Kalla A A, Tooke A F, Bhettay E, Meyers O L
Department of Medicine, University of Cape Town, South Africa.
Drug Saf. 1994 Jul;11(1):21-36. doi: 10.2165/00002018-199411010-00004.
There is no ideal slow-acting antirheumatic drug. Therapy of rheumatoid arthritis (RA) is currently being modified, with strong recommendations to abandon the traditional pyramidal approach. The call is for a more aggressive, earlier approach to suppress inflammation. Combination therapy rather than the use of a single agent is advocated by some. Improved methods for assessing disease activity as well as measurement of outcome have been developed. Markers of poor prognosis have helped to define patients for earlier treatment. Comparison of toxicity among such a diverse group of drugs is probably best achieved with a toxicity index measuring the number of episodes expressed in terms of patient-years of exposure. Toxicity remains the commonest reason for discontinuing an agent, while remission beyond 36 months on therapy is uncommon, except with methotrexate. The profile of toxicity is clearly defined for individual agents, but combination therapy may reveal an entirely different set of toxic manifestations. There is an urgent need to develop a set of risk factors to predict toxicity in an individual patient. Juvenile chronic arthritis behaves differently from adult RA. Drug toxicity profiles are similar, but less common. Outcome is more difficult to measure, with the major impact of disease and therapy being on growth retardation.
目前尚无理想的慢作用抗风湿药物。类风湿关节炎（RA）的治疗方法正在改变，强烈建议摒弃传统的金字塔式治疗方法。现在提倡采取更积极、更早的方法来抑制炎症。一些人主张采用联合治疗而非单一药物治疗。已经开发出了评估疾病活动以及测量治疗结果的改进方法。预后不良的标志物有助于确定需要更早治疗的患者。对于如此多样化的一组药物，毒性比较可能最好通过毒性指数来实现，该指数测量以患者暴露年数表示的发作次数。毒性仍然是停用药物最常见的原因，而除了甲氨蝶呤外，治疗超过36个月仍处于缓解状态的情况并不常见。单个药物的毒性特征已明确，但联合治疗可能会揭示出一组完全不同的毒性表现。迫切需要制定一套风险因素来预测个体患者的毒性。青少年慢性关节炎与成人RA的表现不同。药物毒性特征相似，但不太常见。治疗结果更难衡量，疾病和治疗的主要影响是生长发育迟缓。
