Assessing the Safety of Biologic Disease Modifying Anti-Rheumatic Drugs in Pa

类风湿性关节炎患者应用生物性疾病缓解类风湿药物的安全性评价 类风湿性关节炎（RA）患者的预期寿命较短， 他们患严重感染、早期心血管疾病、胰岛素抵抗和糖尿病的风险增加。 耐药性和淋巴增生性肿瘤。目前的治疗RA是基于疾病修饰抗风湿药 药物（DMARD），包括肿瘤坏死因子α（TNF α）的新型生物拮抗剂， 白细胞介素1（IL-1）。通过阻断关键炎症介质，这些药物控制RA活动; 然而，这些相同的机制也可能损害免疫反应，使患者 易受感染因子或异常细胞增殖的影响。是否使用生物DMARD治疗 增加类风湿关节炎患者严重感染和肿瘤的风险仍然存在争议。 已经评估了TNF α拮抗剂用于治疗没有TNF α抑制剂的患者的充血性心力衰竭。 风湿性疾病没有显示出任何益处，矛盾的是，高剂量的这些DMARD 对某些患者有害。然而，生物DMARD对RA患者的心脏影响， 是否存在充血性心力衰竭尚不清楚。 RA增加了冠心病的风险，这不能完全用传统的风险来解释。 因素慢性炎症被认为在这种加速的炎症反应的发病机制中起着不可或缺的作用。 动脉粥样硬化尽管先前的研究表明DMARD治疗可以降低 由于RA患者存在心血管疾病，特异性DMARDs对心肌梗死风险的影响尚不清楚。 慢性炎症也与代谢综合征和胰岛素抵抗有关， 动脉粥样硬化的危险因素和RA患者的高患病率。糖皮质 治疗反而改善了RA患者的胰岛素敏感性，这表明炎症和 胰岛素抵抗可能密切相关。此外，阿那白滞素，IL-1受体拮抗剂，改善 糖尿病患者的血糖控制，英夫利西单抗改善RA患者的胰岛素抵抗。 这种益处是否延伸到其他DMARD或DMARD治疗是否可以延迟糖尿病的发作 RA患者的情况目前尚不清楚。 为了评估生物DMARD在RA患者中的安全性，我们提出了一系列研究 有三个具体目标：1）检验使用生物DMARD会增加严重不良反应风险的假设。 与传统的DMARD相比，2)为了检验使用生物DMARD 与传统DMARD相比，增加了淋巴增生性肿瘤的风险。3)到 测试使用生物DMARD会增加充血性心力衰竭的风险， 与传统DMARDs相比，心肌梗死和糖尿病的风险。

Assessing the Safety of Biologic Disease Modifying Anti-Rheumatic Drugs in Patients with Rheumatoid Arthritis Patients with rheumatoid arthritis (RA) have shorter life expectancy compared to the general population and they are at increased risk for serious infections, early cardiovascular disease, insulin resistance and lymphoproliferative neoplasias. Current treatment of RA is based on disease modifying antirheumatic drugs (DMARDs), including novel biologic antagonists of tumor necrosis factor alpha (TNFa) and interleukin 1 (IL-1). Through the blockade of key inflammatory mediators, these drugs control RA activity; however, these same mechanisms could also impair immune responses, rendering patients more susceptible to infectious agents or abnormal cell proliferation. Whether or not therapy with biologic DMARDs increases the risk of serious infections and neoplasias among patients with RA remains controversial. TNFa antagonists have been evaluated for the treatment of congestive heart failure in patients without rheumatic diseases. No benefits were shown and paradoxically, high doses of these DMARDs were deleterious in some patients. Nevertheless, the cardiac effects of biologic DMARDs in patients with RA but without preexisting congestive heart failure remain unclear. RA imparts an increased risk for coronary heart disease that is not fully explained by traditional risk factors. Chronic inflammation is postulated to play an integral role in the pathogenesis of this accelerated atherosclerosis. Although previous studies suggested that DMARD therapy could reduce the risk of cardiovascular disease in RA, the effect of specific DMARDs on the risk of myocardial infarction is unknown. Chronic inflammation is also associated with the metabolic syndrome and insulin resistance, known risk factors for atherosclerosis and highly prevalent conditions among patients with RA. Glucocorticoid therapy paradoxically improved insulin sensitivity in patients with RA, suggesting that inflammation and insulin resistance may be closely related. Furthermore, anakinra, the IL-1 receptor antagonist, improved glucose control in patients with diabetes, and infliximab improved insulin resistance in patients with RA. Whether this benefit extends to other DMARDs or whether DMARD therapy can delay the onset of diabetes in patients with RA is currently unknown. To evaluate the safety of biologic DMARDs in patients with RA, we propose a sequence of studies with three specific aims: 1) To test the hypothesis that use of biologic DMARDs increases the risk of serious infections compared with traditional DMARDs. 2) To test the hypothesis that use of biologic DMARDs increases the risk of developing lymphoproliferative neoplasias compared with traditional DMARDs. 3) To test the hypothesis that use of biologic DMARDs increases the risk of congestive heart failure and decreases the risk of myocardial infarction and diabetes compared with traditional DMARDs.