基于智能疾病管理系统的类风湿关节炎疾病活动度评估的随机对照研究

目的:探讨基于智能疾病管理系统（SSDM）对类风湿关节炎患者心理状况、自我效能以及活动度的影响。方法:选取2019年5月至12月于东莞东华医院治疗的类风湿关节炎患者115例。脱组3例,最终纳入112例患者,其中男60例,女52例,年龄23～76岁。采用随机数字表法分为对照组与研究组,对照组应用常规教育+电话随访教育,研...     

类风湿关节炎的治疗新进展

类风湿关节炎（rheumatoid arthritis，RA）是一种以关节的慢性、反复发作性炎症和破坏为主的全身性疾病。由于其病因仍不明确，治疗相当困难。近10年来临床医师和药物研究者为研究类风湿关节炎的发病机制和药物治疗做出了很大的努力，这些努力将为今后类风湿关节炎病人的治疗、改善其生活质量和减少经济损失产生良好效果。现仅就这一方面的进展作简要的综述。     

类风湿关节炎患者抑郁情况及与疾病活动度相关性分析

目的本研究探讨类风湿关节炎(RA)患者抑郁水平及其与RA疾病活动度相关性分析。方法收集2018年6月至10月于山西医科大学第二医院风湿免疫科住院的80例RA患者。采用健康评估问卷(HAQ)和28个关节疾病活动度评分(DAS28)评估RA病情活动度。采用贝克抑郁量表第2版(BDI-Ⅱ)测量抑郁严重程度。依据HAQ及DAS28评分高低,分析RA患者抑郁程度与疾病活动度间的关系。结果 80例RA患者中,女性62例(78%),男性18例(22%)。患者年龄(50±12)岁,病程(5.8±4.1)年;红细胞沉降率(38±24)mm/h;C反应蛋白(14±5)mg/L;BMI(27.8±2.2)kg/m2;DAS28评分(4.4+1.3)分;类风湿因子(RF)100%阳性。RA患者中患有不同程度抑郁患者有52例,占65%。其中,轻度、中度和重度抑郁症分别为18例(22%)、20例(25%)和14例(18%)。高度病情活动组的VAS评分、BDI-Ⅱ评分以及HAQ评分均高于低度和中度病情活动组,且均与RA病情活动度呈正相关(P<0.05)。HAQ与BDI-Ⅱ评分(r=0.35,P=0.001)呈正相关。结论本研究中约有65%(52/80)的RA患者合并有抑郁症,且RA的疾病活动度与抑郁程度间有明显相关性。临床上积极联系精神卫生科对RA患者行抑郁筛查是必要的,帮助医生慢病管理同时,更好地帮助患者恢复身心健康。     

扶他林治疗类风湿关节炎

５１例活动性类风湿关节炎（ＲＡ）患者经扶他林２５ｍｇ，每日３次，治疗３周的结果为明显进步率和进步率达７８．０％。９例（１７．６％）出现副反应，除１例（１．９６％）因皮疹撤药，其余副反应均为轻度。结果提示扶他林为一治疗ＲＡ的有效而安全的抗炎止痛药物     

类风湿关节炎患者血红蛋白水平与疾病活动度相关性分析

目的 探讨类风湿关节炎(RA)患者血红蛋白水平与疾病活动度相关性.方法 选取本院收治的208例RA患者,根据患者血红蛋白水平将贫血患者作为观察组(男＜120 g/L,女＜110 g/L,n = 57),将非贫血患者作为对照组(n = 151),比较两组的疾病活动度、临床指标,分析RA患者血红蛋白水平与疾病活动度的关系....     

类风湿关节炎治疗新药艾拉莫德

类风湿关节炎(RA)是一种难以治愈的复杂的自身免疫性疾病,临床以综合治疗为主.新型缓解病情用抗风湿药物(DMARD)艾拉莫德(iguratimod)近期在国内开发上市,用于RA治疗.本文综述其药动学、作用机制及临床评价.     

类风湿关节炎合并类风湿血管炎的临床治疗观察

目的观察类风湿关节炎合并类风湿血管炎的临床治疗方法与效果。方法从我院2014年1月至2016年6月收治的类风湿关节炎合并类风湿血管炎患者选取76例进行研究,并根据其入院顺序随机分为两组,每组38例;对照组采用常规西药治疗,观察组则在此基础上联合中医治疗,比较两组患者的治疗效果以及治疗前后的临床症状以及试验室指标情况。结果 (1)治疗后,两组的各项指标均明显改善(P<0.05),且观察组各指标均显著优于对照组(P<0.05)。(2)组间总有效率比较。观察组的86.84%,显著高于对照组的68.79%(P<0.05)。结论采用中西医结合的方法治疗该病可以取得显著效果,改善临床症状,而且安全可靠,具有良好的临床应用价值。     

