传统慢作用抗风湿药

传统慢作用抗风湿药是目前治疗风湿病的主要用药类别之一。本文就传统慢作用抗风湿药的品种、用药选择及其不良反应作一概要介绍。     

改变病情抗风湿药临床研究进展

改变病情抗风湿药(Disease modifying antirheumatic dru_gs,DMARDs)是一类减轻类风湿性关节炎(Rheumatoid arthr_itis,RA)症状体征、控制病情发展和阻止关节结构继续破坏的药物[1]。主要通过抑制或调节机体免疫反应中的某一环节而起作用,起效慢,一般在6wk以上才显示作用,故又称慢作用抗风湿药(SAARDs)。根据其作用特点和来源,可分为经典的慢作用抗风湿药、抗疟药、免疫抑制剂、生物制剂、植物提取物等。1经典的慢作用抗风湿药包括多种传统上未用于RA治疗的药物如青霉胺、金诺芬、柳氮磺胺吡啶。其抗风湿机制可能与对某些免疫细胞和…     

抗风湿病药的副作用

抗风湿病药主要分以下四大类:(1)非激素抗炎药(包括扶他林、芬必得等);(2)改善病情药物或称慢作用药(包括瑞得、D-青霉胺、柳氮磺吡啶、羟基氯喹、雷公藤等);而慢作用药其特点是服药后2～4个月才起效.     

我院治疗类风湿性关节炎用药调查

目的：了解近年我院治疗类风湿性关节炎用药的基本情况。方法：调查1990年1月至1999年6月间我院收冶的类风湿性关节炎患选用抗风湿药物的品种、剂量、疗程、毒副作用及停换药原因等情况。有关计数资料的统计采用x。检验。结果：非甾体抗炎药(NSAIDs)的首选品种依次为：阿斯匹林与百乐来、布洛芬与芬必得、双氯芬酸及其缓释荆、吲哚美辛与氨糖美辛、酮基布洛芬、萘普生等。分别有33％联合应用了同类药物,联合用药毒副作用发生率显上升,有40％应用了糖皮质激素,5l％未适时应用慢作用抗风湿药。结论：目前治疗存在着选用NSAIDs剂量偏小、不合理联合用药、滥用激素、不及时加用慢作用抗风湿药物等问题。     

甲氨蝶呤和羟氯喹联用治疗58例类风湿性关节炎的护理体会

类风湿性关节炎（rheumatoid arthritis,RA）是以关节滑膜炎为特征的一种慢性全身性疾病,其病因不明,临床表现复杂。早期使用慢作用抗风湿药物可控制病情的进展,而此类药物具有用药起效慢、时间长和药物副作用多等特点,     

2013~2015年我院门诊抗风湿药品应用分析

目的：了解我院门诊抗风湿药品的使用情况及用药趋势。方法收集2013~2015年我院门诊抗风湿药的使用数据,采用销售金额、用药频度（ DDDs）、日均费用（ DDC）等进行统计分析。结果2013~2015年,我院抗风湿药品的销售金额呈逐年增长趋势,其中改善病情抗风湿药（DMARDs）增幅最大,占主导地位。按单个药品统计,各个抗风湿药的销售金额、DDDs逐年上升（沙利度胺片除外）,DDC呈逐年下降趋势,其中,销售金额始终最高的口服药品为羟氯喹片,DDDs及排序比稳居第一的为甲氨喋呤片。结论我院抗风湿药的临床应用基本符合我国风湿病治疗的现状和趋势,但也存在一些问题需加强监管。     

氨甲喋呤的抗风湿治疗应用进展

氨甲喋呤(Methotrexate,MTX)用于抗风湿治疗已逾40年,具见效快、疗效好、经济、简便等优点,被誉为“和激素一样不需统计学证明的有效抗炎药”,其对类风湿关节炎(RA)的疗效相当或优于硫唑嘌呤,D-青霉胺,抗疟药和金制剂等慢作用抗风湿药,在其它风湿性疾病中的应用也日渐广泛,现将近年来MTX在抗风湿治疗中的应用进展综述如下。     

类风湿性关节炎用药选择

类风湿性关节炎是一种临床常见的以关节滑膜炎为特征的慢性自身免疫性疾病，可致患者骨关节僵直、畸形，致残率很高。由于病因未明，至今尚无根治办法。所以早期诊断、选择高效低毒的药物和合理有效的治疗方案，是改善症状，减少致残发生的重要措施。临床上常用非甾体抗炎药、糖皮质激素和慢作用抗风湿药进行治疗。因这些药物不良反应较多，使用不当会引起药源性疾病，为确保临床用药安全有效，因此开展用药监测和药学服务尤为重要。     

风湿病治疗用生物制剂

生物制剂因具有靶向特点,近10年来在风湿病治疗领域中得到了广泛应用。本文介绍目前已获准用于临床的各生物制剂的特点以及这些生物制剂类慢作用抗风湿药在各种风湿病治疗中的应用和不良反应。     

糖皮质激素联合慢作用抗风湿药治疗类风湿关节炎的临床观察

目的观察小剂量糖皮质激素联合慢作用抗风湿药物治疗类风湿关节炎的临床疗效。方法将76例初发类风湿关节炎患者随机分为小剂量糖皮质激素联合慢作用抗风湿药物组(激素联合治疗组,共38例)及慢作用抗风湿药物治疗组(对照组,共38例),两组均给予慢作用抗风湿药物,其中激素联合治疗组另给予小剂量糖皮质激素,对照组给予洛索洛芬钠治疗,全部患者在治疗前与治疗后2、4、12、24周检测临床指标、免疫学指标及足跟骨密度值。结果治疗后联合治疗组VAS评分、DAS28评分及ESR、CRP水平与治疗前、同期对照组相比,差异均有统计学意义(P<0.05)。治疗24周,两组足跟骨密度值比较差异无统计学意义(P>0.05)。结论小剂量糖皮质激素联合慢作用抗风湿药物可在短期内明显缓解临床症状,降低炎性指标,且短期内未见增加骨质疏松风险。     

