ACR关于DMARDs在RA合并HBV感染患者中的应用.docVIP

American College of Rheumatology 2008 Recommendations for the Use of Nonbiologic and Biologic Disease-Modifying Antirheumatic Drugs in Rheumatoid Arthritis Liver contraindications. Abnormal liver transaminases.\ When the levels of liver transaminases (aspartate aminotransferase or alanine aminotransferase) were greater than 2-fold the upper limit of normal, the TFP recommended that the initiation or resumption of leflunomide, methotrexate,and sulfasalazine was contraindicated (although recommendations on when to discontinue are not provided).There are a large number of studies addressing leflunomide (48,50,61,132,153,154), methotrexate (41,43,46,48,49,130?132,134?137,154?179), and sulfasalazine(44,56,60,61,63,153,180,181). Acute hepatitis B or C. In the presence of acute hepatitis B or C, treatment with methotrexate, leflunomide, sulfasalazine,minocycline, and biologic agents was contraindicated by the TFP. Chronic hepatitis B or C. In the presence of chronic hepatitis B or C (treated or untreated), the severity of compromised liver function was considered by the TFP as a key factor in making therapeutic decisions. The Child-Pugh scoring system for chronic liver disease (182?184) was used based on the advice of our expert advisor in the field of hepatology. This system is a liver disease severity instrument used to determine the prognosis of chronic liver disease. It is based on the serum albumin and total bilirubin levels, the prothrombin time, the presence or absence of ascites, and the presence or absence of encephalopathy. Child-Pugh class C is associated with a 1-year survival rate of 50%, whereas patients with Child-Pugh classes A or B have a 5-year survival rate of 70?80%. The recommendations for nonbiologic DMARDs in patients with chronic hepatitis B or C were stratified based on the type of hepatitis, the Child-Pugh grade, and whether or not antiviral agents to treat hepatitis had been initiated (Table 2). When treating patients with chronic hepatitis