Furst D E
University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick.
Postgrad Med. 1990 Feb 15;87(3):79-92. doi: 10.1080/00325481.1990.11704583.
The treatment of rheumatoid arthritis is undergoing steady change as new medications are approved and new regimens are attempted. Once the diagnosis is ensured, therapy should include appropriate rest, physical and occupational therapy, involvement of the family or a supportive caregiver, and, most important, participation of the patient. If the disease is not terribly aggressive, therapy with nonsteroidal anti-inflammatory drugs is appropriate initially. If no response is obtained within 2 to 3 weeks, a new dose or different nonsteroidal agent is recommended. In many patients, aspirin, particularly if enteric-coated, is successful and very cost-effective. Disease-modifying antirheumatic drugs (DMARDs) are sometimes being used earlier in disease than previously. Hydroxychloroquine sulfate (Plaquenil Sulfate), auranofin (Ridaura), or sulfasalazine (Azulfidine, S.A.S.-500) is sometimes effective for early rheumatoid arthritis. For patients with more aggressive disease, intramuscular gold is the drug of first choice, and it is the only one that has been shown to decrease the rate of formation of new erosions. Significant toxic reactions occur in 30% to 40% of patients, however. D-penicillamine (Cuprimine, Depen) and azathioprine (Imuran) can be used if intramuscular gold is unsuccessful. Methotrexate (Rheumatrex Dose Pack) is the newest DMARD approved for treatment of rheumatoid arthritis. Its onset of action is rapid, and it is an effective anti-inflammatory agent. Its toxicity in patients with rheumatoid arthritis is not yet fully understood, however. Combination therapy with DMARDs is in its infancy, but such treatment is likely to become more prevalent in the future.
随着新药物获批以及新治疗方案的尝试，类风湿关节炎的治疗正在稳步变化。一旦确诊，治疗应包括适当休息、物理和职业治疗、家人或支持性护理人员的参与，以及最重要的患者自身的参与。如果病情不是特别严重，最初使用非甾体抗炎药进行治疗是合适的。如果在2至3周内没有效果，建议增加剂量或换用不同的非甾体药物。在许多患者中，阿司匹林，尤其是肠溶片，疗效良好且性价比高。病情缓解抗风湿药（DMARDs）有时比以前更早地用于疾病治疗。硫酸羟氯喹（硫酸羟氯喹片）、金诺芬（瑞得）或柳氮磺吡啶（艾得辛、SAS-500）有时对早期类风湿关节炎有效。对于病情更严重的患者，肌肉注射金制剂是首选药物，也是唯一已被证明能降低新糜烂形成率的药物。然而，30%至40%的患者会出现明显的毒性反应。如果肌肉注射金制剂无效，可以使用青霉胺（青霉胺片、地拉罗司）和硫唑嘌呤（依木兰）。甲氨蝶呤（甲氨蝶呤片）是最新获批用于治疗类风湿关节炎的DMARDs。其起效迅速，是一种有效的抗炎药物。然而，其在类风湿关节炎患者中的毒性尚未完全了解。DMARDs的联合治疗尚处于起步阶段，但这种治疗方法在未来可能会更普遍。
