英夫利西单抗治疗类风湿关节炎、强直性脊柱炎与克罗恩病

肿瘤坏死因子α(TNF-α)是一种促炎细胞因子,在多种自身免疫性疾病中起重要的病理作用。英夫利西单抗(infliximab)是一种针对TNF-α、人鼠嵌合的单克隆抗体,和人体中多种形式的TNF-α具有很强的结合能力,可以很好的阻断TNF-α的病理作用,从而治疗疾病。在多项临床研究中,包括类风湿关节炎(RA)、强直性脊柱炎(AS)和克罗恩病(CD)的治疗试验中,英夫利西单抗都具有良好的疗效、可以减缓甚至阻断疾病的慢性破坏。此外,英夫利西单抗也逐渐试用于其他自身免疫性疾病并取得良好疗效,同时具有很高的耐受性和安全性。因此,英夫利西单抗是RA、AS和CD等自身免疫性疾病的治疗新选择。     

云克治疗强直性脊柱炎及类风湿关节炎临床探讨

目的 观察强直性脊柱炎及类风湿关节炎患者运用云克治疗效果。方法 用云克注射液，按药理要求，对RA、AS患者进行静脉注射。据病情轻重，选择治疗疗程，一般2-3个疗程，每日一次，20d为一疗程。结果 患者经云克治疗后，疼痛缓解或消失。强直的关节可以自由活动，肿胀的关节逐渐减退，恢复正常，实验室指标有明显改善。结论 云克治疗强直性脊柱炎和类风湿关节炎疗效显著。     

强直性脊柱炎合并类风湿关节炎一例并文献复习

目的探讨强直性脊柱炎(AS)合并类风湿关节炎(RA)的临床特点,以便及时准确的诊断,及时治疗,有效减少漏诊误治。方法在总结我院诊治1例AS合并RA的基础上,分析AS合并RA的临床表现、发病机制、实验室检查、诊断标准、治疗及相关文献复习。结果①AS合并RA典型临床表现以中轴关节病变、肌腱端炎症为首发表现,并伴有慢性多关节滑膜炎为特征。②遗传背景及免疫学异常及易感基因人类白细胞抗原(HLA)-B27、HLA-DR4及其共享表位在AS合并RA的发生中有重要作用。③实验室检查上首选HLA-B27、类风湿因子(RF)、抗环瓜氨酸多肽(CCP)抗体、骶髂关节CT、关节X线或磁共振成像(MRI)检查,有条件者可检测HLA-DR4、DR2。④诊断上,具有AS影像学改变及临床表现,对称性外周关节破坏,抗CCP抗体阳性,外加RA的影像学改变,可诊断AS合并RA。⑤治疗上,首选改善病情抗风湿药物,同时可应用非甾体抗炎药和糖皮质激素。结论临床上AS合并RA患者比较少见,大部分患者是隐匿起病,容易漏诊,当患者出现腰背或腰骶部疼痛或肌腱端炎为首发症状时,同时伴发对称性外周多关节肿痛时,应高度怀疑AS合并RA,并需积极诊治。     

强直性脊柱炎与类风涅关节炎有何区别？

我最近被诊断为强直性脊柱炎，另有医生说是类风湿关节炎，究竟哪种讲法对？两者都属于类风湿疾病，但强直性脊柱炎与类风湿关节炎有着本质上的区别：     

补肾祛邪法治疗强直性脊柱炎关节炎与类风湿性关节炎二例

强直性脊柱炎过去曾被认为是类风湿关节炎的一个临床类型，近些年来由于类风湿因子和组织相容抗原(HLA-B27)的发现，证明了该病是不同于类风湿性关节炎的一种独立的疾病。此两病虽病理机制复杂，但均为肾气不充，风寒湿之邪深侵，久则痰浊、瘀血之邪痹阻脉络，且临床均以骨骼变形、筋脉挛急、肌肉萎缩、形体桎赢为特点，因此，在治疗中补肾祛邪之法应贯穿始终，现介绍如下。     

英夫利昔治疗类风湿关节炎和强直性脊柱炎的参考意见

<正>类风湿关节炎(RA)和强直性脊柱炎(AS)是一种病因尚未清楚的炎性关节病。在其病理过程中,肿瘤坏死因子-α(TNF-α)等炎症因子扮演了至关重要的角色。目前多种TNF-α拮抗剂已     

强直性脊柱炎的鉴别诊断

强直性脊柱炎早期仅表现为腰骶、下背部疼痛及晨僵,常不引起注意而被误诊为其他疾病;另外,某些引起腰背疼痛的疾病,如脊柱、骨盆原发或转移的肿瘤、腰椎间盘突出等,也常易被误诊为该病。本文就强直性脊柱炎与类风湿关节炎、骨关节炎、椎间盘突出症、脊柱结核、急性或慢性腰肌劳损的鉴别作了叙述。     

国产尼美舒利治疗类风湿关节炎和骨关节炎

观察国产尼美美舒利对类风湿关节炎和骨关节炎（ＯＡ）的疗效和安全性。方法：选取ＲＡ患者１１２例和ＯＡ患者９１例。口服尼美舒利片１００ｍｇ,ｂｉｄ;对照组口服布洛芬缓释胶囊３００ｍｇ,ｂｉｄ。治疗时间为４周。分别观察治疗前后临床指标和炎性实验指标的变化。     