类风湿关节炎的治疗现状及研究进展

对目前类风湿关节炎的治疗方法及其进展进行综述。介绍和评价临床常用的类风湿关节炎的治疗药物,包括快速起效的非甾体抗炎药、皮质激素、缓慢起效的慢作用抗风湿药、生物制剂,以及干细胞移植、免疫净化、基因治疗等治疗手段。     

类风湿关节炎的基因治疗

类风湿性关节炎是一常见的以关节组织慢性炎症性病变为主要表现的全身性疾病。传统的药物治疗，总是在疗效和费用方面存在着不少缺陷。近几年来，随着对该病关节破坏的分子、细胞机制的深入研究，基因治疗应运而生。本文将就基因治疗的分类、载体、主要治疗方法及所取得的成就做一综述。     

老年类风湿关节炎的中医治疗

类风湿关节炎（rheumatoid arthritist，RA）是以慢性、对称性、多关节炎为主的一种周身性疾病。病因尚不明确，一般认为本病是感染后引起自身免疫反应，导致以滑膜炎为基础的关节病变。常见症状是关节肿痛，后期可引起关节强直、畸形和功能严重障碍。属中医“痹证”范畴，与“历节风”、“痛风”、“鹤膝风”相似.     

Anakinra for the treatment of rheumatoid arthritis: a safety evaluation

Introduction: The anti-interleukin-1 receptor antagonist, anakinra, was approved for the treatment of rheumatoid arthritis (RA) more than 12 years ago. However, its adverse effects are not well known.

Areas covered: We review the safety profile of anakinra, analyzing clinical trials, observational studies, and registry data.

Expert opinion: Due to its lower efficacy compared with other biological therapies approved for RA and its daily subcutaneous administration, anakinra is used only marginally for the treatment of RA. This has limited the experience with this drug in RA, with a lack of data from long-term observational studies or registries. From the five clinical trials performed, and given the unfeasibility of developing new studies of anakinra in RA, it may be concluded that site injection reactions, infections at higher doses (>100 mg), and immunogenicity are the most frequent adverse events related to anakinra administration.     

我国类风湿性关节炎治疗的药物经济学评价研究现状

类风湿性关节炎是常见的慢性自身免疫性疾病,病程长且较难治愈.生物制剂等药物治疗效果好,但患者无法承担其高昂的费用.为了达到经济有效治疗的目的 ,亟需对我国类风湿性关节炎治疗进行药物经济学评价.本文通过系统检索数据库相关文献,系统评价我国类风湿性关节炎药物经济学评价的研究现状,以研究方法、模型建立等方面为重点进行探讨,以...     

阿达木单抗在类风湿关节炎治疗中的应用

生物制剂治疗风湿性疾病是近十年来风湿病诊治领域的重大突破和进展,首个全人源化肿瘤坏死因子(TNF)-α单克隆抗体——阿达木单抗(adalimumab)的问世,有效推进了临床类风湿关节炎治疗的进展。本文综述阿达木单抗在类风湿关节炎治疗中的应用。     

Anti-TNF treatment in rheumatoid arthritis

Rheumatoid arthritis (RA), the most common autoimmune disease, is characterized by persistent synovitis and systemic inflammation. Genetic predisposition as well as autoantibodies and environmental factors, such as smoking, are associated with an increased risk of RA. Traditionally RA has been treated with disease modifying anti-rheumatic drugs (DMARDs) but in the last 15 years or so the introduction of biological response modifiers has revolutionized the treatment of RA. Among these anti-tumor necrosis factor (TNF) agents were the first to be successfully used in treating RA. The goal in treating RA is to induce remission or very low disease activity; remission is now accepted as the ultimate therapeutic goal by adoption of a "treat to target" strategy to achieve tight disease control. Therefore early diagnosis, as well as immediate intervention, are of the utmost importance. This review of the role of TNF in RA pathogenesis describes the mechanisms of action of currently used anti-TNF agents and the adverse events and safety of these drugs. Guidance on the use of anti-TNFs during pregnancy and prior to surgical procedures is also discussed. The intense efforts currently being made to identify biomarkers of response to anti-TNF therapy and recent progress in defining genetic predictors of response using genome- wide association studies (GWAS) are covered. However, so far, none of these studies have been translated into clinical application. The development of biosimilars or follow-on biologicals is also discussed and the first reported study of a biosimilar, involving a multicenter study of an etanercept biosimilar, Etanar, is described.     

