Furst D E, Halbert R J, Bingham C O, Fukudome S, Anderson L, Bonafede P, Bray V, Cohen S B, Sherrer Y R S, St Clair E W S, Tesser J R P, Weinblatt M, Dubois R W
Geffen School of Medicine, University of California at Los Angeles, 1000 Veteran Ave Rm 32-59, Los Angeles, CA 90095-1670, USA.
Rheumatology (Oxford). 2008 Feb;47(2):194-9. doi: 10.1093/rheumatology/kem326. Epub 2008 Jan 4.
There is a lack of agreement on assessing disease activity in patients with RA and determining when the RA treatment should be changed or continued. A panel of rheumatologists was convened to develop guidelines to assess adequacy of disease control, focusing on the use of disease-modifying anti-rheumatic drugs.
The Research and Development/University of California in Los Angeles (RAND/UCLA) Appropriateness Method was used to evaluate disease control adequacy. After a literature review, 108 scenarios were developed to simulate situations most likely to be encountered in clinical practice and rated on a 9-point scale by a 10-member expert panel.
Final appropriateness rankings for the scenarios were as follows: 37% 'appropriate', 48% 'inappropriate', and 16% 'neutral'. The panelists felt that patients with disease control in the 'appropriate' range have adequate control with their current therapy, whereas those in the 'inappropriate' range should be considered for a change in therapy. Those in 'neutral' areas should have their therapy reviewed carefully. The panelists recommended that the clinically active joint count should be considered the most important decision factor. In patients with no clinically active joints, regardless of other factors no change in therapy was felt to be warranted. Patients with five or more active joints should be considered inadequately treated, and in patients with one to four active joints other variables must be considered in the decision to change therapy.
These preliminary guidelines will assist the clinician in determining when a patient's clinical situation warrants therapy escalation and when continuing the current regimen would be appropriate.
在评估类风湿关节炎（RA）患者的疾病活动度以及确定何时应改变或继续RA治疗方面，目前尚未达成共识。为此召集了一组风湿病专家制定指南，以评估疾病控制的充分性，重点关注改善病情抗风湿药的使用。
采用洛杉矶加利福尼亚大学研发部（RAND/UCLA）的适宜性方法来评估疾病控制的充分性。在进行文献综述后，制定了108种临床情景以模拟临床实践中最可能遇到的情况，并由一个10人专家小组按照9分制进行评分。
这些情景的最终适宜性排名如下：37%“适宜”，48%“不适宜”，16%“中性”。专家小组成员认为，疾病控制处于“适宜”范围的患者目前的治疗方案控制良好，而处于“不适宜”范围的患者应考虑改变治疗方案。处于“中性”区域的患者应仔细评估其治疗方案。专家小组成员建议，临床活动关节计数应被视为最重要的决策因素。对于没有临床活动关节的患者，无论其他因素如何，均认为无需改变治疗方案。有五个或更多活动关节的患者应被视为治疗不充分，而对于有一至四个活动关节的患者，在决定是否改变治疗方案时必须考虑其他变量。
这些初步指南将帮助临床医生确定患者的临床情况何时需要加强治疗，以及何时继续当前治疗方案是合适的。
