Girgis L, Conaghan P G, Brooks P
St. Vincent's Hospital, Darlinghurst, New South Wales, Australia.
Curr Opin Rheumatol. 1994 May;6(3):252-61. doi: 10.1097/00002281-199405000-00003.
Recently, there has been an interest in rethinking the classification of antirheumatic drugs. Emphasis continues to be on aggressive control of inflammation in the early phase of rheumatoid arthritis. The mistake of extrapolating short-term clinical trial results to long-term outcomes has been appreciated, pointing to the need for long-term studies. Interest in the role of cytokines and their receptors in the inflammatory process continues, as well as in the cellular mechanisms of action of the various disease-modifying antirheumatic drugs (DMARDs). Troublesome toxicity profiles continue to be reported, and a consideration of efficacy-toxicity trade-offs are important. Methotrexate still shows long-term efficacy, and low-dose folinic acid has been shown to reduce toxicity but not efficacy. New information on other DMARDs is presented, ie, sulfasalazine inhibition of signal transduction, the effects of hydroxychloroquine on cytokines and lipid metabolism, and the immunosuppressive effects of bucillamine, a penicillamine-related compound.
最近，人们对重新思考抗风湿药物的分类产生了兴趣。类风湿关节炎早期积极控制炎症仍然是重点。将短期临床试验结果外推至长期疗效的错误已受到重视，这表明需要进行长期研究。细胞因子及其受体在炎症过程中的作用以及各种改善病情抗风湿药（DMARDs）的细胞作用机制仍备受关注。令人烦恼的毒性反应仍不断有报道，权衡疗效与毒性很重要。甲氨蝶呤仍显示出长期疗效，低剂量亚叶酸已被证明可降低毒性但不影响疗效。文中还介绍了其他DMARDs的新信息，即柳氮磺胺吡啶对信号转导的抑制作用、羟氯喹对细胞因子和脂质代谢的影响，以及与青霉胺相关的化合物布西拉明的免疫抑制作用。
