Conaghan P G, Brooks P
St. Vincent's Hospital, Sydney, Australia.
Curr Opin Rheumatol. 1993 May;5(3):276-81. doi: 10.1097/00002281-199305030-00003.
Rheumatoid arthritis is a progressive inflammatory disease with evidence of early cartilage damage. Consequently, there is a trend toward earlier use of disease-modifying antirheumatic drugs. This review focuses on recent data on methotrexate, sulfasalazine, gold, hydroxychloroquine, D-penicillamine, and combination therapy. Methotrexate is focused on most, reflecting the increasing popularity of this agent; studies continue to show its good clinical efficacy. Combination therapy studies have been disappointing and are still marred by short duration and low power. Sulfasalazine has a fairly rapid onset of clinical effects and modulates immune function. Gold is still the subject of new studies, with evidence that clinical experience leads to improved patient efficacy. The beneficial effect of hydroxychloroquine in mild rheumatoid arthritis has been confirmed, and information on D-penicillamine suggests an effect on oxygen radical scavenging. Clinical studies are still required to ascertain the relative efficacy of these drugs, and potential long-term adverse effects remain a source of concern.
类风湿性关节炎是一种进行性炎症性疾病，有早期软骨损伤的证据。因此，有更早使用改善病情抗风湿药物的趋势。本综述重点关注甲氨蝶呤、柳氮磺胺吡啶、金制剂、羟氯喹、青霉胺及联合治疗的最新数据。其中对甲氨蝶呤的关注最多，这反映出该药物越来越受欢迎；研究继续表明其具有良好的临床疗效。联合治疗的研究结果令人失望，且仍存在疗程短和效力低的问题。柳氮磺胺吡啶临床起效相当快，并能调节免疫功能。金制剂仍是新研究的对象，有证据表明临床经验可提高患者疗效。羟氯喹对轻度类风湿性关节炎的有益作用已得到证实，有关青霉胺的信息表明其具有清除氧自由基的作用。仍需要进行临床研究以确定这些药物的相对疗效，其潜在的长期不良反应仍是令人担忧的问题。
