Fiehn C, Holle J, Iking-Konert C, Leipe J, Weseloh C, Frerix M, Alten R, Behrens F, Baerwald C, Braun J, Burkhardt H, Burmester G, Detert J, Gaubitz M, Gause A, Gromnica-Ihle E, Kellner H, Krause A, Kuipers J, Lorenz H-M, Müller-Ladner U, Nothacker M, Nüsslein H, Rubbert-Roth A, Schneider M, Schulze-Koops H, Seitz S, Sitter H, Specker C, Tony H-P, Wassenberg S, Wollenhaupt J, Krüger K
Deutsche Gesellschaft für Rheumatologie (DGRh), Berlin, Deutschland.
Praxis für Rheumatologie, Tätigkeitsschwerpunkt Klinische Immunologie und Belegarzteinheit der ViDia-Kliniken Karlsruhe am Medical Center Baden-Baden, Beethovenstr. 2, 76530, Baden-Baden, Deutschland.
Z Rheumatol. 2018 Aug;77(Suppl 2):35-53. doi: 10.1007/s00393-018-0481-y.
Medication-based strategies to treat rheumatoid arthritis are crucial in terms of outcome. They aim at preventing joint destruction, loss of function and disability by early and consistent inhibition of inflammatory processes.
Achieving consensus about evidence-based recommendations for the treatment of rheumatoid arthritis with disease-modifying anti-rheumatic drugs in Germany.
Following a systematic literature research, a structured process among expert rheumatologists was used to reach consensus.
The results of the consensus process can be summed up in 6 overarching principles and 10 recommendations. There are several new issues compared to the version of 2012, such as differentiated adjustments to the therapeutic regime according to time point and extent of treatment response, the therapeutic goal of achieving remission as assessed by means of the simplified disease activity index (SDAI) as well as the potential use of targeted synthetic DMARDs (JAK inhibitors) and suggestions for a deescalating in case of achieving a sustained remission. Methotrexate still plays the central role at the beginning of the treatment and as a combination partner in the further treatment course. When treatment response to methotrexate is inadequate, either switching to or combining with another conventional synthetic DMARD is an option in the absence of unfavourable prognostic factors. Otherwise biologic or targeted synthetic DMARDs are recommended according to the algorithm. Rules for deescalating treatment with glucocorticoids and-where applicable-DMARDs give support for the management of patients who have reached a sustained remission.
The new guidelines set up recommendations for RA treatment in accordance with the treat-to-target principle. Modern disease-modifying drugs, now including also JAK inhibitors, are available in an algorithm.
基于药物的类风湿关节炎治疗策略对治疗结果至关重要。其旨在通过早期持续抑制炎症过程来预防关节破坏、功能丧失和残疾。
就德国使用改善病情抗风湿药物治疗类风湿关节炎的循证推荐达成共识。
在进行系统文献研究后，采用专家风湿病学家之间的结构化流程来达成共识。
共识过程的结果可归纳为6项总体原则和10项推荐。与2012年版本相比有若干新问题，例如根据治疗反应的时间点和程度对治疗方案进行差异化调整、通过简化疾病活动指数（SDAI）评估实现缓解的治疗目标、靶向合成抗风湿药物（JAK抑制剂）潜在的使用以及在实现持续缓解时逐步降级治疗的建议。甲氨蝶呤在治疗开始时以及后续治疗过程中作为联合用药仍发挥核心作用。当对甲氨蝶呤的治疗反应不足时，在不存在不良预后因素的情况下，可选择换用或联合另一种传统合成抗风湿药物。否则，根据算法推荐使用生物制剂或靶向合成抗风湿药物。糖皮质激素和（适用时）抗风湿药物逐步降级治疗的规则为已实现持续缓解的患者管理提供了支持。
新指南根据治疗达标原则制定了类风湿关节炎治疗的推荐。现代改善病情药物，现在还包括JAK抑制剂，都在算法中有体现。
