Division of Rheumatology, Institute of Rheumatology, School of Medicine, Catholic University of the Sacred Heart-CIC, Via Moscati 31, Rome, Italy.
Intern Emerg Med. 2011 Oct;6 Suppl 1:11-5. doi: 10.1007/s11739-011-0668-6.
Rheumatoid arthritis (RA) has become one of the most studied autoimmune chronic inflammatory diseases (ACIDs), either from the pathogenetic or from the therapeutic point of view. It is recognized that synovial fibroblasts, TH1 and TH17 cells likely play along with the B cells the most relevant role. The disease has a polygenic background that characterizes the seropositive and the seronegative subsets. Over the years, we realized that no more than 15-20% of long-standing RA (LSRA) treated with conventional drugs can reach full remission, whereas the most recent data in early RA (ERA) have demonstrated that 40-60% can be put into clinical and biological remission. This of course is of crucial importance to avoid any progression of the structural damage that leads to functional disability. If we consider that a disability index score (Health Assessment Questionnaire 0-3) of a severe arthritis can cost up to 21,000 EUs, while a mild disease will cost not more than 5,500 EUs per year, it appears very clear that a low disease activity (LDA) or a remission state (Rem) should be the aim in each single patient, in order to keep the workability and maintain the productivity. This is and should be the major aim in each RA patient.
类风湿关节炎 (RA) 已成为研究最多的自身免疫性慢性炎症性疾病 (ACIDs) 之一，无论是从发病机制还是治疗角度来看。人们认识到，滑膜成纤维细胞、TH1 和 TH17 细胞可能与 B 细胞一起发挥最相关的作用。该疾病具有多基因背景，可将血清阳性和血清阴性亚组区分开来。多年来，我们意识到，在接受常规药物治疗的长期 RA (LSRA) 中，只有不超过 15-20%的患者能够达到完全缓解，而在早期 RA (ERA) 的最新数据中表明，40-60%的患者可以达到临床和生物学缓解。这对于避免导致功能障碍的结构损伤进展当然至关重要。如果我们考虑到严重关节炎的残疾指数评分（健康评估问卷 0-3）可能高达 21,000 欧元，而轻度疾病每年的费用不超过 5,500 欧元，那么很明显，低疾病活动度 (LDA) 或缓解状态 (Rem) 应该成为每个患者的目标，以保持工作能力并维持生产力。这是并且应该是每个 RA 患者的主要目标。
