Department of Rheumatology, Leiden University Medical Center, C4R, PO Box 9600, 2300RC Leiden, The Netherlands.
Clin Rheumatol. 2011 Mar;30 Suppl 1:S33-9. doi: 10.1007/s10067-010-1638-5. Epub 2011 Feb 25.
Rheumatoid arthritis (RA) is associated with progressive joint destruction, with functional status influenced by both disease activity and radiographic progression. The case for early aggressive treatment of RA is based on large amounts of good data in many countries. Studies with conventional disease-modifying anti-rheumatic drugs in early RA have shown improved outcomes compared with later treatment, especially if an aggressive approach with combinations of drugs is used. Early intervention with tumour necrosis factor (TNF) inhibitors has been shown to improve clinical outcomes, induce remission and prevent radiographic progression. It also improves patients' functional status, health-related quality of life, and reduces fatigue. Patients with RA have reduced productivity, an increased number of lost work days and retire early; enabling patients to work should be at the core of a therapy's cost-effectiveness. Introduction of anti-TNF therapy early in RA has been shown to decrease job loss and reduce the amount of working time missed. Although the drug costs of initial treatment with combination therapy including a TNF inhibitor are high, these may be compensated by the reduction in lost productivity, making such a strategy cost-effective overall. In addition, some patients who respond well to combination therapy may be able to stop the TNF inhibitor. It is important to assess the benefits of any intervention not just to healthcare costs but to society as a whole, and physicians should be advocates for optimal access to effective therapies for their patients.
类风湿关节炎（RA）与进行性关节破坏有关，其功能状态既受疾病活动度影响，也受放射学进展影响。RA 早期积极治疗的理由是基于许多国家大量良好的数据。早期 RA 采用传统的疾病修饰抗风湿药物的研究显示，与后期治疗相比，结局得到改善，尤其是采用联合药物的积极治疗方法时。早期使用肿瘤坏死因子（TNF）抑制剂已被证明可改善临床结局、诱导缓解并预防放射学进展。它还改善了患者的功能状态、健康相关生活质量，并减轻了疲劳。RA 患者的生产力降低，丧失工作的天数增加，提前退休；使患者能够工作应该是治疗成本效益的核心。早期引入 RA 中的抗 TNF 治疗已被证明可减少失业并减少错过的工作时间。尽管包括 TNF 抑制剂的联合治疗的初始治疗药物费用较高，但这可能会因生产力损失减少而得到补偿，从而使该策略具有总体成本效益。此外，一些对联合治疗反应良好的患者可能能够停止使用 TNF 抑制剂。评估任何干预措施的益处不仅要考虑医疗保健费用，还要考虑整个社会，医生应该倡导为患者获得有效的治疗提供最佳途径。
