难治性类风湿关节炎的治疗策略
Therapeutic strategies for difficult-to-treat refractory rheumatoid arthritis
谢文慧 1张卓莉1
作者信息
- 1. 北京大学第一医院风湿免疫科,北京 100034
- 折叠
摘要
难治性类风湿关节炎(D2T-RA)是目前类风湿关节炎(RA)临床管理所面临的重要挑战.根据欧洲抗风湿病联盟发布的定义,D2T-RA可见于10％～20％的RA人群.根据是否存在活动性炎症,可将D2T-RA初步分为持续性炎症性D2T-RA和非炎症性D2T-RA两类.前者通常被认为属于"真正的"D2T-RA,其治疗核心策略是积极调整治疗方案.转换为其他类型的生物或靶向合成改善病情抗风湿药(b/tsDMARDs)通常是治疗的首要选择,其中Janus激酶抑制剂在临床试验和真实世界研究中均展现突出疗效.对于特定药物(如巴瑞替尼、托珠单抗),提高药物治疗剂量也可进一步提高疗效.考虑到临床利弊,目前尚不推荐b/tsDMARDs联合治疗方案.此外,CAR-T细胞疗法、贝林妥欧单抗也有望成为这一人群的重要选择.而对于非炎症性D2T-RA,往往因突出的疼痛、工作障碍、心理和社会并发症等导致D2T-RA状态.由于缺乏活动性证据,非药物干预(例如运动疗法、心理干预)往往更为重要,而非升级改善病情抗风湿药(DMARDs)治疗.
Abstract
Difficult-to-treat rheumatoidarthritis(D2T-RA)is an important challenge in the clinical management of RA.According to the definition proposed by European League Against Rheumatism,D2T-RA is seen in 10％-20％of RA population.According to the presence or absence of inflammation,D2T-RA can be primarily divided into two categories:persistent inflammatory D2T-RA and non-inflammatory D2T-RA.The former is often considered to be"true"D2T-RA and active treatment adjustment is therefore recommended as core strategy.Switching to other types of biologic/targeted synthetic disease-modifying anti-rheumatic drugs(b/tsDMARDs)is often the first treatment option of which Janus kinase inhibitors have showen outstanding efficacy in both clinical trials and real-world studies.Higher therapeutic doses of some special drugs(such as baricitinib,and tocilizumab)are also proven to improve the efficacy.Considering the clinical risks and benefits,the b/tsDMARDs combination strategy is not recommended at present.In addition,CAR-T cell therapy and belintuozumab are also expected to become important options for this population.For non-inflammatory D2T-RA,D2T-RA status is often the result of prominent pain,work disability,psychological and social complications.Due to the lack of evidence of inflammation,non-pharmacological interventions(e.g.exercise therapy,psychological interventions)are considered to be more important than escalation of DMARDs treatment.
关键词
难治性类风湿关节炎/药物治疗/非药物治疗Key words
difficult-to-treat rheumatoid arthritis/pharmacological therapy/non-pharmacological therapy引用本文复制引用
出版年
2024
国家科技期刊平台
NSTL
万方数据