Contemporary treatment principles for early rheumatoid arthritis: a consensus statement
Contemporary treatment principles for early rheumatoid arthritis: a consensus statement
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DOI：
10.1093/rheumatology/kep073
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发表时间：
2009-07-01
期刊：
影响因子：
5.5
通讯作者：
Conaghan, Philip G.
中科院分区：
文献类型：
--
作者：
Kiely, Patrick D. W.;Brown, Andrew K.;Conaghan, Philip G.
方法.一组执业英国风湿病学家制定了现代管理原则和临床实践的建议，涉及诊断和治疗。临床不确定性的领域被记录下来，导致研究的简化。控制RA治疗的基本概念是最小化累积炎症，称为炎症时间曲线下面积（AUC）。为了实现这一目标，确定了四个核心管理原则：（i）早期发现和转诊患者，即使诊断不确定：患者应在首次怀疑持续性炎症性多关节炎时转诊，风湿科应提供快速的诊断和预后服务;（ii）立即治疗RA：优化传统DMARD和生物制剂的结果需要在症状发作后3个月内尽早开始有效治疗;（iii）严格控制RA炎症可改善结果：频繁的评估和一个客观的协议应被用来使治疗的变化，保持低疾病活动/缓解在一个商定的目标;（iv）考虑风险效益比，并为每个病人量身定制治疗：不同的病人，疾病和药物的特点，需要长期监测的风险和效益与治疗的适应，以适应个人的情况。这些原则的重点是有效控制RA的炎症过程，但最佳的吸收可能需要改变服务提供，以适应适当的护理途径。
Methods. A group of practicing UK rheumatologists formulated contemporary management principles and clinical practice recommendations concerning both diagnosis and treatment. Areas of clinical uncertainty were documented, leading to research recommendations.Results. A fundamental concept governing treatment of RA is minimization of cumulative inflammation, referred to as the inflammationtime area under the curve (AUC). To achieve this, four core principles of management were identified: (i) detect and refer patients early, even if the diagnosis is uncertain: patients should be referred at the first suspicion of persistent inflammatory polyarthritis and rheumatology departments should provide rapid access to a diagnostic and prognostic service; (ii) treat RA immediately: optimizing outcomes with conventional DMARDs and biologics requires that effective treatment be started earlyideally within 3 months of symptom onset; (iii) tight control of inflammation in RA improves outcome: frequent assessments and an objective protocol should be used to make treatment changes that maintain low-disease activity/remission at an agreed target; (iv) consider the riskbenefit ratio and tailor treatment to each patient: differing patient, disease and drug characteristics require long-term monitoring of risks and benefits with adaptations of treatments to suit individual circumstances.Conclusion. These principles focus on effective control of the inflammatory process in RA, but optimal uptake may require changes in service provision to accommodate appropriate care pathways.