类风湿关节炎达标控制策略与治疗新进展.pptVIP

滑膜炎症 骨侵蚀 促炎性细胞因子 Biologic Activities of IL-6 RA病程的划分 早期治疗的前提是： 早期诊断 抗CCP和RF有助于预测关节痛发展为关节炎 目标治疗（treat to target） 严格控制（tight control） 如何监测病情？ 7个指标：压痛关节数、肿胀关节数、休息痛、日常生活能力、医生评价、病人评价、血沉或C反应蛋白。 ACR20反应： 压痛及肿胀关节数有20%的改善以及其他5项中至少3项有20%的改善。 ACR50、ACR70:采用相同的标准分别定义为50%及70%的改善。 DAS28及疾病活动度定义 DAS28=0.56Xsqrt（TJC）+0.28Xsqrt（SJC）+0.7XIn（ESR）+0.014XGH 临床意义： DAS28 2.4：疾病缓解 DAS28 ≤ 3.2：低度活动 3.2DAS28 ≤5.1:中度活动 DAS285.1：高度活动 类风湿关节炎临床活动指数Rheumatoid arthritis Clinical Disease Activity Index (CDAI) ? CDAI = SJC28 + TJC28 + PGA + EGA CDAI =2.8: Remission CDAI 2.8 and =10: Low Disease Activity CDAI 10 and =22: Moderate Disease Activity CDAI 22: High Disease Activity 简化的类风湿关节炎病情活动指数Rheumatoid arthritis Simplified Disease Activity Index (SDAI) ? SDAI = SJC28 + TJC28 +PGA + EGA + CRP SDAI =3.3:Remission SDAI 3.3 and =11:Low Disease Activity SDAI 11 and =26:Moderate Disease Activity SDAI 26:High Disease Activity 建议采用多种病情活动度评估方法 治 疗 策 略 近几年各种药物使用情况 Factors believed to predict bad outcome independently are (a) the presence of autoantibodies, that is, rheumatoid factor and/or anticitrullinated peptide antibodies, particularly at high levels; (b) high disease activity as measured by composite indices (DAS, DAS28, Simplifi ed Disease Activity Index and Clinical Disease Activity Index), swollen joint counts or acute phase reactants (C reactive protein, erythrocyte sedimentation rate); (c) Early occurrence of erosions Routine Assessment of Patient Index Data (RAPID) 3 T Pincus et al. Rheum Dis Clin N Am.2009;35:773 包括3个病人自我评价指标: 病人自我功能评分 病人疼痛评分 病人总体评分 评分（ 0– 30） RAPID3 12.0 高疾病活动度 RAPID3 6.1‐12.0 中等疾病活动度 RAPID3 3.1‐6.0 低疾病活动度 RAPID3 0‐3.0 缓解 在临床试验中和DAS28 CDAI相关 ? For tender and swollen joint counts, use of a 28-joint count may miss actively involved joints, especially in the feet and ankles, and it is preferable to include feet and ankles also when evaluating remission. ? For the assessment of remission we suggest the following format and wording for the global assessment questions.