Choy E H, Scott D L
Academic Rheumatology Unit, King's College School of Medicine and Dentistry, London, England.
Drugs. 1995;50 Suppl 1:15-25. doi: 10.2165/00003495-199500501-00004.
Rheumatoid arthritis is characterised by a generally poor outcome and high morbidity, and has a variable course. Identifying those patients most likely to have a poor prognosis is of key clinical significance. Disease outcome can be predicted from a variety of prognostic markers. Some of these are simple demographic features of the patients, and include age, disease duration, and gender. Others are more specific features of rheumatoid arthritis, including the presence of early erosive changes on plain radiographs, high rheumatoid factor titres, high levels of C-reactive protein, and high scores for disease activity. Although no single marker has adequate specificity or sensitivity to form the basis of clinical decisions, the presence of several is predictive of more severe disease. Thus, patients with early erosive damage who are seropositive for rheumatoid factor and have high levels of C-reactive protein are more likely to have a poor outcome. New markers and imaging techniques are likely to become the prognostic tools for the future. These include genetic markers, and a combination of magnetic resonance imaging and dual energy x-ray absorption scans for localised osteoporosis.
类风湿关节炎的特点是总体预后较差、发病率高，且病程多变。识别那些最有可能预后不良的患者具有关键的临床意义。疾病预后可通过多种预后标志物来预测。其中一些是患者的简单人口统计学特征，包括年龄、病程和性别。其他则是类风湿关节炎更具特异性的特征，包括平片上早期侵蚀性改变的存在、高类风湿因子滴度、高C反应蛋白水平以及高疾病活动评分。尽管没有单一标志物具有足够的特异性或敏感性来作为临床决策的依据，但多种标志物的存在可预测更严重的疾病。因此，类风湿因子血清阳性且C反应蛋白水平高的早期侵蚀性损伤患者更有可能预后不良。新的标志物和成像技术可能会成为未来的预后工具。这些包括基因标志物，以及用于局部骨质疏松症的磁共振成像和双能X线吸收扫描的联合应用。
