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成人中度到重度活动性类风湿关节炎的初始治疗

Authors
Peter H Schur, MD
Stanley Cohen, MD
Section Editor
James R O'Dell, MD
Deputy Editor
Paul L Romain, MD
Translators
周宗科, 主任医师

引言

类风湿关节炎(rheumatoid arthritis, RA)治疗的直接目标是控制滑膜炎及预防关节损伤。支持早期积极治疗是基于以下观察结果：可能最终导致残疾的关节损伤始于疾病早期；活动性疾病持续时间越长，患者就越不可能对治疗有所反应[1]。结局改善得益于强效、耐受良好的非生物性(传统性)与生物性改变病情的抗风湿药(disease-modifying antirheumatic drug, DMARD)的单独或联合应用以促使和维持对疾病的严密控制[2-10]。这些药物及治疗策略具有控制滑膜炎以及延缓或停止放射影像学性进展的可能性[2,9,11,12]。

关于疾病病程和这些治疗方法有效性的观察结果，连同精确识别不良预后患者的能力的局限性，这些均支持我们的观点，即每位确诊活动性RA的患者均应在疾病的最早期阶段接受DMARD治疗，最好是在出现症状后3个月内。 (参见“成人类风湿关节炎治疗的一般原则”)

中到重度活动性RA患者(不论持续时间长短)的初始治疗将总结在此。RA的诊断与鉴别诊断、治疗的一般原则(即RA治疗的概述)、轻度活动性RA的初始治疗以及抵抗初始治疗的RA的治疗，均参见其他专题。 (参见“类风湿关节炎的诊断与鉴别诊断”和“成人类风湿关节炎治疗的一般原则”和“用于成人类风湿关节炎初始治疗的甲氨蝶呤替代药物”和“对初始非生物性DMARD治疗抵抗的成人类风湿关节炎的治疗”)

中到重度活动性RA的定义

中到重度活动性RA患者较轻度活动性RA患者发生关节损伤及残疾的风险更大[13]。这些患者通常满足美国风湿病学会(American College of Rheumatology, ACR)/欧洲抗风湿病联盟(European League Against Rheumatism, EULAR)所制定的RA标准，存在以下特征的联合：

●至少5个关节出现炎症。

                             

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Literature review current through: 2017-06 . | This topic last updated: 2016-07-11.
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