Smolen J, Aletaha D
Division of Rheumatology, Internal Medicine III, Medical University of Vienna, Vienna, Austria.
Eur J Health Econ. 2008 Jan;8 Suppl 2:S39-47. doi: 10.1007/s10198-007-0087-9.
As part of the investigation into the burden of rheumatoid arthritis (RA) and the access to treatment, this article reviews the medical aspects of the disease. RA is mediated by a variety of pathogenic events which culminate in the activation of B-cells, T-cells and other cell populations and lead to secretion of proinflammatory cytokines. These events result in signs and symptoms of active disease, such as pain and swelling, joint damage and disability, the three cornerstones of the clinical expression of RA. Active disease leads to joint damage and both to disability, whereby joint destruction is associated with the irreversible portion of disability. The diagnosis of RA is based on characteristic clinical and laboratory features, however, these may not be obvious in early disease. Therapy aims at interfering with disease activity, ideally leading to remission, as well as at retarding, ideally holding or even healing, joint destruction. This can be achieved by using disease modifying anirheumatic drugs (DMARDs). Among the chemical DMARDs, methotrexate is the anchor drug, although there exist many more such agents. Among the biological compounds, TNF-inhibitors have been in use for more than one decade, and co-stimulation blockade and B-cell targeted therapy have been recent additions to the armamentarium. Therapeutic outcome can be predicted by clinical means.
作为对类风湿关节炎（RA）负担及治疗可及性调查的一部分，本文回顾了该疾病的医学方面。RA由多种致病事件介导，这些事件最终导致B细胞、T细胞和其他细胞群体的激活，并导致促炎细胞因子的分泌。这些事件导致活动性疾病的体征和症状，如疼痛和肿胀、关节损伤和残疾，这是RA临床表型的三个基石。活动性疾病导致关节损伤和残疾，其中关节破坏与残疾的不可逆部分相关。RA的诊断基于特征性的临床和实验室特征，然而，这些在疾病早期可能并不明显。治疗旨在干预疾病活动，理想情况下实现缓解，同时延缓，理想情况下阻止甚至治愈关节破坏。这可以通过使用改善病情抗风湿药物（DMARDs）来实现。在化学DMARDs中，甲氨蝶呤是基础药物，尽管还有许多其他此类药物。在生物制剂中，TNF抑制剂已经使用了十多年，共刺激阻断和B细胞靶向治疗是最近才添加到治疗手段中的。治疗结果可以通过临床手段预测。
