Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
Am Fam Physician. 2018 Apr 1;97(7):455-462.
Rheumatoid arthritis is the most commonly diagnosed systemic inflammatory arthritis, with a lifetime prevalence of up to 1% worldwide. Women, smokers, and those with a family history of the disease are most often affected. Rheumatoid arthritis should be considered if there is at least one joint with definite swelling that is not better explained by another disease. In a patient with inflammatory arthritis, the presence of a rheumatoid factor and/or anti-citrullinated protein antibody, elevated C-reactive protein level, or elevated erythrocyte sedimentation rate is consistent with a diagnosis of rheumatoid arthritis. Rheumatoid arthritis may impact organs other than the joints, including lungs, skin, and eyes. Rapid diagnosis of rheumatoid arthritis allows for earlier treatment with disease-modifying antirheumatic drugs, which is associated with better outcomes. The goal of therapy is to initiate early medical treatment to achieve disease remission or the lowest disease activity possible. Methotrexate is typically the first-line agent for rheumatoid arthritis. Additional disease-modifying antirheumatic drugs or biologic agents should be added if disease activity persists. Comorbid conditions, including hepatitis B or C or tuberculosis infections, must be considered when choosing medical treatments. Although rheumatoid arthritis is often a chronic disease, some patients can taper and discontinue medications and remain in long-term remission.
类风湿关节炎是最常见的系统性炎症性关节炎，全球终身患病率高达 1%。女性、吸烟者和有家族病史的人最常受到影响。如果至少有一个关节存在明确的肿胀，且无法用其他疾病更好地解释，则应考虑类风湿关节炎。在患有炎症性关节炎的患者中，如果存在类风湿因子和/或抗瓜氨酸蛋白抗体、C 反应蛋白水平升高或红细胞沉降率升高，则与类风湿关节炎的诊断一致。类风湿关节炎可能会影响关节以外的器官，包括肺、皮肤和眼睛。及早诊断类风湿关节炎可更早地使用疾病修正抗风湿药物治疗，从而获得更好的结果。治疗的目标是尽早开始药物治疗以实现疾病缓解或尽可能低的疾病活动度。甲氨蝶呤通常是类风湿关节炎的一线药物。如果疾病活动持续存在，应添加其他疾病修正抗风湿药物或生物制剂。在选择药物治疗时，必须考虑合并症，包括乙型或丙型肝炎或结核病感染。虽然类风湿关节炎通常是一种慢性疾病，但有些患者可以减少和停止药物治疗并长期缓解。
