Skapenko Alla, Prots Iryna, Schulze-Koops Hendrik
Division of Rheumatology, Medizinische Poliklinik, University of Munich, Munich, Germany.
Nat Rev Rheumatol. 2009 Sep;5(9):491-6. doi: 10.1038/nrrheum.2009.157. Epub 2009 Jul 28.
The management of patients with rheumatoid arthritis (RA) has changed dramatically in recent years, largely because of the unrivaled efficacy of biologic agents in ameliorating clinical disease activity and in preventing joint damage; however, the use of biologic agents is associated with medical risks and socioeconomic costs. Guidance is, therefore, needed to identify those patients who might benefit most from this intensive treatment approach--and to identify those individuals who can be spared the potential adverse effects of such treatment without risking disease progression. As reviewed here, a variety of serological, clinical, immunological, radiological, and genetic markers have been proposed to predict clinical outcome in RA. These markers can all be determined without difficulty; however, with the notable exception of the genetic markers and erosions, these parameters are for the most part indicative of inflammatory disease activity and, therefore, subject to variation. As tight control of disease activity dissociates the prognostic markers from the clinical course, these predictive parameters should be assessed at baseline for every patient and used to guide individualized treatment strategies.
近年来，类风湿关节炎（RA）患者的管理发生了巨大变化，这主要是因为生物制剂在改善临床疾病活动和预防关节损伤方面具有无与伦比的疗效；然而，生物制剂的使用与医疗风险和社会经济成本相关。因此，需要指导方针来确定哪些患者可能从这种强化治疗方法中获益最大——并确定哪些个体可以避免这种治疗的潜在不良反应而不冒疾病进展的风险。如下所述，已经提出了多种血清学、临床、免疫学、放射学和基因标志物来预测RA的临床结果。这些标志物都可以很容易地确定；然而，除了基因标志物和骨侵蚀外，这些参数在很大程度上指示炎症性疾病活动，因此会有所变化。由于对疾病活动的严格控制使预后标志物与临床病程脱节，这些预测参数应该在每位患者的基线时进行评估，并用于指导个体化治疗策略。
