Fujimori J, Yoshino S, Koiwa M, Nakamura H, Shiga H
Department of Joint Disease, Nippon Medical School, Tokyo.
Ryumachi. 1995 Jun;35(3):543-51.
One hundred twenty-eight rheumatoid arthritis (RA) patients were followed up over a long period of time (mean, 13.3 years; range, 10-16 years) in order to determine the role of pharmacotherapy in RA. Patients were aged 48.2 years on the average (23-79 years) and the mean RA duration was 7.8 years (0-58 years) upon initial visit to this unit. Although pharmacotherapy was effective in improving Lansbury's activity index and ESR, articular bone and cartilage destruction and functional impairment progressed gradually, resulting in the need for total hip, knee or ankle arthroplasty in 46 (96 joints) of the 128 patients. This finding indicates that current pharmacotherapy for RA has limitations in that it cannot completely prevent joint destruction and resulting functional impairment. This suggests that new therapeutic modalities, including new drugs, are necessary. Efforts were also made to determine factors which affect the prognosis of RA. The prognosis seemed pessimistic in RA patients with high activity and rheumatoid factor (RAPA) levels, long duration of illness, high Larsen scores and advanced functional impairment at the time of initial active therapy. It appeared necessary to maintain Lansbury's activity index at 30% or below in order to obtain a good prognosis.
为了确定药物治疗在类风湿性关节炎（RA）中的作用，对128例类风湿性关节炎患者进行了长期随访（平均13.3年；范围10 - 16年）。患者初诊时平均年龄为48.2岁（23 - 79岁），类风湿性关节炎平均病程为7.8年（0 - 58年）。尽管药物治疗在改善兰斯伯里活动指数和血沉方面有效，但关节骨和软骨破坏以及功能障碍仍逐渐进展，导致128例患者中有46例（96个关节）需要进行全髋关节、膝关节或踝关节置换术。这一发现表明，目前针对类风湿性关节炎的药物治疗存在局限性，即无法完全预防关节破坏及由此导致的功能障碍。这表明需要新的治疗方式，包括新药。研究还努力确定影响类风湿性关节炎预后的因素。在初始积极治疗时，活动度高、类风湿因子（RAPA）水平高、病程长、拉森评分高以及功能障碍严重的类风湿性关节炎患者预后似乎较为悲观。为了获得良好的预后，似乎有必要将兰斯伯里活动指数维持在30%或以下。
