类风湿关卜节炎诊断及治疗重医.pptVIP

Tight control强调： 早期强化治疗（联合DMARDs或联合生物制剂） 密切随访，充分判断病情 更精确的疾病评价体系：应用 个体化治疗，随时调整治疗方案 需要建立一个统一的评价体系，对患者进行个体化评估：DAS评分体系比ACR体系更能反映患者当时的情况。也许主要标准可以是关节肿胀数，因为这是RA的一个主要特征。另一个需要探讨的是临床缓解的持续时间、放射学检查是否加入到临床缓解的标准中。 是否会出现过度治疗的问题：早期多种药物联合治疗，会不会增加药物毒性、患者能否耐受等等，也许一个解决办法是达到临床缓解后及时减量。 * * * low titer, defined as more than the upper limit of normal but not higher than three times the upper limit of normal high titer, defined as more than three times the upper limit of normal * 美国欣凯公司培训幻灯 * 有些人因为害怕抗风湿药的副作用，仅服用中药治疗，最终出现关节破坏、畸形就是例证。因此，对类风关可以采用中西药联合治疗，但不要因为服用中药而停用疗效已经肯定的抗风湿药，切忌乱投医，以免延误病情，失去治疗时机。 大体来讲，类风关的治疗分为三部分：一般治疗、药物治疗和外科手术治疗。其中一般治疗和药物治疗适应于所有的患者，外科手术治疗有一定的指征，在后面我们将专门谈到。 一般治疗是指休息，急性期关节制动，恢复期进行关节功能锻炼以及物理疗法等等。需要注意的是：卧床休息只适宜于急性期、发热、内脏受累患者。 * ACR推荐的TNF-a抑制剂的患者类型 * * ACR推荐的TNF-a抑制剂的患者类型 * * * What is remission in RA? Despite the significant advances in treatment of RA, true remission in RA is difficult to define precisely with a single disease activity measure. Clinical remission is defined as an absence of joint inflammation and extraarticular disease activity and measures such as ACR, DAS, SDAI and CDAI are used to evaluate clinical remission. (Various definitions of remission in rheumatoid arthritis (RA) have been proposed. The ACR (American College of Rheumatology) remission criteria are rigorous and require 5 of the 6 criteria [no joint swelling, tenderness, pain, and fatigue, normal sedimentation rate (ESR), and morning stiffness = 15 minutes] to be met. The Disease Activity Score (DAS) and DAS28 were developed as an index of disease activity on a continuous scale, including joint swelling, tenderness, ESR (or CRP), and patients global assessment of health. Low scores (DAS1.6 and DAS282.6) have been introduced to indicate remission. However, patients who meet the DAS28 requirement for remission may have tender and/or swollen joints). #### PLEASE DO NOT DELETE CONTENT BELOW THIS LINE ! #### ########### Presentation RA_Optimize_core_26MAR09_WIRE.ppt created on Thursday, 26 M