Krüger K, Wollenhaupt J, Albrecht K, Alten R, Backhaus M, Baerwald C, Bolten W, Braun J, Burkhardt H, Burmester G, Gaubitz M, Gause A, Gromnica-Ihle E, Kellner H, Kuipers J, Krause A, Lorenz H-M, Manger B, Nüßlein H, Pott H-G, Rubbert-Roth A, Schneider M, Specker C, Schulze-Koops H, Tony H-P, Wassenberg S, Müller-Ladner U
Praxiszentrum Rheumatologie, St. Bonifatius Str. 5, 81541, München, Deutschland.
Z Rheumatol. 2012 Sep;71(7):592-603. doi: 10.1007/s00393-012-1038-0.
Following the EULAR recommendations published in 2010 German guidelines for the medical treatment of rheumatoid arthritis were developed based on an update of the systematic literature search and expert consensus. Methotrexate is the standard treatment option at the time of diagnosis, preferably in combination with low dose glucocorticoids. Combined disease-modifying antirheumatic drugs (DMARD) therapy should be considered in patients not responding within 12 weeks. Treatment with biologicals should be initiated in patients with persistent high activity no later than 6 months after conventional treatment and in exceptional situations (e.g. early destruction or unfavorable prognosis) even earlier. If treatment with biologicals remains ineffective, changing to another biological is recommended after 3-6 months. In cases of long-standing remission a controlled reduction of medical treatment can be considered.
根据2010年发布的欧洲抗风湿病联盟（EULAR）建议，德国类风湿关节炎医学治疗指南是基于系统文献检索的更新和专家共识制定的。甲氨蝶呤是诊断时的标准治疗选择，最好与低剂量糖皮质激素联合使用。对于在12周内无反应的患者，应考虑联合使用改善病情抗风湿药（DMARD）治疗。对于持续高活动度的患者，应在传统治疗后不迟于6个月开始使用生物制剂治疗，在特殊情况下（如早期破坏或预后不良）甚至更早开始。如果生物制剂治疗仍然无效，建议在3 - 6个月后更换为另一种生物制剂。对于长期缓解的病例，可以考虑逐步减少药物治疗。
