Bykerk Vivian
Mount Sinai Hospital, Joseph and Wolfe Lebovic Building, 60 Murray Street, Main Floor, Room 2-005, Toronto, Ontario M5G 1X5.
J Rheumatol Suppl. 2009 Jun;82:42-6. doi: 10.3899/jrheum.090131.
Despite recent advances in the treatment of rheumatoid arthritis (RA), including the introduction of biologic therapies and employment of combination disease-modifying antirheumatic drug (DMARD) strategies, remission rates remain suboptimal and patients with RA are still missing a significant number of work days. Early diagnostic criteria are needed to ensure that appropriate treatment is initiated early so as to prevent joint damage. Better prognostic markers are also needed to identify patients with the potential for poor outcomes, in whom more aggressive strategies can be applied at the outset. Because of stringent inclusion criteria and heterogeneous definitions of remission, results seen in clinical trials of RA are not necessarily generalizable to results seen in clinical practice. As a result, existing guidelines may not adequately reflect current practice. In the absence of biomarkers to predict the course of disease, methotrexate remains the standard of care initially for most patients with RA. The ability to predict the course of disease could allow more appropriately targeted therapy and higher rates of remission.
尽管类风湿关节炎（RA）的治疗近期取得了进展，包括引入生物疗法以及采用联合改善病情抗风湿药（DMARD）策略，但缓解率仍不尽人意，RA患者仍有大量工作日缺勤。需要早期诊断标准以确保尽早开始适当治疗，从而预防关节损伤。还需要更好的预后标志物来识别预后可能较差的患者，对于这些患者可在一开始就应用更积极的策略。由于严格的纳入标准和缓解定义的异质性，RA临床试验中的结果不一定能推广到临床实践中的结果。因此，现有指南可能无法充分反映当前的实践情况。在缺乏预测疾病进程的生物标志物的情况下，甲氨蝶呤仍然是大多数RA患者初始治疗的标准方案。预测疾病进程的能力可以实现更有针对性的治疗并提高缓解率。
