中国风湿科医生类风湿关节炎治疗策略调查

A survey on therapy strategies for rheumatoid arthritis in Chinese rheumatologists

旨在了解我国风湿科医生对类风湿关节炎(RA)治疗策略的认识情况。于2016年9月26—29日亚太风湿病学学会联盟上海会议上发放纸质调查问卷,调查参会医师治疗RA时一线和二线改善病情抗风湿药(DMARDs)的选择、生物制剂的选择、甲氨蝶呤与糖皮质激素应用及疾病活动度评估与监测频率。结果显示,治疗RA时,85.1%的医生首选甲氨蝶呤;存在甲氨蝶呤禁忌证时,71.0%的医生选择来氟米特或柳氮磺吡啶。当甲氨蝶呤治疗失败时,62.0%的医生选择换为或加用其他传统合成DMARDs,若选择应用生物制剂,65.2%的医生选择依那西普。97.3%的医生以甲氨蝶呤7.5~15 mg/周剂量起始;73.8%的医生使用最大甲氨蝶呤剂量为10~15 mg/周。初始治疗时,49.3%的医生选择口服糖皮质激素。42.6%的医生在日常工作中从不或不太经常评估RA疾病活动。患者病情达到缓解后,74.2%的医生会选择每1~3个月随访。提示,被调查医生治疗RA时,在一线和二线治疗方案的选择上与国内外RA管理指南推荐一致,但甲氨蝶呤的最大给药剂量、初始治疗是否应用糖皮质激素、疾病活动度的评估及疾病缓解后的监测频率与国内外RA管理指南不一致。

To investigate how Chinese rheumatologists treated patients with rheumatoid arthritis(RA).We performed a survey on the choices of first-line and second-line anti-RA therapies,prescription of methotrexate and glucocorticoids,assessment of disease activity and frequencies of follow-up at the Asia Pacific League of Associations for Rheumatology meeting 2016 in Shanghai.The majority(85.1%)of rheumatologists preferred methotrexate as first-line treatment.As alternative agents,71.0% rheumatologists chose leflunomide or sulfasalazine.If methotrexate was not tolerable,only 8.6% rheumatologists would switch to parenteral administration.After failure of responding to methotrexate,62.0% rheumatologists recommended to change or combine other conventional synthetic disease modifying anti-rheumatic drugs(DMARDs).Etanercept was the most popular biological option in 65.2%rheumatologists.Almost all(97.3%)rheumatologists prescribed methotrexate at an initial dose of 7.5 to 15 mg/week and 73.8% rheumatologists at a maximum of 10 to 15 mg/week.There were 49.3% rheumatologists prescribing oral glucocorticoids at first-line therapy.Surprisingly,42.6% rheumatologists never or rarely assessed disease activity in daily work.For patients having achieved remission,74.2% rheumatologists would follow up them every 1 to 3 months.This study suggests that most Chinese rheumatologists treat RA patients consistent with international guidelines,while the maximum dose of methotrexate,glucocorticoid as first-line treatment,assessment of disease activity and follow-up frequency are locally modified.