Lau Chak Sing, Chia Faith, Dans Leonila, Harrison Andrew, Hsieh Tsu Yi, Jain Rahul, Jung Seung Min, Kishimoto Mitsumasa, Kumar Ashok, Leong Khai Pang, Li Zhanguo, Lichauco Juan Javier, Louthrenoo Worawit, Luo Shue Fen, Mu Rong, Nash Peter, Ng Chin Teck, Suryana Bagus, Wijaya Linda Kurniaty, Yeap Swan Sim
Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore.
Int J Rheum Dis. 2019 Mar;22(3):357-375. doi: 10.1111/1756-185X.13513. Epub 2019 Feb 27.
To update recommendations based on current best evidence concerning the treatment of rheumatoid arthritis (RA), focusing particularly on the role of targeted therapies, to inform clinicians on new developments that will impact their current practice.
A search of relevant literature from 2014 to 2016 concerning targeted therapies in RA was conducted. The RA Update Working Group evaluated the evidence and proposed updated recommendations using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach, to describe the quality of evidence and strength of recommendations. Recommendations were finalized through consensus using the Delphi technique.
This update provides 16 RA treatment recommendations based on current best evidence and expert clinical opinion. Recommendations 1-3 deal with the use of conventional synthetic disease-modifying antirheumatic drugs. The next three recommendations (4-6) cover the need for screening and management of infections and comorbid conditions prior to starting targeted therapy, while the following seven recommendations focus on use of these agents. We address choice of targeted therapy, switch, tapering and discontinuation. The last three recommendations elaborate on targeted therapy for RA in special situations such as pregnancy, cancer, and major surgery.
Rheumatoid arthritis remains a significant health problem in the Asia-Pacific region. Patients with RA can benefit from the availability of effective targeted therapies, and these updated recommendations provide clinicians with guidance on their use.
基于目前关于类风湿关节炎（RA）治疗的最佳证据更新建议，尤其关注靶向治疗的作用，以便让临床医生了解将影响其当前实践的新进展。
对2014年至2016年有关RA靶向治疗的相关文献进行检索。RA更新工作组评估证据，并采用推荐分级、评估、制定与评价（GRADE）方法提出更新建议，以描述证据质量和推荐强度。通过德尔菲技术达成共识，最终确定推荐意见。
本次更新基于当前最佳证据和专家临床意见提供了16条RA治疗建议。建议1 - 3涉及传统合成改善病情抗风湿药的使用。接下来的三条建议（4 - 6）涵盖在开始靶向治疗前对感染和合并症进行筛查和管理的必要性，而随后的七条建议聚焦于这些药物的使用。我们讨论了靶向治疗的选择、转换、减量和停药。最后三条建议详细阐述了在妊娠、癌症和大手术等特殊情况下RA的靶向治疗。
类风湿关节炎在亚太地区仍然是一个重大的健康问题。RA患者可从有效的靶向治疗中获益，这些更新建议为临床医生使用这些治疗提供了指导。
