治疗风湿免疫性疾病的药物研究进展

风湿性疾病（简称风湿病）是一组涉及肌肉骨骼系统、关节、关节周围软组织,并以疼痛症状为主的慢性疾病^[1]。风湿病成因复杂,至今未完全明了。一般认为,其发病是在遗传易感性的基础上,受性激素、环境因素、社会、生理、心理等因素相互作用下机体免疫功能紊乱而引起的慢性炎症性疾病。目前还没有一种特效药物能彻底根治风湿病,但根据其发病机制,通过阻滞不同关键环节,     

抗炎免疫药物的研究进展

本文依据抗炎免疫药理学的新观点，综述了非甾体类抗炎免疫药、甾体类抗炎免疫药和疾病调修药的药理作用、临床应用及研究进展。     

抗风湿药物的疗效评价

风湿是指肌、关节、关节周软组织的慢性疼痛,可因局部器质性病理改变引起如关节炎、关节周软组织病、肌炎等,也可能因一些至今尚未找到明确的病理引起改变的疼痛如纤维肌痛、腰背痛等.对不论是哪种病因的风湿痛,其疼痛往往呈慢性、反复发作性的过程,因此在评价任一抗风湿的措施包括药物治疗时就应考虑到多方面因素,如病程的自然规律、客观指标和患者主观感受等.本文对抗风湿药物的疗效评价标准谈几点看法.     

类风湿性关节炎治疗药物研究进展

类风湿性关节炎（RA）是一种常见的慢性全身性自身免疫性疾病,其病情错综复杂,发病机制尚未完全明确,目前普遍认为个体遗传易感性、环境因素和失调的免疫反应与RA发病有关。主要就RA的发并机制及其治疗药物研发进展进行综述。     

骨关节炎的药物治疗进展

骨关节炎(osteoarthritis,OA)是老年人最常见的一种关节疾病,临床主要表现为反复发作的关节疼痛和逐渐出现的关节活动障碍。目前,对此病的药物治疗方法较多,并取得了较满意的疗效。美国风湿病学院(American College of Rheumatology,ACR)2000年发表的骸、膝OA治疗指南,推荐的OA药物治疗包括口服、关节腔内注射和局部用药三个方面。     

环磷酰胺冲击治疗风湿免疫疾病的疗效分析

目的:探讨风湿免疫疾病采用环磷酰胺冲击治疗进行治疗的临床效果。方法:选择某院从2017年1月～2018年1月确诊为风湿免疫疾病的患者52例,将其分为观察组和对照组。对照组患者采用甲氨蝶呤进行治疗,观察组患者使用环磷酰胺冲击治疗,比较两组的临床治疗效果。结果:观察组的各项观察指标恢复情况要优于对照组,检验数据与治疗前相比改善情况也要优于对照组,患者复发率和不良反应发生率要明显低于对照组,两组数据差异明显(P<0.05)。结论:使用环磷酰胺冲击治疗方法对于风湿免疫疾病患者进行治疗,治疗效果较好,对于患者临床指标的改善具有显著效果,患者治疗后疼痛感明显降低,且复发情况较少,是一种有效的风湿免疫疾病治疗方法。     

风湿免疫疾病中肺部并发症的预防治疗

目的探讨如何预防治疗风湿免疫疾病中肺部并发症的发生。方法我院2012年3月至2014年8月收治的明确诊断患有风湿免疫疾病患者118例。随机分为对照组与观察组各59例,对照组主要针对风湿免疫性疾病采取常规治疗。观察组患者在对照组基础上对肺部并发症采取相应的预防治疗。结果观察组中无患者有肺部并发症发生。对照组中有12例(20.34%)患者发生肺部并发症。对照组患者肺部并发症的发生率明显高于观察组,差异具有统计学意义(P<0.05)。结论在治疗风湿免疫疾病的基础上,加强肺部并发症预防,可缓解患者的临床症状,避免肺部并发症的发生。     

