Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Berlin, Germany.
Division of Rheumatology, St Joseph's Hospital, Western University, London, ON, Canada.
Lancet. 2017 Jun 10;389(10086):2338-2348. doi: 10.1016/S0140-6736(17)31491-5.
New treatment strategies have substantially changed the course of rheumatoid arthritis. Many patients can achieve remission if the disease is recognised early and is treated promptly and continuously; however, some individuals do not respond adequately to treatment. Rapid diagnosis and a treat-to-target approach with tight monitoring and control, can increase the likelihood of remission in patients with rheumatoid arthritis. In this Series paper, we describe new insights into the management of rheumatoid arthritis with targeted therapy approaches using classic and novel medications, and outline the potential effects of precision medicine in this challenging disease. Articles are included that investigate the treat-to-target approach, which includes adding or de-escalating treatment. Rheumatoid arthritis treatment is impeded by delayed diagnosis, problematic access to specialists, and difficulties adhering to treat-to-target principles. Clinical management goals in rheumatoid arthritis include enabling rapid access to optimum diagnosis and care and the well informed use of multiple treatments approved for this disease.
新的治疗策略极大地改变了类风湿关节炎的病程。如果疾病早期被识别，并及时、持续地进行治疗，许多患者可以实现缓解；然而，有些患者对治疗反应不佳。快速诊断和采用靶向治疗方法，并进行密切监测和控制，可以增加类风湿关节炎患者缓解的可能性。在本系列论文中，我们描述了使用经典和新型药物进行靶向治疗方法的新见解，并概述了精准医学在这种具有挑战性的疾病中的潜在影响。其中包括研究靶向治疗方法的文章，包括增加或降低治疗强度。类风湿关节炎的治疗受到延迟诊断、专业人员获取困难以及难以遵循靶向治疗原则的阻碍。类风湿关节炎的临床管理目标包括使患者能够快速获得最佳诊断和治疗，并明智地使用多种针对该疾病批准的治疗方法。
