Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands.
Ann N Y Acad Sci. 2014 May;1318:50-4. doi: 10.1111/nyas.12430. Epub 2014 Apr 16.
In the past, patients with rheumatoid arthritis (RA) were treated with monotherapy with conventional drugs, such as sulfasalazine, methotrexate, and intramuscular gold, which often leads to persistent arthritis, loss of functional capacity, and decreased quality of life. Both active RA and the use of high-dose glucocorticoids (GCs) are associated with generalized bone loss and fractures, but it is well known that GCs have a strong immunosuppressive effect. With the introduction of tumor necrosis factor (TNF-α)-blockers and other biologics, clinical remission is a realistic target in approximately half of the early RA patients; the same seems to be true for the use of methotrexate with chronic low-dose or initially high-dose GCs. With the use of a treat-to-target strategy focusing on clinical remission or low disease activity in early RA patients, the negative effects of systemic inflammation on bone can be arrested, and both local bone loss (in the joints) and generalized bone loss at the spine and hips can be prevented.
过去，类风湿关节炎（RA）患者接受传统药物的单一疗法治疗，如柳氮磺胺吡啶、甲氨蝶呤和肌肉内金，这往往导致持续性关节炎、功能能力丧失和生活质量下降。活跃的 RA 和使用高剂量糖皮质激素（GCs）都与全身性骨质流失和骨折有关，但众所周知，GCs 具有很强的免疫抑制作用。随着肿瘤坏死因子（TNF-α）-阻滞剂和其他生物制剂的引入，大约一半的早期 RA 患者可以实现临床缓解这一现实目标；在使用慢性低剂量或初始高剂量 GCs 联合甲氨蝶呤时，情况似乎也是如此。通过采用针对早期 RA 患者临床缓解或低疾病活动度的治疗目标策略，可以阻止全身性炎症对骨骼的负面影响，防止局部骨丢失（关节）和脊柱和臀部的全身性骨质流失。
