老年类风湿性关节炎治疗进展

Progress on rheumatoid arthritis in elderly

老年类风湿性关节炎患者在选择NSAIDs药物时,需评估老年患者的危险因素。目前研究热点多集中于生物制剂治疗,老年患者使用生物制剂时应更多关注其感染的风险。传统中医药方案疗效确切,尤以雷公藤为突出,应开展大型关于中西医治疗老年类风湿性关节炎临床试验精确用药策略。老年患者更易合并心血管疾病、间质性肺病等共存病,治疗共存病同时也可控制类风湿本身疾病活动。老年类风湿性关节炎与其他年龄发病类风湿性关节炎一致,也需要"达标治疗",以疾病完全缓解及降低疾病活动度为目标,但由于老年类风湿性关节炎的发病及临床特点及治疗策略与其他年龄发病类风湿性关节炎不同,因此其达标治疗理念可能也会有所不同,目前临床试验多将老年患者排除在外,导致相应循证数据缺乏。因此需开展针对老年患者的临床研究,为临床治疗方案提供依据和指导。

During choosing non steroidal anti inflammatory drugs（NSAIDs）,risk factors should be evaluated in elder patients with rheumatoid arthritis. The present study focused on biological therapies,and elderly patients should be more concerned about the risk of infection when used it. Traditional Chinese medicine has advantages of obvious curative effect,especially for tripterygium wilfordii,large clinical trial on western and Chinese medical accurate drug strategies for old patients with rheumatoid arthritis. Old patients are easier to suffer from cardiac diseases and interstitial lung disease,rheumatoid arthritis could be controlled along with the treatment for coexistent disease. The incidence of rheumatoid arthritis in old patients is the same with other RA,and need to treat to target based on the aim of relieve pain and reduce activity of diseases,while the clinical charteristic and treatment target in elder patients with rheumatoid arthritis were not similar with other aged patient,so treatment standard target would vary with aging. Resent clinical studies excluded old patients,lead to lack of evidence based medicine data. Clinical study for elder patients with rheumatoid arthritis are energetically carrying out,and could provide base and guide for clinical treatment.