Department of Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria.
Nat Rev Rheumatol. 2024 Dec;20(12):760-769. doi: 10.1038/s41584-024-01169-7. Epub 2024 Oct 24.
Management of rheumatoid arthritis (RA) has evolved from simply the direct translation of drug efficacy results from clinical trials to patient care, to a more complex longitudinal process that considers not only drug efficacy but also the safety gestalt of a treatment and patient profiles and preferences, as well as health-economic factors. With numerous DMARDs available to treat RA, knowledge about trial efficacy becomes less important than data that inform an appropriate clinical strategy for their optimal selection and use. Overly ambitious approaches targeting the 'maximum' level of success could, for example, be prone to failure and create frustration, and lead to a large number of patients then being considered as 'difficult to treat'. Safety profiles might be more informative than efficacy profiles for precision medicine approaches. Contemporary RA management strategies might therefore take a more holistic approach, beyond merely efficacy, to the setting of targets that lead to improved compliance rather than aspirational successes, with consideration of each patient's multimorbidity profile and preferences, as well as the safety profile of each treatment. Ultimately, the goal remains unchanged: maximizing health-related quality of life; however, with a focus on optimal balance rather than superlatives.
类风湿关节炎（RA）的管理已经从简单地直接将临床试验中的药物疗效结果翻译成患者护理，演变为一个更复杂的纵向过程，不仅考虑药物疗效，还考虑治疗的整体安全性、患者特征和偏好，以及健康经济学因素。有许多 DMARD 可用于治疗 RA，因此关于试验疗效的知识变得不如为其最佳选择和使用提供信息的临床策略数据重要。过于雄心勃勃的针对“最大”成功水平的方法可能容易失败并导致挫败感，并导致大量患者被认为“难以治疗”。安全性概况可能比疗效概况对精准医学方法更具信息性。因此，当代 RA 管理策略可能会采取更全面的方法，超越单纯的疗效，设定目标，以提高依从性，而不是追求理想的成功，同时考虑每个患者的多种疾病特征和偏好，以及每种治疗方法的安全性概况。最终，目标保持不变：最大限度地提高与健康相关的生活质量；然而，重点是最佳平衡，而不是追求卓越。