尼美舒利治疗骨关节炎和类风湿关节炎的临床疗效

目的：了解尼美舒利治疗骨关节炎（ＯＡ）及类风湿关节炎（ＲＡ）的疗效及副作用。方法：尼美舒利组：ＯＡ和ＲＡ各３０例，予尼美舒利１００ｍｇ，ｐｏ，ｂｉｄ；对照组：ＯＡ和ＲＡ各３０例，予双氯芬酸２５ｍｇ，ｐｏ，ｔｉｄ，或萘普生２５０ｍｇ，ｐｏ，ｂｉｄ，观察４ｗｋ。结果：治疗前后２组病人各项临床指标均有明显改善；而实验室指标改善不明显（Ｐ＞０．０５）。２组总有效率分别是８８％和８５％，差别无显著意义；副作用发生率分别为３％和１３％，差别有显著意义（Ｐ＜０．０５）。结论：尼美舒利抗炎镇痛疗效肯定，副作用较少，是一种安全性较佳的非甾体类消炎止痛药。     

醋甲唑胺治疗强直性脊柱炎

目的新骨形成和骨吸收是强直性脊柱炎(AS)的2个主要组织病理学特征。研究已经表明,碳酸酐酶阻断剂可以抑制骨吸收,本实验室也发现碳酸酐酶1(CA1)在AS滑膜中高表达,并可以促进碳酸钙沉淀导致新骨形成。醋甲唑胺是一种抗碳酸酐酶的药物,本文探索醋甲唑胺治疗AS的有效性和安全性。方法 2名处于AS活动期患者(分别称为S和L)每天口服甲醋唑胺片2次,25mg/次,共3个月。每个月进行常规血检、尿检、血生化检测和CT检查。同时根据AS疾病的活动指标(BASDAI)和AS功能性指标(BASFI)进行临床观察。2名患者均经历过非类固醇抗炎药(NSAIDs)和缓解病情抗风湿药(DMARDs)治疗,但无明显疗效。结果经过3个月的治疗之后,2名AS患者在疲劳度、晨僵和全身关节疼痛度方面均明显好转。患者S的BASDAI从5.4降到4.4,患者L的BASDA1从2.4降到2。患者L的BASFI从1.2降到0.2。患者S的红细胞沉积率(ESR)明显降低,而患者L的ESR没有发生变化,仍然处于正常范围。患者S的IgM从2.32g/L明显下降到1.86g/L,尤其是治疗1个月时IgM的水平显著性下降。患者L的IgM没有发生明显的改变,仍然保持在正常的范围内。虽然患者S在治疗第1个月时IgG和IgA有所降低,但是这2名患者的IgG和IgA总体水平上升。患者S的钙浓度从3.05mmol/L降到2.39mmol/L。CT结果表明,治疗后被侵蚀的骶髂关节的关节面变得清晰,炎症区域、钙化沉积面积开始缩小。患者用药后没有表现明显不良反应,虽然患者S和L的尿液中的蛋白质含量有所升高,但是仍处于正常的范围。结论醋甲唑胺对AS有一定治疗,无明显不良反应。醋甲唑胺可能通过抑制CA1活性来抑制AS新骨形成和骨吸收过程。     

Efficacy and safety of adalimumab treatment in patients with rheumatoid arthritis,ankylosing spondylitis and psoriatic arthritis

Introduction: In the last couple of years, the number of patients with chronic inflammatory rheumatic diseases being treated with TNF α antagonist has increased dramatically. Adalimumab, a fully human monoclonal antibody against TNF α, is one of the most frequently administered TNF α antagonists. Yet, unresolved issues are the long-term safety of TNF α antagonists and high treatment costs.

Areas covered: The authors summarize the available data on short- and long-term efficacy and safety of adalimumab in the treatment of rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. The reader will find a comprehensive overview on the safety and efficacy of adalimumab for these conditions. Clinically relevant questions of adalimumab therapy are discussed. A special focus of this review is on the safety of adalimumab therapy.

Expert opinion: Adalimumab is effective and reasonably safe in the short- and long-term treatment of patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis who do not respond to the standard therapy. It inhibits radiographic progression in rheumatoid and psoriatic arthritis. Treatment with a TNF α inhibitor such as adalimumab is associated with high treatment costs.     

怡美力治疗类风湿关节炎和骨关节炎的疗效观察

目的 :观察新型非甾体消炎止痛药怡美力治疗类风湿关节炎和骨关节炎的疗效和不良反应。方法 :80例类风湿关节炎病人随机分为治疗组 5 0例 ,对照组 30例。 40例骨关节炎病人分为治疗组 2 0例 ,对照组 2 0例。治疗组服怡美力 10 0mg ,po ,bid× 4wk ;对照组服双氯芬酸钠 2 5mg ,po,tid× 4wk。 结果 :在治疗组中类风湿关节炎组和骨关节炎组的疗效分别为 84%和80 % ,对照组为 83.33 %和 80 % ,两组无显著差异 (P >0 .0 5 )。不良反应发生率治疗组和对照组分别为 13.75 %和 30 % ,治疗组明显低于对照组 (P <0 .0 5 )。结论 :怡美力是一种安全有效的新型非甾体消炎止痛药。     

Golimumab improves socio economic and health economic parameters in patients with rheumatoid arthritis,psoriatic arthritis,and ankylosing spondylitis

Abstract

Background

Golimumab (GLM) has shown its efficacy and safety in various clinical trials. We aimed to assess the effect of GLM on socio economic and health economic parameters in daily clinical practice.     

