Prognostic factors in early rheumatoid arthritis
Prognostic factors in early rheumatoid arthritis
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DOI：
10.1093/oxfordjournals.rheumatology.a031490
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发表时间：
2000-06-01
期刊：
影响因子：
5.5
通讯作者：
Scott, DL
中科院分区：
文献类型：
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作者：
Scott, DL
目前类风湿性关节炎的治疗模式表明，持续性滑膜炎会导致侵蚀性关节损伤，其进展会导致功能障碍。对随访1-9年的X线进展的研究表明，40%-83%的后续进展可以通过联合受累、高水平的C反应蛋白和类风湿因子(RF)阳性等预后因素来预测。在随访2-15年的研究中，对功能性残疾的预测因素也有类似的发现。最一致的预后特征是BF阳性，这在预测关节损害和功能障碍方面同样重要，免疫球蛋白A RF和RF与抗角蛋白或抗微丝蛋白抗体共同存在可能会提高预测水平。遗传预测因子相对于RF的附加值仍然没有定论。因此，治疗管理应该是个体化的。活动性疾病和血清RF试验阳性的病例需要积极治疗；相反，很少有滑膜炎和血清阴性的病例需要保守治疗。
The current paradigm for rheumatoid arthritis suggests that persistent synovitis leads to erosive joint damage, progression of which results in functional disability. Studies of X-ray progression followed for 1-9 yr have shown that 40-83% of subsequent progression can be predicted by a combination of prognostic factors such as joint involvement, high levels of C-reactive protein and rheumatoid factor (RF) positivity. There are similar findings for predictors of functional disability in studies followed for 2-15 yr. The most consistent prognostic feature is BF positivity which is equally important in predicting joint damage and functional disability Immunoglobulin A RF and the co-presence of RF with anti-keratin or anti-filaggrin antibodies may increase levels of prediction. Added value of genetic predictors over that of RF remains inconclusive. Therefore, therapeutic management should be individualized. Cases with active disease and seropositive RF tests merit aggressive therapy; conversely, cases with little synovitis and seronegative tests require conservative management.