Vaidya Binit, Baral Rikesh, Nakarmi Shweta
Department of Rheumatology, National Center for Rheumatic Diseases, Ratopul, Kathmandu, Nepal.
JNMA J Nepal Med Assoc. 2018 Nov-Dec;56(214):983-990. doi: 10.31729/jnma.3893.
Early undifferentiated arthritis is a group of inflammatory joint disease of less than 3 months duration that do not classify under any of the specific rheumatic or connective tissue disorder. Previously, inflammatory arthritis used to be treated only when there was a clear evidence of damage or deformity occurring with it. Use of disease modifying anti-rheumatic drugs were considered potentially harmful early in the course of arthritis which could be self-limiting. However, with the abundance of data on outcomes of early arthritis and identification of factors that can help to predict those outcomes lead to earlier use of such DMARDs. Better understanding of serological tests like anti-CCP antibodies and imaging modalities like high frequency ultrasound with power doppler and magnetic resonance imaging has increased the diagnostic and prognostic yield of such early arthritis cases. It is now imperative that the risk be assessed early in the course of disease and early DMARDs be instituted for better outcome in these cases. This review analyses the historical evolution of evidence in the management of early undifferentiated arthritis and summarises the treatment approach, monitoring and disease outcomes till date. Keywords: arthritides; Nepal; power doppler; rheumatoid; ultrasonography.
早期未分化关节炎是一组病程少于3个月的炎性关节疾病，不属于任何特定的风湿性或结缔组织疾病。以前，炎性关节炎只有在出现明显的损伤或畸形证据时才会进行治疗。在关节炎病程早期，使用改善病情抗风湿药物被认为可能有害，因为关节炎可能是自限性的。然而，随着大量关于早期关节炎结局的数据以及有助于预测这些结局的因素的确定，使得此类改善病情抗风湿药物得以更早使用。对抗环瓜氨酸肽抗体等血清学检测以及功率多普勒高频超声和磁共振成像等成像方式的更好理解，提高了此类早期关节炎病例的诊断和预后价值。现在必须在疾病病程早期评估风险，并尽早应用改善病情抗风湿药物，以在这些病例中获得更好的结局。本综述分析了早期未分化关节炎管理中证据的历史演变，并总结了迄今为止的治疗方法、监测和疾病结局。关键词：关节炎；尼泊尔；功率多普勒；类风湿性；超声检查
