Yukawa Naoichiro, Mimori Tsuneyo
Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University.
Clin Calcium. 2009 Mar;19(3):395-403.
Because of a paradigm shift in the therapeutic strategy of RA by biologics, the goal of RA therapy became not only the clinical remission, but also the imaging remission. From the results of randomized controlled clinical trials of disease modifying anti-rheumatic drugs (DMARDs), decreased radiographic progression has been documented. In particular, methotrexate (MTX) is described as "anchor drug" of RA therapy because inhibitory effects of MTX on radiographic progression are proved by many clinical trials. Although DMARDs can slow down the radiographic progression with the achievement of clinical remission in RA, some patients still have subclinical synovitis detected by imaging technique. Such subclinical inflammation may explain the observed discrepancy between disease activity and radiographic progression in RA during DMARD therapy.
由于生物制剂在类风湿关节炎（RA）治疗策略上引发了范式转变，RA治疗的目标不仅是临床缓解，还包括影像学缓解。从改善病情抗风湿药（DMARDs）的随机对照临床试验结果来看，已证明放射学进展有所减缓。特别是，甲氨蝶呤（MTX）被描述为RA治疗的“锚定药物”，因为许多临床试验证实了MTX对放射学进展具有抑制作用。尽管DMARDs可在实现RA临床缓解的同时减缓放射学进展，但仍有一些患者通过影像学技术检测出存在亚临床滑膜炎。这种亚临床炎症可能解释了在DMARD治疗期间RA疾病活动度与放射学进展之间观察到的差异。
