类风湿关节炎-----.pptVIP

类风湿关节炎的治疗------2005 高冠民 郑大一附院 主要内容 早期诊断早期治疗 生物制剂和经典方案的应用 小剂量激素的利弊 预后评价和药物反应的监测与判断 生物制剂的应用 最有希望的,但真正的治疗还没到来 起效快 效力大 易反复 特别贵 需联合 副作用 也不少 适用于早期诱导,重症,难治病人 生物制剂的应用 美国(iRAMT) trial, the Infliximab Rheumatoid Arthritis Methotrexate Tapering trial 生物制剂的应用可减少 MTX 的用量平均达 57%.Curr Med Res Opin. 2005 Aug 法国,对生物制剂反映不好可增加 MTX 的用量Ann Rheum Dis. 2005 Sep infliximab plus methotrexate 澳大利亚ATTRACT Study Group. Rheum. 2005 Apr IMPACT研究the infliximab multinational psoriatic arthritis controlled trial Arthritis Rheum. 2005 Apr 荷兰the BeSt study Arthritis Rheum. 2005 Nov 508例:单药序贯疗法 (group 1), 上台阶联合方案 (group 2), 联合治疗并递减激素疗法 (group 3), 与infliximab的联合疗法(group 4). group 3 or group 4比group 1 and 2功能改善早且明显, 三个月 groups 1 and 2 D-HAQ1.0 , groups 3 and 4 0.6 (P 0.001). 一年 groups 1 and 2 D-HAQ 0.7 in groups 3 and 4 0.5 (P = 0.009). total Sharp/Van der Heijde radiographic joint score were 2.0, 2.5, 1.0, and 0.5 in groups 1-4, respectively (P 0.001). There were no significant differences in the number of adverse events and withdrawals between the groups. 联合治疗 FIN-RACo trial (芬兰Rheumatoid Arthritis Combination Therapy trial).159例,5年,早期控制疾病活动是改善远期关节功能的关键 Arthritis Rheum2005(1) 荷兰TEMPO study 682例 应用methotrexate, etanercept, 或二者的联合 有预后不良指标者早期应用生物制剂延缓骨侵蚀,即使停药仍能保持疗效 Arthritis Rheum2005(1) 联合治疗 加拿大the METGO study 对 MTX反映欠佳, 加用肌注金制剂 Arthritis Rheum. 2005 May 联合治疗 CSA + MTX最好,无统计学差异 Italy早期类风湿105例 (CSA + MTX n = 34, CSA + HCQ n = 35) or CSA alone (n = 36)l联合治疗, Rheumatol Int.25(1) MTX疗效的影响因素 lower RBC MTX PG levels (median 40 nmol/l) and a lower pharmacogenetic index (median 2) were associated with a higher number of joint counts, higher disease activity, and higher mHAQ (p0.09). higher RBC folate PG levels (median 1062 nmol/l) were associated with a higher number of tender and swollen joints after adjustment for RBC MTX PG levels and the pharmacogenetic index (p0.05). 叶酸减低 MTX的作用 叶酸减低 MTX的ACR 20%, 50%, or 70%作用达9-21% Arthriti