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类风湿性关节炎(RA)的治疗策略历经了多次的变革,现已在世界范围内达成共识——早期联合干预治疗有助于保持关节的功能,减缓骨质破坏。今年《Rheumatology andArthritis》上刊登了有关RA治疗的指引(guideline),这为临床医生正确地选择治疗方案提供更多帮助。 有关激素在RA中的应用以前一直存在争议,80年代中期到90年代强调小剂量短效疗程的激素治疗,目的在于减轻关节的炎症反应(肿胀、积液等)。来自《Cochrane Library》中对中等疗程、小剂量皮质激素治疗RA的有效文献做的系统评估,结果显示采用激素治疗比用安慰剂显著改善临床指标,与服阿斯匹林或羟氯喹无区别。评估中不足之处是未将X线的改变纳入为评估指标,而在另外的文献中已有报道说早期小剂量激素的应用能减慢骨质破坏的发生或进程。为此,美国风湿病协会将小剂量激素的应用列入RA治疗指引中,便于推广使用。有关激光疗法在RA的应用尚很不成熟,尽管看到一些近期疗效,但还有许多的问题,包括评估的标准有待研究探讨。温热疗法对RA的症状改变并无明显作用,仅患者的自我感觉良好,故只能作为家庭的辅助保健措施。
The rheumatoid arthritis (RA) treatment strategy has undergone many changes and consensus has now been reached worldwide that early joint interventions can help maintain joint function and reduce bone destruction. This year’s Rheumatology and Arthritis published a guideline on RA treatment, which provides clinicians with more assistance in choosing the right treatment. The use of hormones in RA has been controversial until the mid-1980s to the mid-1990s when hormone therapy was focused on short-acting, short-acting regimens in order to reduce inflammation (swelling, effusion, etc.) in joints. A systematic review of the available literature from the Cochrane Library on moderate-course, low-dose corticosteroid therapy of RA showed that steroid treatment improved clinical outcomes significantly compared with placebo without any difference from aspirin or hydroxychloroquine. The inadequacies of the assessment were that X-ray changes were not included in the assessment. In other literatures, it has been reported that the early application of low-dose hormones can slow down the occurrence or progression of bone destruction. To this end, the American College of Rheumatology will be included in the application of low-dose hormone RA treatment guidelines, easy to promote the use. The application of laser therapy in RA is still immature. Although some short-term effects are seen, many problems, including the criteria for evaluation, are to be explored. The thermotherapy has no obvious effect on the change of the symptoms of RA, and only the patients feel good about themselves, so they can only serve as a supplementary health care measure for the family.