Scott David L
Department of Rheumatology, King's College London, Weston Education Centre, London, UK.
Br Med Bull. 2007;81-82:97-114. doi: 10.1093/bmb/ldm011. Epub 2007 May 31.
This review outlines current knowledge of diagnosis, assessment, treatment and risk factors for early rheumatoid arthritis (RA).
Selective review of current literature was obtained by searching the terms 'rheumatoid arthritis' and 'early'.
Three issues dominate the current views on early RA. First, its recognition may be difficult. Many experts consider that early inflammatory arthritis should only be classified as RA after several months' of observation. Secondly, there is emphasis on early intensive treatment with conventional disease-modifying drugs or biologics, especially tumour necrosis factor inhibitors. Thirdly, there is a debate on the risk factors with evidence of genetic risks and environmental factors like smoking that may trigger RA. Developing citrullinated proteins followed by anti-cyclic citrullinated peptide antibodies, specific for RA, appears to be a crucial pathogenetic step.
Early RA needs immediate specialist assessment and review. Early intensive therapy is effective but needs to be focussed on patients mostly at risk of severe progressive disease.
本综述概述了早期类风湿性关节炎（RA）的诊断、评估、治疗及风险因素的现有知识。
通过搜索“类风湿性关节炎”和“早期”等术语，对当前文献进行了选择性综述。
当前对早期RA的观点主要集中在三个问题上。其一，其识别可能存在困难。许多专家认为，早期炎性关节炎只有经过数月观察后才能归类为RA。其二，强调使用传统的病情缓解药物或生物制剂进行早期强化治疗，尤其是肿瘤坏死因子抑制剂。其三，对于遗传风险和吸烟等可能引发RA的环境因素等风险因素存在争议。产生瓜氨酸化蛋白，随后出现对RA具有特异性的抗环瓜氨酸肽抗体，似乎是一个关键的发病步骤。
早期RA需要立即进行专科评估和复查。早期强化治疗是有效的，但需要针对那些最有可能患严重进展性疾病的患者。
