风湿病治疗争议.pptx

风湿病治疗争议
风湿病学科充满争议
・单纯高尿酸血症是否需要药物干预? -DMARD是否适合治疗中轴SpA?
•活动性RA起始治疗：单药还是联合? •生物制剂是否作为RA首选治疗？
• “亚临床”狼疮是否需要药物治疗?
1 .单A SileghemJ3 G De Brabanter,14 J Joly,2 S Meyfroidt,1 K Van der Elst,2,15 R Westhovens1,2
Handling editor Tore K Kvien
► Additional material is published online only. To viav please visit the journal online ( 136/ annrheumdis-2014-205489).
For numbered affiliations see end of article.
Correspondence to
D De Cock, Skeletal Biology and Engineering Research Center, KU Leuven Department of Development and Regeneration, Herestraat 49, Leuven 3000, Belgium; diederik.******@med.
PV and DDC are co-first authors.
ABSTRACT
Objectives To compare the efficacy and safety of intensive combination strategies with glucocorticoids (GCs) in the first 16 weeks (W) of early rheumatoid arthritis (eRA) treatment, focusing on high-risk patients, in the Care in early RA trial.
Methods 400 disease-modifying antirheumatic drugs (DMARD)-naive patients with eRA were recruited and stratified into high risk or low risk according to dassical prognostic markers. High-risk patients (n=290) were randomised to 1/3 treatment strategies: combination therapy for eariy rheumatoid arthritis (COBRA) Classic (methotrexate (MIX)+ sulfasalazine+60 mg prednisone tapered to mg daily from W7), COBRA Slim (MTX +30 mg prednisone tapered to 5 mg from W6) and COBRA Avant-Garde (MTX+leflunomide+30 mg prednisone tapered to 5 mg from W6). Treatment modifications to target low-disease activity were
INTRODUCTION
Wliile in the past patients with early rheumatoid arthritis (eRA) were treated conservatively, current guidelines recommend treating high-risk patients intensively, early and to A lot of interesting and important pioneering work has already been done, but many questions regarding the optimal dosage and combination of medication in the management of patients with eRA remain
Trials using early intensive combination strategies with cl