氯诺昔康治疗类风湿关节炎和骨性关节炎41例

目的:研究氯诺昔康治疗类风湿关节炎和骨性关节炎的疗效及安全性.方法:类风湿关节炎(34例)和骨性关节炎(48例)所致膝关节疼痛患者分别随机双盲分成2组,试验组(n=41)行膝关节腔注射氯诺昔康(8mg,每周1次),对照组(n=41)用安慰剂,疗程为3周.对二药治疗前后的疼痛指数进行比较.结果:试验组和对照组在治疗3周后的平均疼痛指数分别减少31.80和8.20(P＜0.05),显示氯诺昔康对关节炎的疼痛有显著疗效.2组不良事件发生率分别为7.31%和4.87%,均无严重不良事件发生.结论:氯诺昔康对类风湿关节炎和骨性关节炎具有良好的镇痛抗炎作用,且耐受性良好.     

Flurbiprofen in rheumatoid arthritis therapy

Summary

Preliminary findings are reported from an open study of 300?mg flurbiprofen daily in 24 patients and from 6 out of 30 patients treated so far in a double-blind crossover comparison of 300?mg flurbiprofen daily and 150?mg indomethacin daily in the treatment of rheumatoid arthritis. The results indicate that flurbiprofen is effective in relieving symptoms and is better tolerated than indomethacin. Using an experimental model in rats to assess the anti-inflammatory activity of flurbiprofen, data suggest that flurbiprofen is unable to prevent an immunological type of inflammation but is capable of modifying the type and extent of cellular infiltration.     

Etanercept: long-term clinical experience in rheumatoid arthritis and other arthritis

Etanercept is a dimeric fusion protein based on the p75 TNF-α receptor. It binds to TNF-α and blocks its biologic activity. In randomized, double-blind, placebo-controlled trials, etanercept has therapeutic activity in rheumatoid arthritis, psoriatic arthritis, polyarticular-course juvenile idiophatic arthritis and ankylosing spondylitis. Etanercept improves joint inflammation, physical function and slows/halts structural damage, especially when combined with methotrexate. A sustained response is observed in a substantial percentage of patients. Although some safety issues should be considered before starting etanercept treatment, in general terms, etanercept is a well tolerated drug with an acceptable safety profile. The use of any TNF-α antagonist must be in agreement with the National Recommendations for Biologic Therapy, and in difficult clinical situations, a balance between risk/benefit needs to be obtained.     

尼美舒利治疗类风湿关节炎和骨性关节炎的临床研究

目的：观察国产尼美舒利对类风湿关节炎（ＲＡ）和骨性关节炎（ＯＡ）的疗效和安全性。方法：选取ＲＡ患者５９ 例和ＯＡ患者４４ 例。ｐｏ 尼美舒利片１００ ｍｇ,ｂｉｄ;对照组ｐｏ 布洛芬缓释胶囊３００ｍｇ,ｂｉｄ。治疗时间为４ｗｋ。分别观察治疗前后临床指标和炎性实验指标的变化。结果：尼美舒利治疗ＲＡ４ｗｋ 后,疼痛程度、压痛关节数、关节压痛指数、关节肿胀指数、握力、晨僵时间、血沉均显著改善。对ＲＡ的总有效率为８３．３％ 。治疗ＯＡ４ｗｋ 后,膝关节活动痛、１５ｍ 行走时间、日常活动能力及病人综合评估均有显著改善。对ＯＡ的总有效率为７５．０％ 。其不良反应总发生率为１９．２％ , 以胃肠道反应为常见（９．６％）。尼美舒利对ＲＡ和ＯＡ的疗效及不良反应的发生率与布洛芬相比均无显著性差异。结论：尼美舒利对ＲＡ和ＯＡ的疗效及不良反应的发生率均与布洛芬相当。     

Relationship between enantiomer levels of flurbiprofen and clinical response in rheumatoid arthritis

The pharmacokinetics of flurbiprofen (ANSAID™) was evaluated in 25 patients with rheumatoid arthritis following an NSAID-free washout period. Statistically significant improvements were noted in pain, patient and physician global rating, Ritchie articular index, walk time, bead intubation coordinometry and zeta sedimentation rate. However, no statistically significant correlation was noted between these outcome measures and the primary pharmacokinetic parameters for S(+)-flurbiprofen (total plasma clearance, average steady state concentration, overnight trough plasma concentration). We conclude that the variability in the response to flurbiprofen cannot be accounted for on the basis of variability in the active drug concentrations in plasma for this racemic anti-inflammatory analgesic compound.