Department of Rheumatology, King's College London School of Medicine, London, UK.
Lancet. 2010 Sep 25;376(9746):1094-108. doi: 10.1016/S0140-6736(10)60826-4.
Rheumatoid arthritis is characterised by persistent synovitis, systemic inflammation, and autoantibodies (particularly to rheumatoid factor and citrullinated peptide). 50% of the risk for development of rheumatoid arthritis is attributable to genetic factors. Smoking is the main environmental risk. In industrialised countries, rheumatoid arthritis affects 0·5-1·0% of adults, with 5-50 per 100 000 new cases annually. The disorder is most typical in women and elderly people. Uncontrolled active rheumatoid arthritis causes joint damage, disability, decreased quality of life, and cardiovascular and other comorbidities. Disease-modifying antirheumatic drugs (DMARDs), the key therapeutic agents, reduce synovitis and systemic inflammation and improve function. The leading DMARD is methotrexate, which can be combined with other drugs of this type. Biological agents are used when arthritis is uncontrolled or toxic effects arise with DMARDs. Tumour necrosis factor inhibitors were the first biological agents, followed by abatacept, rituximab, and tocilizumab. Infections and high costs restrict prescription of biological agents. Long-term remission induced by intensive, short-term treatment selected by biomarker profiles is the ultimate goal.
类风湿关节炎的特征为持续性滑膜炎、系统性炎症和自身抗体（尤其是类风湿因子和瓜氨酸化肽）。50%的类风湿关节炎发病风险归因于遗传因素。吸烟是主要的环境风险因素。在工业化国家，类风湿关节炎影响 0.5-1.0%的成年人，每年每 100000 人中就有 5-50 例新发病例。这种疾病在女性和老年人中最为典型。未经控制的活动性类风湿关节炎会导致关节损伤、残疾、生活质量下降以及心血管等合并症。疾病修饰抗风湿药物（DMARDs）是主要的治疗药物，可减轻滑膜炎和系统性炎症并改善功能。甲氨蝶呤是主要的 DMARD，可与其他此类药物联合使用。当关节炎无法控制或 DMARDs 出现毒性作用时，会使用生物制剂。肿瘤坏死因子抑制剂是首批生物制剂，随后是阿巴西普、利妥昔单抗和托珠单抗。感染和高成本限制了生物制剂的处方。通过基于生物标志物谱选择的强化短期治疗诱导长期缓解是最终目标。
