2013年风湿免疫病学主要临床进展

The main clinical progress in rheumatology disease during 2013

风湿免疫病学科是内科领域最年轻的学科,但也是发展速度最快的学科之一。每年都有多种疾病治疗指南得到更新。2013年,类风湿关节炎(RA)新的治疗指南仍将传统合成改变病情抗风湿药物(csDMARDs)作为一线治疗方案,不再推荐生物制剂作为一线治疗,而是作为csDMARDs治疗反应不佳的RA患者的二线选择。应用生物制剂治疗前后均应高度重视结核病筛查与预防性治疗。关节超声、磁共振成像检查有助于诊断不典型RA、预测进展型未分化炎症性关节炎、了解疾病活动度、评估预后和治疗反应等。侵蚀性关节炎有了明确定义。部分系统性红斑狼疮(SLE)患者有望接受少或无激素治疗,生物制剂在SLE中的应用也初显端倪。尽管SLE患者预后显著改善,但心血管疾病、抑郁症、骨质疏松和骨折等合并症患病率显著增高。放射学阴性中轴型脊柱关节炎(SpA)概念的提出和系统性硬化病(SSc)分类标准的更新,显著提高了SpA和SSc的早期诊断率。"达标治疗"方案成为高尿酸血症和痛风的目标治疗策略,特别是反复发作的痛风患者血尿酸水平应长期控制在300μmol/L以下。

Reumatology is the youngest subject of internal medicine,and is one of the rapid growing disciplines.Every year,there are many kinds of disease treatment guidelines to be updated.In 2013,conventional synthetic disease-modifying antirheumatic drugs（csDMARDs） are still as first-line treatment drugs in the new treatment guideline of rheumatoid arthritis（RA）.Biological agent DMARDs are no longer recommended as first-line treatment strategies,but as second-line choice when the patients have poor response to csDMARDs.Whenever more attention should pay to TB screening and prophylactic treatment before or after treatment.Joint ultrasound and magnetic resonance imaging（MRI） are helpful to diagnosis of atypical RA,to prediction of progressive undifferentiated inflammatory arthritis,and to judge ment in the activity of the disease,and to assessment of prognosis and treatment response,etc.The erosion arthritis has been clearly defined.Part of patients with systemic lupus erythematosus（SLE） are expected to accept less or no hormone therapy.Application of biological agents in SLE is also emerging trend.Although the prognosis of patients with SLE improved much,but incidence of the cardiovascular disease,depression,osteoporosis,bone fracture and other complications increased significantly.Radiology negative concept of axial type spinal arthritis（SpA） and the classification standard of systemic sclerosis（SSc） updates are helpful to improve the early diagnostic rate of SpA and SSc.The treatment strategy of ＂treat to target＂ has become the aim of patients with high blood uric acid and gout.Especially for the recurrent gout patients,their blood uric acid level should be controlled for a long time below 300 μmol/L.