Pincus T
Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232.
Scand J Rheumatol Suppl. 1994;100:21-30. doi: 10.3109/03009749409095198.
Rheumatoid arthritis (RA), previously considered to be a benign controllable disease with a good prognosis in the majority of patients, is now known to be a severe, progressive disease in terms of radiographic damage, severe functional deterioration, progressive work disability and premature mortality. The traditional approach to RA therapy (from less toxic to more toxic drugs) is inadequate and the risk of drug toxicity is generally overestimated while that of severe disease is underestimated. Consequently, aggressive treatment could be considered in an attempt to reverse the inflammation prior to long-term end-organ damage, rather than in response to such damage. As patients with RA may progress to an anticipated 5-year survival similar to that in patients with cardiovascular or neoplastic disease, RA should be viewed as an urgent medical problem--a "medical emergency"--in order to control the long-term consequences of the disease process.
类风湿性关节炎（RA），以前被认为是一种良性可控制疾病，大多数患者预后良好，现在已知就影像学损伤、严重功能恶化、进行性工作残疾和过早死亡而言，是一种严重的进行性疾病。传统的RA治疗方法（从毒性较小的药物到毒性较大的药物）并不充分，药物毒性风险通常被高估，而严重疾病的风险则被低估。因此，可以考虑积极治疗，试图在长期终末器官损伤之前逆转炎症，而不是在出现这种损伤后才进行治疗。由于RA患者的预期5年生存率可能与心血管疾病或肿瘤疾病患者相似，因此应将RA视为一个紧急医疗问题——一种“医疗急症”——以便控制疾病进程的长期后果。
