Atzeni Fabiola, Talotta Rossella, Masala Ignazio F, Bongiovanni Sara, Boccassini Laura, Sarzi-Puttini Piercarlo
IRCCS Galeazzi Orthopedic Institute, Milan, Italy.
Rheumatology Unit, Sacco University Hospital, Milan, Italy.
Isr Med Assoc J. 2017 Aug;19(8):512-516.
Biomarkers are important for guiding the clinical and therapeutic management of all phases of rheumatoid arthritis because they can help to predict disease development in subjects at risk, improve diagnosis by closing the serological gap, provide prognostic information that is useful for making therapeutic choices and assessing treatment responses and outcomes, and allow disease activity and progression to be monitored. Various biomarkers can be used to identify subjects susceptible to the disease and those with pre-clinical rheumatoid arthritis before the onset of symptoms such as rheumatoid factor and anti-citrullinated protein antibodies. They can be correlated with a risk of developing rheumatoid arthritis and can predict more bone erosions and severe disease progression. Biomarkers such as the erythrocyte sedimentation rate and C-reactive protein levels provide information about disease activity, while predictive biomarkers allow clinicians to assess the probability of a treatment response before starting a particular therapy particularly in the era of biological drugs. This move from traditional approaches to patient stratification and targeted treatment should greatly improve patient care and reduce medical costs.
生物标志物对于指导类风湿关节炎各阶段的临床和治疗管理至关重要，因为它们有助于预测有风险的受试者的疾病发展，通过弥合血清学差距改善诊断，提供有助于做出治疗选择和评估治疗反应及结果的预后信息，并能够监测疾病活动和进展。各种生物标志物可用于识别易患该疾病的受试者以及在类风湿因子和抗瓜氨酸化蛋白抗体等症状出现之前患有临床前期类风湿关节炎的受试者。它们可与类风湿关节炎的发病风险相关联，并可预测更多的骨质侵蚀和严重的疾病进展。红细胞沉降率和C反应蛋白水平等生物标志物可提供有关疾病活动的信息，而预测性生物标志物使临床医生能够在开始特定治疗之前评估治疗反应的可能性，尤其是在生物药物时代。从传统方法转向患者分层和靶向治疗应能大大改善患者护理并降低医疗成本。
