Columbia University, College of Physicians & Surgeons, New York, NY, USA.
Clin Ther. 2019 Jul;41(7):1246-1255. doi: 10.1016/j.clinthera.2019.04.018. Epub 2019 Jun 10.
Rheumatoid arthritis (RA) is associated with a wide variety of extra-articular manifestations and comorbidities, several of which can be organ- or even life-threatening. These extra-articular manifestations and comorbidities can also contribute to the physical disability and psychological morbidity of RA that lead to reduced quality of life, higher direct and indirect costs, and societal burden of the disease. Although the expansion of RA treatment options and adoption of treat-to-target approaches has reduced the incidence and severity of several nonarticular manifestations of RA, such as rheumatoid vasculitis and cardiovascular disease events, this does not seem to be shared by all RA comorbidities. Moreover, a number of highly prevalent and impactful RA-driven comorbidities, such as accelerated atherosclerosis, interstitial lung disease, and sarcopenia, can present clinically in the years before the manifestation of joint pain or observable synovitis. A larger proportion of patients with RA have atherosclerosis, myocardial dysfunction, interstitial lung disease, and sarcopenia that is subclinical in the preclinical and earliest clinical phases of RA, emphasizing the importance of targeting the pre-RA phase for the prevention of comorbidities that are often poorly responsive to treatment once they develop. Herein, we review the potential impact of pre-RA prevention on the incidence and burden of extra-articular manifestations and nonarticular comorbidities.
类风湿关节炎（RA）与多种关节外表现和合并症相关，其中一些可能危及器官甚至危及生命。这些关节外表现和合并症也会导致 RA 的身体残疾和心理痛苦，从而降低生活质量，增加直接和间接成本，并增加疾病的社会负担。尽管 RA 治疗选择的扩大和达标治疗方法的采用降低了几种非关节表现的 RA 的发生率和严重程度，如类风湿血管炎和心血管疾病事件，但这似乎并非所有 RA 合并症都如此。此外，许多高发且影响较大的 RA 驱动的合并症，如动脉粥样硬化加速、间质性肺疾病和肌少症，在出现关节疼痛或可观察到滑膜炎之前的数年中就会出现临床症状。在 RA 的临床前和最早阶段，有更大比例的 RA 患者存在动脉粥样硬化、心肌功能障碍、间质性肺疾病和肌少症，这些疾病在临床上是亚临床的，这强调了针对 RA 前阶段进行预防的重要性，因为这些合并症一旦发生，往往对治疗反应不佳。在此，我们回顾了 RA 前预防对关节外表现和非关节合并症的发生率和负担的潜在影响。
