Singh Jasvinder A
Medicine Service, VA Medical Center, 700 19th Street South, Birmingham, AL 35233, USA; Department of Medicine at the School of Medicine, University of Alabama at Birmingham, 510 20th Street South, Birmingham, AL 35294-0022, USA; Department of Epidemiology, University of Alabama at Birmingham School of Public Health, 1665 University Boulevard, Ryals Public Health Building, Birmingham, AL 35294-0022, USA.
Rheum Dis Clin North Am. 2022 Aug;48(3):679-689. doi: 10.1016/j.rdc.2022.03.005. Epub 2022 Jul 5.
Rheumatoid arthritis is the most common autoimmune, destructive, inflammatory arthritis in adults. Effective treatments include oral conventional synthetic disease-modifying antirheumatic drugs (DMARDs; eg, methotrexate), injectable biologic DMARDs, and targeted synthetic DMARDs (oral). Key recommendations are to start effective treatment immediately with DMARDs to reduce disability; use effective doses of methotrexate (oral or subcutaneous) with folic acid as the initial treatment; rapidly escalate treatment with various DMARDs, if methotrexate alone is not effective in controlling rheumatoid arthritis; and aim for a treat-to-target strategy with a goal of low disease activity or remission by frequently monitoring disease activity and escalating treatment.
类风湿关节炎是成人中最常见的自身免疫性、破坏性炎性关节炎。有效的治疗方法包括口服传统合成改善病情抗风湿药（DMARDs，如甲氨蝶呤）、注射用生物DMARDs和靶向合成DMARDs（口服）。关键建议是立即开始使用DMARDs进行有效治疗以减少残疾；使用有效剂量的甲氨蝶呤（口服或皮下注射）并联合叶酸作为初始治疗；如果单独使用甲氨蝶呤无法有效控制类风湿关节炎，则迅速升级使用各种DMARDs进行治疗；通过频繁监测疾病活动并升级治疗，以实现疾病活动度低或缓解为目标的达标治疗策略。
