Zatarain Ernesto, Strand Vibeke
Division of Immunology and Rheumatology at Stanford University School of Medicine, Palo Alto, CA 94035, USA.
Nat Clin Pract Rheumatol. 2006 Nov;2(11):611-8. doi: 10.1038/ncprheum0246.
Rheumatoid arthritis is a heterogeneous and progressive autoimmune disease, and patients with this condition show varied responses to treatment. Practical, reliable, individually tailored measures of disease activity and treatment responses are needed. Outcome measures used in randomized, controlled trials, including American College of Rheumatology response criteria and Disease Activity Scores, identify when treatment should be initiated or changed, but can be time consuming and impractical in daily practice. Simplified disease activity indices, abbreviated joint counts and patient-report questionnaires are more-convenient ways to assess therapeutic responses in the clinic. Patient-reported measures of physical function, pain and global disease activity best differentiate the results of active treatment from those of placebo treatment in randomized, controlled trials. Improvements in physical function closely reflect changes in health-related quality of life. Recent trials have demonstrated limited correlations between clinical responses and radiographically demonstrated responses; both should be assessed on a regular basis. It is recommended that three domains be assessed in the clinic for therapeutic responses: patient-reported measures of physical function and/or global disease activity; physician assessment of disease activity; and imaging of the hands and/or feet on a biannual basis. Problematic joints and cervical spine involvement should be followed as clinically indicated. Measures of improvement for individually relevant physical activities need to be defined for each patient.
类风湿关节炎是一种异质性的进行性自身免疫性疾病，患有这种疾病的患者对治疗表现出不同的反应。需要实用、可靠、个性化定制的疾病活动度和治疗反应评估方法。随机对照试验中使用的疗效指标，包括美国风湿病学会反应标准和疾病活动评分，可确定何时应开始或改变治疗，但在日常实践中可能耗时且不实用。简化疾病活动指数、简化关节计数和患者报告问卷是在临床中评估治疗反应更便捷的方法。在随机对照试验中，患者报告的身体功能、疼痛和整体疾病活动度指标最能区分积极治疗与安慰剂治疗的结果。身体功能的改善密切反映与健康相关的生活质量的变化。最近的试验表明临床反应与影像学显示的反应之间相关性有限；两者均应定期评估。建议在临床中从三个方面评估治疗反应：患者报告的身体功能和/或整体疾病活动度指标；医生对疾病活动度的评估；以及每年两次对手和/或脚进行成像检查。有问题的关节和颈椎受累情况应根据临床指征进行随访。需要为每位患者确定与个体相关的身体活动的改善指标。