类风湿性关节炎治疗经验

对类风湿性关节炎进行详细的病因病机探讨,通过总结个人临床经验,对症施治,治以祛风除湿、活血化瘀、补益肝肾之法,收效满意,值得临床推广。     

纳米脂质体药物在类风湿性关节炎治疗中的研究进展

类风湿性关节炎（RA）是一种病因未明的自身免疫性疾病,典型病理改变为慢性滑膜炎,严重影响患者生活质量。目前的治疗药物能够缓解症状,延缓病程,但均存在明显的不良反应。以脂质体为代表的纳米药物递送系统在临床上已显现出了明显的优势,其能够通过被动或主动靶向从而提高药物的治疗效应及减少不良反应。在本文中,我们回顾了脂质体药物递送系统在RA治疗中的作用,阐述了其在临床前研究和临床试验的进展,并讨论了可能阻碍其临床转化的因素。     

Anti-cytokines and cytokines in the treatment of rheumatoid arthritis

The treatment approach to rheumatoid arthritis has undergone a major evolutionary change in recent years in part as a consequence of growing appreciation of the severity of this condition and in part due to very considerable progress in understanding the important role of cytokines in the immunopathogenesis of this disease. The major focus of this review is on the rationale for targeting TNFalpha and IL-1 in rheumatoid arthritis and the results of clinical studies designed to assess the validity of this therapeutic approach. Recently published studies confirm that the long term use of a several biological agents targeting TNFalpha give rise to sustained improvements in symptoms and signs of rheumatoid disease and, furthermore, that TNFalpha blockade protects joints from structural damage. Although these drugs are well tolerated and have a good overall safety profile, pitfalls to the use of anti-TNFalpha agents apparent with increasing clinical experience include rare cases of tuberculosis. The mechanism of action of anti-TNFalpha therapy is discussed. Clinical trials of interleukin-1 receptor antagonist show relatively modest anti-inflammatory efficacy and an effect on X-ray indicative of retardation of joint damage. Other pro-inflammatory cytokines representing potential therapeutic targets include interferon-beta, interferon-alpha, IL-6, IL-15, IL-17 and IL-18. I will consider preliminary data, where available, arising from clinical trials designed to inhibit the activity of such molecules. In this review I will also discuss the rationale and preliminary data for other potential therapeutic strategies designed to augment the activity of anti-inflammatory cytokines such as IL-4, IL-10, and IL-11 in rheumatoid disease.     

Oral tolerance in the treatment of rheumatoid arthritis

Oral tolerance (OT) consists of the oral administration of antigens (Ag) that could alter the response of the immune system. This is a form of peripheral immune tolerance in which mature lymphocytes in the peripheral lymphoid tissues are rendered non functional or hyporesponsive by prior oral administration of Ag. It was first described in 1911 in animal models of anaphylaxis. This therapeutic approach requires the orally administration of Ag and the active participation of the gut-associated lymphoid tissue (GALT), a tissue comprising Peyer's patches, intraepitelial cells and villi containing epithelials cells which is a well organized immune network. The mechanisms by which OT is mediated included deletion or anergy and active cellular suppression. The primary factor determining which form of tolerance will be developed after oral administration of Ag is the Ag dosage. Thus, it is thought that low doses of Ag induce the generation of active suppression, via regulatory T cells in the GALT, which then migrate to the systemic immune system. These regulatory T cells produce down-regulatory cytokines such as IL4, IL10 and TGFbeta, a Th2 / Th3 cytokine pattern. Conversely, high dose of Ag favors anergy or clonal deletion. The phenomenon in which regulatory cells, as generated by oral tolerization, are primed in an Ag specific manner, but act in the respective microenvironment in a non-Ag specific manner is called bystander suppression. This phenomenon is of particular interest and explained the use of OT in T cell mediated autoimmune diseases such as rheumatoid arthritis (RA), multiple sclerosis (MS) and type I diabetes, some diseases in which the autoAg remains unknown or where there are reactivities to multiple autoAgs. There were several studies demonstrating the effectiveness of orally administered Ag in different animal models of autoimmune diseases, such as experimental allergic encephalomyelitis, collagen induced arthritis, diabetes, but also uveitis, myastenia gravis and transplantation. These mouse or rat models of autoimmune diseases gave the rationale for the therapeutic use of OT in human and this therapeutic approach has been tried in MS and RA, using oral myelin or oral collagen, respectively. In RA, 4 trials of oral type II collagen (CII) in RA have been published. Taken together, these studies suggested that oral CII in RA gave a trend toward clinical improvement, with significance in only 2 studies. Bacterial extract from Escherichia coli containing heat shock proteins has been tried in oral treatment for RA. Two placebo controlled trials and 2 comparative studies gave favorable results for this bacterial extract with no or mild adverse events. Although oral/mucosal tolerance has given successful results in animal models of autoimmune diseases, the enthusiasm for this therapeutic approach in human diseases must be tempered. The discrepancies between the effectiveness of OT in animal models and the results in human trials raise some questions, the identification of the subgroup of patients who might respond to this treatment and the source (or nature) of the administered Ag (homologous versus heterologous), for instance.