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。     

Management of spondyloarthropathy: new pharmacological treatment options

Spondyloarthropathies (SpA) are a group of inflammatory arthritides classified according to common features of peripheral and spinal arthritis. The conventional anti-inflammatory and disease-modifying or slow-acting anti-rheumatic drugs do appear to be efficacious in treatment of the peripheral arthritis in a comparable fashion to seropositive rheumatoid arthritis, however, their efficacy in axial disease is unproven. This review examines new pharmacological developments in the treatment of SpA including the specific features of sacroiliitis, enthesitis and spondylitis in addition to the peripheral manifestations. The main points that are discussed are new cyclo-oxygenase (COX)-2 specific anti-inflammatories, biological therapies, such as anti-TNF compounds, and novel uses of well-known agents.     

TNF inhibitors in the treatment of arthritis

Rheumatoid arthritis (RA) is a chronic destructive arthritis leading to joint destruction as a consequence of chronic inflammatory processes. Established therapy with slow-acting disease-modifying anti-rheumatic drugs (DMARDs), as with low-dose methotrexate (MTX), leads to a significant improvement of disease symptoms, but are unable to stop joint destruction. Novel therapeutic agents like monoclonal antibodies (mAb), cytokine receptor-human immunoglobulin constructs or recombinant human proteins have been tested in RA and in other chronic arthritides like ankylosing spondylitis or psoriatic arthritis with convincing success. In particular, clinical trials testing anti-TNF alpha agents either alone or in combination with MTX have proven the feasibility and efficacy of these novel approaches.     

Impact of traditional therapies and biologics on cardiovascular diseases in rheumatoid arthritis

In chronic inflammatory diseases such as rheumatoid arthritis (RA), systemic inflammation appears as an independent risk factor, contributing to increased cardiovascular mortality. This high cardiovascular mortality reveals the existence of accelerated atherosclerosis, the pathogenesis of which may be associated with traditional risk factors such as smoking, hypertension, dyslipidemia, deterioration of insulin sensitivity, and less traditional risk factors such as hyperhomocysteinemia, inflammatory conditions and endothelial dysfunction. Control of systemic inflammation theoretically provides a means of preventing this higher cardiovascular mortality among RA patients. In this review we address the question of the impact of anti-rheumatic drugs currently used in RA, such as non-steroidal anti-inflammatory drugs (e.g. non-selective or cyclooxygenase-2 selective inhibitors), steroidal anti-inflammatory drugs (glucocorticoids), traditional disease-modifying anti-rheumatic drugs (e.g. methotrexate) or biologics (e.g. anti-tumour necrosis factor alpha anti-tumour necrosis factor alpha) on cardiovascular diseases in RA patients. We also discuss the specific mechanisms involved in the differential cardiovascular effects of these therapeutic agents.     

风湿免疫疾病治疗药物的研究进展

风湿免疫疾病是一种病因尚未完全明了的疾病,临床表现多样。临床治疗主要使用非甾体抗炎药、糖皮质激素和以改善病情为主合成类抗风湿药物。随着近年对发病机制的深入研究,出现了一系列作用于靶向细胞因子或细胞表面受体的以改善病情为主的生物药物。药物种类也从小分子发展到单克隆抗体再到融合蛋白等,从而加速了抗风湿免疫药物更加有效安全地被用于临床治疗。分析了非甾体抗炎药、糖皮质激素类药物、以改善病情为主的抗风湿药的临床使用情况,为发现更加低毒有效地治疗风湿免疫疾病药物提供了途径。     

Safety of conventional drugs and biologic agents for Rheumatoid Arthritis

While initial researches documented that Rheumatoid Arthritis (RA) patients who took biologic agents had decreased symptoms with those receiving traditional treatment, safety of the drugs remains a concern. The authors in this paper review the safety of the RA new therapeutic approach utilizing biological agents and compare it with the safety of conventional disease-modifying anti-rheumatic drugs (DMARDs).     

Pharmacokinetic interactions and adverse drug experiences in rheumatoid arthritis

While numerous kinetic interactions between anti-rheumatic drugs have been documented, this review deals only with those of clinical significance. Pharmacokinetic interactions clearly do not explain all the toxic effects of anti-rheumatic drugs, but, through effects on drug absorption, distribution, metabolism, and excretion, kinetic interactions can help to explain some of the toxicity seen when anti-rheumatic drugs are used.     

强直性脊柱炎的药物治疗进展

探讨慢作用药物、细胞毒性药物、非甾体抗炎药、其他药物如反应停、帕米膦酸钠及中药的治疗和治疗策略。药物对强直性脊柱炎的治疗是安全有效的。早期治疗和恰当的选用药物，可以延缓强直性脊柱炎的疾病进程，提高患者的生活质量，降低致残率。对强直性脊柱炎的治疗应选用不同类药物的联合应用疗效会更满意。     

抗风湿类中成药及保健品中非法添加双氯芬酸钠与尼美舒利的快速筛查

目的建立抗风湿类中成药及保健品中非法添加化学成分双氯芬酸钠与尼美舒利的快速检测方法。方法采用化学鉴别方法进行快速筛查,并用薄层色谱法进行进一步确认验证。结果化学鉴别与薄层色谱法能快速准确地检测出抗风湿类中成药及保健品中非法添加化学成分双氯芬酸钠与尼美舒利。结论本方法简便、快速、准确、专属性较强,可用于抗风湿类中成药及保健品中非法添加双氯芬酸钠与尼美舒利的快速筛查。