期刊
BEST PRACTICE & RESEARCH IN CLINICAL RHEUMATOLOGY
卷 24, 期 4, 页码 443-455出版社
ELSEVIER SCI LTD
DOI: 10.1016/j.berh.2009.11.009
关键词
early rheumatoid arthritis; disease-modifying anti-rheumatic drugs; biologic DMARDS; window of opportunity; tight control; low disease activity; clinical remission
类别
资金
- Chief Scientist Office [CAF/08/03] Funding Source: Medline
- Chief Scientist Office [CAF/08/03] Funding Source: researchfish
In rheumatoid arthritis (RA), early use of disease-modifying antirheumatic drugs (DMARDs), intensive follow-up and 'treating to target' to achieve low disease activity produce significant improvements in measures of disease activity, functional impairment and retard erosive radiographic progression. Step-up, parallel and step-down regimens are all significantly more effective than sequential monotherapy; although the most effective regimen has not been established. Minimising the period of exposure to synovitis, by including a rapidly acting agent (e.g., corticosteroids or tumour necrosis factor cc (TNF alpha) inhibitor), may slow radiographic progression further. Biologic therapies, especially TNF alpha inhibitors, are effective in early RA; however, their exact role is unclear. Current measures may overestimate the number of patients in clinical remission; therefore, musculoskeletal ultrasound and/or novel biomarkers may also have a role. Pre-clinical immunological markers could possibly be used to trigger pre-emptive treatment in asymptomatic, 'at risk' individuals. Potential treatment developments include combining biologic agents or targeting alternative immunological pathways. (C) 2009 Elsevier Ltd. All rights reserved.
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