Paulus H E
Ann Rheum Dis. 1982;41 Suppl 1(Suppl 1):26-9. doi: 10.1136/ard.41.suppl_1.26.
In chronic rheumatoid arthritis (RA), disease modifying drugs are used in an attempt to suppress the progressive damage to tissues and joints that is associated with active disease. Their success in achieving this goal is variable; responses vary from complete suppression of all signs and symptoms of RA to continued active disease, with progressive disability, despite prolonged therapy. Because disease activity almost always recurs after the therapy is stopped, early interruption of an effective therapy for any reason will make its benefit insignificant in a lifelong disease such as RA. Similarly, short-term sequential use of multiple disease modifying therapies is unlikely to be beneficial. The immediate problems with these therapies are substantial. In general, fewer than 50% of patients are able to continue a particular drug for more than one year. Since it takes three to 12 months or longer to achieve maximum effects, those patients who are unable to continue the drug receive little benefit from it. Inevitable delayed side-effects, such as those associated with chronic corticosteroid therapy, may make the benefit/risk ratio unacceptable. Potential late lethal adverse effects, such as malignancy, weight the benefit/risk ratio to varying extents for individual patients, depending on the relative probability that the adverse effect will occur during the remainder of the patient's anticipated life span, and are of greater importance in younger patients. In that minority of patients who achieve remission or near remission and are able to tolerate a disease modifying treatment for many years, it is of truly significant benefit. We are still searching for a therapy that will reliably achieve this goal for most patients with RA.
在慢性类风湿性关节炎（RA）中，使用改善病情的药物试图抑制与活动性疾病相关的对组织和关节的渐进性损害。它们在实现这一目标方面的成功率各不相同；反应从完全抑制RA的所有体征和症状到疾病持续活动、尽管经过长期治疗仍出现进行性残疾不等。由于在治疗停止后疾病活动几乎总是会复发，因此以任何理由过早中断有效治疗对于像RA这样的终身疾病来说，其益处将变得微不足道。同样，短期连续使用多种改善病情的疗法不太可能有益。这些疗法带来的直接问题相当严重。一般来说，不到50%的患者能够持续使用一种特定药物超过一年。由于需要三到十二个月或更长时间才能达到最大效果，那些无法持续使用该药物的患者从中获益甚微。不可避免的延迟副作用，如与长期使用皮质类固醇治疗相关的副作用，可能使获益/风险比变得不可接受。潜在的晚期致命不良反应，如恶性肿瘤，会因个体患者而异，在不同程度上影响获益/风险比，这取决于在患者预期寿命的剩余时间内发生不良反应的相对概率，并且在年轻患者中更为重要。在少数实现缓解或接近缓解且能够耐受多年改善病情治疗的患者中，这种治疗具有真正显著的益处。我们仍在寻找一种能为大多数RA患者可靠地实现这一目标的疗法。
