류마티스 관절염의 치료 동향과 지침
Recent trends and guidelines for the management of rheumatoid arthritis
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
최근 류마티스 관절염 치료는 새로운 항류마티스 약제와 생물학적 제제의 도입 등 여러 혁신적 변화를 통해, 과거에 비해 괄목할만한 치료 효과를 보이고 있다. 치료의 개념도 과거의 피라미드식 접근 방법에서 조기 진단과 더불어 강력 한 치료를 질병 초기에 시행함으로써 질병의 진행을 억제하 는 것으로 바뀌었다. 류마티스 관절염을 조기에 진단하여 질병의 초기부터 강력한 치료를 하는 것이 환자의 예후에 있어 매우 중요하다.
Abstract
The paradigm for the management of rheumatoid arthritis (RA) has shifted in the past two decades. The appreciation of increased mortality in patients with RA and the poor outcomes with conventional therapy led to the concept of the early aggressive treatment to suppress ongoing inflammation and prevent joint injury. RA results from acute and chronic inflammation in the synovium associated with proliferative and destructive processes in the joint. Affected areas may either heal without structural defects, or be irreversibly damaged if inflammation is severe and does not remit. Therefore, measures aimed at identifying early active disease and ameliorating inflammation are essential and may be highly effective in modifying disease outcome. The goal of treatment is to achieve and maintain a state of remission or, at the least, a state of low disease activity, in order to prevent joint damage and disability. This requires the initiation of treatment early in the disease process, as well as vigilant monitoring throughout the course of disease, with prompt readjustment of therapy, for flares of activity and for medication toxicity. This aggressive approach has been made possible by the increasing number of effective non-biologic and biologic disease-modifying anti-rheumatic drugs (DMARDs). Recent trends and guidelines for the management of RA are presented here.
참고문헌 (24)
- Lee DM, "Rheumatoid arthritis", Lancet, 358, pp.903~911 (2001)
- Scott DL, "Long-term outcome of treating rheumatoid arthritis: Results after 20 years", Lancet, 16, pp.1108~1111 (1987)
- Wolfe F, "The mortality of rheumatoid arthritis", Arthritis Rheum, 37, pp.481~494 (1994)
- Pincus T, "What is the natural history of rheumatoid arthritis?", Rheum Dis Clin North Am, 19, pp.123~151 (1993)
- Quinn MA, "Evaluation and management of early inflammatory polyarthritis. In Rheumatology, 3rd ed", pp.885~891 (2003), Mosby
- Wilske KR, "Remodeling the pyramid: a concept whose time has come", J Rheumatol, 16, pp.565~567 (1989)
- Emery P, "The optimal management of early rheumatoid disease: the key to preventing disability", Br J Rheum, 33, pp.765~768 (1994)
- van der Heijde DM, "Biannual radiographic assessments of hands and feet in a three-year prospective followup of patients with early rheumatoid arthritis", Arthritis Rheum, 35, pp.26~34 (1992)
- Fuchs HA, "Evidence of significant radiographic damage in rheumatoid arthritis within the first 2 years of disease", J Rheumatol, 16, pp.585~591 (1989)
- Visser H, "How to diagnose rheumatoid arthritis early: a prediction model for persistent (erosive) arthritis", Arthritis Rheum, 46, pp.357~365 (2002)
- Pisetsky DS, "Progress in the Treatment of Rheumatoid Arthritis", JAMA, 286, pp.2787~2790 (2001)
- Lard LR, "Early versus delayed treatment in patients with recent-onset rheumatoid arthritis: Comparison of two cohorts who received different treatment strategies", Am J Med, 111, pp.446~451 (2001)
- 이수곤, "류마티스 관절염의 치료. 임상류마티스학, 1판", pp.271~290 (2006), 한국의학사
- Saag KG, "American College of Rheumatology. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis", Arthritis Rheum, 59, pp.762~784 (2008)
- Bathon JM, "The 2008 American College of Rheumatology recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis: where the rubber meets the road", Arthritis Rheum, 59, pp.757~759 (2008)
- Wolfe F, "Which HAQ is best? A comparisonof the HAQ, MHAQ and RA-HAQ, a difficult 8 item HAQ (DHAQ), and a rescored 20 item HAQ (HAQ20): analyses in 2,491 rheumatoid arthritis patients following leflunomide initiation", J Rheumatol, 28, pp.982~989 (2001)
- Nishimura K, "Meta-analysis: Diagnostic accuracy of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis", Ann Intern Med, 146, pp.797~808 (2007)
- Finckh A, "Anti-cyclic citrullinated peptide antibodies in the diagnosis of rheumatoid arthritis: bayes clears the haze", Ann Intern Med, 146, pp.816~817 (2007)
- Donahue KE, "Systematic review: comparative effectiveness and harms of diseasemodifying medications for rheumatoid arthritis", Ann Intern Med, 148, pp.124~134 (2008)
- Smolen JS, "Superior efficacy of combination therapy for rheumatoid arthritis. Fact or Fiction?", Arthritis Rheum, 52, pp.2975~2983
- O'Dell, JR, "Combination DMARD therapy for rheumatoid arthritis: A step closer to the goal", Ann Rheum Dis, 55, pp.781~783 (1996)
- Perdriger A, "Club Rheumatismes et Inflammation. Safety ofinfliximab used in combination with leflunomide or azathioprine in daily clinical practice", J Rheumatol, 33, pp.865~869 (2006)
- Hyrich, KL, "British Society for Rheumatology Biologics Register. Comparison of the response to infliximab or etanercept monotherapy with the response to cotherapy with methotrexate or another disease-modifying antirheumatic drug in patients with rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register", Arthritis Rheum, 54, pp.1786~1794 (2006)
- Furst DE, "Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2007", Ann Rheum Dis, 66(3), pp.2~22 (2007)