Boston University School of Medicine, MA, 02118-2526, USA.
Am Fam Physician. 2011 Dec 1;84(11):1245-52.
Rheumatoid arthritis is the most commonly diagnosed systemic inflammatory arthritis. Women, smokers, and those with a family history of the disease are most often affected. Criteria for diagnosis include having at least one joint with definite swelling that is not explained by another disease. The likelihood of a rheumatoid arthritis diagnosis increases with the number of small joints involved. In a patient with inflammatory arthritis, the presence of a rheumatoid factor or anti-citrullinated protein antibody, or elevated C-reactive protein level or erythrocyte sedimentation rate suggests a diagnosis of rheumatoid arthritis. Initial laboratory evaluation should also include complete blood count with differential and assessment of renal and hepatic function. Patients taking biologic agents should be tested for hepatitis B, hepatitis C, and tuberculosis. Earlier diagnosis of rheumatoid arthritis allows for earlier treatment with disease-modifying antirheumatic agents. Combinations of medications are often used to control the disease. Methotrexate is typically the first-line drug for rheumatoid arthritis. Biologic agents, such as tumor necrosis factor inhibitors, are generally considered second-line agents or can be added for dual therapy. The goals of treatment include minimization of joint pain and swelling, prevention of radiographic damage and visible deformity, and continuation of work and personal activities. Joint replacement is indicated for patients with severe joint damage whose symptoms are poorly controlled by medical management.
类风湿关节炎是最常见的系统性炎症性关节炎。女性、吸烟者和有家族病史的人最常受到影响。诊断标准包括至少有一个关节明显肿胀，不能用其他疾病来解释。类风湿关节炎的诊断可能性随着受累小关节数量的增加而增加。在患有炎症性关节炎的患者中，类风湿因子或抗瓜氨酸蛋白抗体的存在，或 C 反应蛋白水平或红细胞沉降率升高提示类风湿关节炎的诊断。初始实验室评估还应包括全血细胞计数和差异评估以及肾功能和肝功能评估。正在服用生物制剂的患者应进行乙型肝炎、丙型肝炎和结核病检测。类风湿关节炎的早期诊断可更早地使用疾病修饰抗风湿药物进行治疗。通常使用药物组合来控制疾病。甲氨蝶呤通常是类风湿关节炎的一线药物。生物制剂，如肿瘤坏死因子抑制剂，通常被认为是二线药物，或可用于双重治疗。治疗的目标包括最大限度地减轻关节疼痛和肿胀，预防影像学损伤和可见畸形，以及继续工作和个人活动。对于症状经药物治疗控制不佳且关节严重受损的患者，需要进行关节置换。