糖皮质激素在强直性脊柱炎治疗中的临床观察

目的观察糖皮质激素(GCs)对强直性脊柱炎(AS)的疗效及不良反应,以了解GCs在强直性脊柱炎治疗中的利弊。方法回顾分析我院风湿免疫科2005年11月至2014年2月门诊规律随访≥3年的患者中明确诊断为AS患者的临床表现、炎症指标、影像学表现、治疗情况及转归。结果 2005年11月至2014年2月门诊患者确诊AS患者并且随访时间≥1年的患者共有523例。确诊后用非甾体抗炎药(NSAIDs)及传统改善病情抗风湿药(DMARDs)的有79例;用过GCs的441例,分析连续规律治疗及随访的患者,其中连续随访≥3年的102例,最长随访时间8年零3个月。用过GCs的86例(剂量5～30 mg,包括治疗开始及治疗中间效果不理想加用的),未用过GCs的16例,对照2组的症状缓解情况、红细胞沉降率(ESR)、C反应蛋白(CRP)、骶髂关节及脊柱影像学情况,用GCs组症状缓解迅速、明显,ESR及CRP下降理想,2组比较差异有统计学意义(P<0.05);GCs累计用药时间6～24个月,无一例出现严重不良反应,GCs组与非GCs组2组不良反应差异无统计学意义。结论在AS患者的治疗中,短期加用GCs,可以迅速缓解疼痛,控制炎症,改善生活质量,不良反应不明显,性价比高。     

类风湿性关节炎的治疗药物研究进展

类风湿性关节炎（RA）作为一种常见的自身免疫性疾病,临床表现为关节损伤和滑膜炎症。通过阐述临床RA药物的治疗机制和作用靶点,综述了两大类RA药物,包括小分子合成类RA药物和大分子生物RA药物（肿瘤坏死因子α抑制剂、T、B细胞抑制剂、细胞因子受体抑制剂、靶点RANKL生物制剂以及靶点粒细胞-巨噬细胞集落刺激因子生物制剂）,通过结合RA病理机制重点对这两大类药物的治疗机制和作用靶点进行阐明介绍,同时概述了治疗类风湿性关节炎的最新治疗靶点,为类风湿性关节炎患者的治疗提供潜在新方向。     

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。     

Clinical utility of therapeutic drug monitoring in biological disease modifying anti-rheumatic drug treatment of rheumatic disorders: a systematic narrative review

Introduction: Biological Disease Modifying Anti-Rheumatic Drugs (bDMARDs) have improved the treatment outcomes of inflammatory rheumatic diseases including Rheumatoid Arthritis and spondyloarthropathies. Inter-individual variation exists in (maintenance of) response to bDMARDs. Therapeutic Drug Monitoring (TDM) of bDMARDs could potentially help in optimizing treatment for the individual patient.

Areas covered: Evidence of clinical utility of TDM in bDMARD treatment is reviewed. Different clinical scenarios will be discussed, including: prediction of response after start of treatment, prediction of response to a next bDMARD in case of treatment failure of the first, prediction of successful dose reduction or discontinuation in case of low disease activity, prediction of response to dose-escalation in case of active disease and prediction of response to bDMARD in case of flare in disease activity.

Expert opinion: The limited available evidence does often not report important outcomes for diagnostic studies, such as sensitivity and specificity. In most clinical relevant scenarios, predictive value of serum (anti-) drug levels is absent, therefore the use of TDM of bDMARDs cannot be advocated. Well-designed prospective studies should be done to further investigate the promising scenarios to determine the place of TDM in clinical practice.     

Anti-inflammatory drugs as moderators of antidepressant effects,especially those of the selective serotonin-reuptake inhibitor class

Remission is the key treatment goal in rheumatoid arthritis and should provide the optimal state for patients. Clinical remission criteria are based on composite scores of disease activity and are widely used in clinical practice and trials. With the use of biologic therapies and treat to target strategies, rates of clinical remission have significantly improved. Despite achieving this target, many patients demonstrate structural and functional deterioration. This raises the question regarding the validity of clinical criteria, although they have evolved significantly over the years. Imaging modalities such as ultrasound have been described as more accurate methods of assessing the remission state compared with clinical assessment alone. Furthermore, immuno-pathological assessments are gaining significant interest as this would enable assessment of disease activity at the primary site of pathology. Further research is required to develop accurate biomarkers of remission. We aimed to review the evolution of remission criteria in rheumatoid arthritis to date and to evaluate novel concepts in and the future of defining remission.     

