Strand Vibeke, Singh Jasvinder A
Division of Immunology/Rheumatology, Stanford University School of Medicine, 306 Ramona Rd, Portola Valley, CA 94028, USA.
Am J Manag Care. 2007 Dec;13 Suppl 9:S237-51.
Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation of the articular synovium, resulting in bony erosions, deformity, and, ultimately, joint destruction. With associated comorbid conditions, especially cardiovascular, it can result in significant morbidity as well as early mortality. Patients with RA report impairments in health-related quality of life (HRQOL) in comparison with age- and sex-matched populations without arthritis. These decreases in HRQOL are attributed to the pain, impairment in physical function, and fatigue associated with this disease. The introduction of new disease-modifying antirheumatic drugs has revolutionized the treatment of RA, particularly the biologic agents: etanercept, infliximab, adalimumab, abatacept, and rituximab. Importantly, administration of these agents has resulted in statistically significant and clinically meaningful improvements in physical function and HRQOL. Many clinical studies confirm that with these therapies, RA patients report improvements in HRQOL, reflected by improved physical function, less fatigue, and better emotional and mental function. Maintenance of physical function is no longer the only treatment goal for RA but also to improve, restore, and preserve HRQOL. Results from pivotal clinical trials are analyzed in this article and the relevance of the data derived from the clinical studies to day-to-day clinical practice are also discussed.
类风湿关节炎（RA）是一种慢性自身免疫性疾病，其特征为关节滑膜炎症，可导致骨质侵蚀、畸形，最终造成关节破坏。伴有相关合并症，尤其是心血管方面的合并症时，可导致显著的发病率增加以及早期死亡。与年龄和性别匹配的无关节炎人群相比，RA患者报告了健康相关生活质量（HRQOL）受损。HRQOL的这些下降归因于与该疾病相关的疼痛、身体功能受损和疲劳。新型改善病情抗风湿药物的引入彻底改变了RA的治疗，尤其是生物制剂：依那西普、英夫利昔单抗、阿达木单抗、阿巴西普和利妥昔单抗。重要的是，使用这些药物已在身体功能和HRQOL方面带来了具有统计学意义和临床意义的改善。许多临床研究证实，通过这些治疗，RA患者报告HRQOL有所改善，表现为身体功能改善、疲劳减轻以及情绪和心理功能更好。维持身体功能不再是RA的唯一治疗目标，改善、恢复和保持HRQOL也是目标。本文分析了关键临床试验的结果，并讨论了临床研究数据与日常临床实践的相关性。
