Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
Methods Mol Biol. 2022;2547:527-567. doi: 10.1007/978-1-0716-2573-6_19.
Rheumatoid arthritis (RA) is a chronic systemic inflammatory disorder that can lead to severe joint damage and is often associated with a high morbidity and disability. Disease-modifying anti-rheumatic drugs (DMARDs) are the mainstay of treatment in RA. DMARDs not only relieve the clinical signs and symptoms of RA but also inhibit the radiographic progression of disease and reduce the effects of chronic systemic inflammation. Since the introduction of biologic DMARDs in the late 1990s, the therapeutic range of options for the management of RA has significantly expanded. However, patients' response to these agents is not uniform with considerable variability in both efficacy and toxicity. There are no reliable means of predicting an individual patient's response to a given DMARD prior to initiation of therapy. In this chapter, the current published literature on the pharmacogenetics of traditional DMARDS and the newer biologic DMARDs in RA is highlighted. Pharmacogenetics may help individualize drug therapy in patients with RA by providing reliable biomarkers to predict medication toxicity and efficacy.
类风湿关节炎（RA）是一种慢性系统性炎症性疾病，可导致严重的关节损伤，常伴有较高的发病率和残疾率。改善病情抗风湿药（DMARDs）是 RA 的主要治疗药物。DMARDs 不仅能缓解 RA 的临床体征和症状，还能抑制疾病的影像学进展，降低慢性系统性炎症的影响。自 20 世纪 90 年代末生物 DMARDs 问世以来，RA 管理的治疗选择范围显著扩大。然而，这些药物的疗效和毒性存在很大的个体差异，患者对这些药物的反应并不一致。在开始治疗之前，没有可靠的方法可以预测患者对特定 DMARD 的反应。在本章中，重点介绍了 RA 中传统 DMARDs 和新型生物 DMARDs 的药物遗传学的现有文献。药物遗传学可以通过提供可靠的生物标志物来预测药物毒性和疗效，从而帮助 RA 患者实现个体化药物治疗。