Approaches to the treatment of early rheumatoid arthritis with disease-modifying antirheumatic drugs

This paper reviews recent approaches to treatment of early rheumatoid arthritis (RA) with disease-modifying antirheumatic drugs (DMARDs). The literature on treatment the early RA published between 1995 and 2007 was accessed through the PubMed database from the National Library of Medicine. Keywords were 'early rheumatoid arthritis', 'disease-modifying antirheumatic drugs', 'biologic agents' and 'combination therapy'. Only results of trials on human subjects that directly measured the effects of DMARDs or biological agents on clinical, laboratory parameters and radiological progression of early RA were selected. Combination therapy suppresses RA activity and radiological progression more effectively than monotherapy. If better control of RA is evident after 3–6 months of treatment with the combination of DMARDs, one must still decide whether to stop the first DMARD, stop the second, or continue with the combination. Combination therapy biological agents (infliximab, adalimumab) with methotrexate and etanercept therapy alone may induce remission in many patients with early RA. It is a method of choice in patients with an adverse prognosis. The main indications for combination therapy 'standard' DMARDs or combination 1 DMARDs with a biological agent are such variables as detection of a shared epitope, increase of concentration of anticyclic citrullinated peptide antibodies, rheumatoid factor, C-reactive protein, 28-joint disease activity score, Sharp score and presence of erosion in joints. The majority of rheumatologists believe that patients with RA should be treated with DMARDs earlier rather than later in the disease process. Further trials should establish the optimal approaches to early RA therapy.     

银屑病关节炎的药物治疗

银屑病关节炎是一种与银屑病相关的炎症性关节病变,临床表现轻重不一、病情迁延反复,可呈轻微非毁损性单关节炎、也可能发展迅速而出现毁损性多关节炎并出现骨溶解和关节强直.银屑病关节炎的发病机制未明,其治疗长期困扰着风湿科及皮肤科医生.本文就银屑病关节炎的药物治疗进行综述.     

依那西普在风湿性疾病中的应用研究进展

依那西普是目前全球应用极广的肿瘤坏死因子(TNF)抑制剂,可用于多种风湿性疾病的治疗,国外临床已应用十余年。本文综述依那西普在风湿性疾病中的应用研究。     

银屑病关节炎的药物治疗

银屑病关节炎是一种与银屑病相关的炎症性关节病变,临床表现轻重不一、病情迁延反复,可呈轻微非毁损性单关节炎、也可能发展迅速而出现毁损性多关节炎并出现骨溶解和关节强直。银屑病关节炎的发病机制未明,其治疗长期困扰着风湿科及皮肤科医生。本文就银屑病关节炎的药物治疗进行综述。     

高尿酸血症及其治疗药物与肾脏疾病相关性的研究进展

高尿酸血症是人体内嘌呤代谢紊乱而引起的一种代谢性疾病,也是诱发痛风的生物化学基础。由于肾脏是尿酸排泄的主要器官,其在尿酸平衡中发挥重要作用,高尿酸血症与慢性肾病、糖尿病肾病、IgA肾病等肾脏疾病的发生与发展密切相关。目前,临床常用的降尿酸药物包括：抑制尿酸生成药物（别嘌醇和非布司他）、促进尿酸排泄药物（丙磺舒和苯溴马隆）以及促进尿酸降解药物（拉布立酶和普瑞凯希）,但这些药物在有效性和安全性上仍存在使用缺陷。综述高尿酸血症及其治疗药物与肾脏疾病的关联性,以期为临床中具有肾脏获益的新型降尿酸药物开发提供参考。     

非甾体类抗炎药抗阿尔采末病作用的研究进展

神经炎症过程可能是阿尔采末病(AD)的重要发病原因之一。AD的流行病学研究显示,长期服用非甾体类抗炎药(NSAIDs)可减低AD的发病率;实验研究还发现,NSAIDs的作用除了调节COX机制外,还可能涉及一些非COX机制。