用传统的改善病情抗风湿药物进行维持治疗。这些策略对患者预后具有显著的积极影响，支持了这样一种观念，即RA的最佳管理包括积极的早期治疗，同时密切监测疾病进展并调整无效的治疗策略。
