Rheumatology, Allergology and Clinical Immunology, Department of Internal Medicine, University of Rome Tor Vergata, Italy.
Autoimmun Rev. 2011 Aug;10(10):636-40. doi: 10.1016/j.autrev.2011.04.015. Epub 2011 Apr 21.
Anti-TNFα blockers have rapidly become a standard treatment for rheumatoid (RA) and psoriatic arthritis (PsA) because of their acceptable safety profile and efficacy. Clinical and radiological remission may now be a realistic outcome and constitutes the best achievable state. However, clinical practice guidelines and consensus statements on the criteria of introduction, duration and cessation of treatment are under constant revision. Evidence supports that the early use of biologic DMARDs would produce rapid and sustained suppression of inflammatory disease and preserve function and joint erosions. Proof of this concept, anti-TNFα agents would be effective in maintaining response after cessation of treatment. Conversely, when therapy with anti-TNFα is withdrawn, the disease rapidly returns. Remission may be defined as minimal or no clinically detectable disease activity in the presence of continuing drug treatment and a rapid control of disease activity may prevent irreversible damage and disability. The use of US-PD and MRI in the early detection of disease recurrence could become necessary to prevent the relapse and direct the clinician's choice concerning a re-treatment regimen. The use of biological treatment can be for a limited period, at a time when it has the greatest opportunity to make the difference.
抗 TNFα 阻滞剂由于其可接受的安全性和疗效，已迅速成为类风湿性关节炎（RA）和银屑病关节炎（PsA）的标准治疗方法。现在，临床和放射学缓解可能是一个现实的结果，是可达到的最佳状态。然而，关于引入、持续时间和停止治疗的标准的临床实践指南和共识声明仍在不断修订。有证据表明，早期使用生物 DMARD 会迅速和持续抑制炎症性疾病，并保持功能和关节侵蚀。这一概念的证据表明，抗 TNFα 药物在停止治疗后仍能有效维持反应。相反，当停止使用抗 TNFα 治疗时，疾病会迅速复发。缓解可以定义为在持续药物治疗的情况下，疾病活动度最小或无法检测到，并且疾病活动的快速控制可以预防不可逆转的损伤和残疾。在疾病复发的早期检测中使用美国 PD 和 MRI 可能变得必要，以防止疾病复发，并指导临床医生选择重新治疗方案。生物治疗的使用可以是有限的一段时间，在这段时间内它有最大的机会产生影响。
