留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

老年起病类风湿关节炎的诊治进展

宋梦婷 王振杰 郭培霞 李君茹 程海华

宋梦婷, 王振杰, 郭培霞, 李君茹, 程海华. 老年起病类风湿关节炎的诊治进展[J]. 中华全科医学, 2021, 19(4): 648-652. doi: 10.16766/j.cnki.issn.1674-4152.001884
引用本文: 宋梦婷, 王振杰, 郭培霞, 李君茹, 程海华. 老年起病类风湿关节炎的诊治进展[J]. 中华全科医学, 2021, 19(4): 648-652. doi: 10.16766/j.cnki.issn.1674-4152.001884
SONG Meng-ting, WANG Zhen-jie, GUO Pei-xia, LI Jun-ru, CHENG Hai-hua. Advances in the diagnosis and treatment of rheumatoid arthritis in elderly patients[J]. Chinese Journal of General Practice, 2021, 19(4): 648-652. doi: 10.16766/j.cnki.issn.1674-4152.001884
Citation: SONG Meng-ting, WANG Zhen-jie, GUO Pei-xia, LI Jun-ru, CHENG Hai-hua. Advances in the diagnosis and treatment of rheumatoid arthritis in elderly patients[J]. Chinese Journal of General Practice, 2021, 19(4): 648-652. doi: 10.16766/j.cnki.issn.1674-4152.001884

老年起病类风湿关节炎的诊治进展

doi: 10.16766/j.cnki.issn.1674-4152.001884
基金项目: 

河南省卫健委科研基金项目 2018020795

详细信息
    通讯作者:

    王振杰, E-mail: wangzjfeifei@sina.com

  • 中图分类号: R593.22

Advances in the diagnosis and treatment of rheumatoid arthritis in elderly patients

  • 摘要: 类风湿关节炎(rheumatoid arthritis, RA)是一种全身性的自身免疫病,主要表现为以双手近端指间关节、掌指关节及腕关节等小关节受累为主的对称性、持续性、侵蚀性的多关节炎。老年类风湿关节炎是指年龄≥60岁的类风湿关节炎,分为2个临床亚组:老年起病类风湿性关节炎(EORA)和青壮年发病的类风湿关节炎(YORA)。随着人口老龄化和预期寿命的延长,EORA的发病率在逐渐增高,EORA与YORA在流行病学、临床症状及实室特点等方面都有所不同。及时诊断类风湿性关节炎非常重要,因为可以实施早期治疗。EORA与一些其他风湿性疾病的鉴别诊断很复杂,如风湿性多肌痛(PMR)、痛风性关节炎(GA)、骨关节炎(OA)等,这些疾病会出现与EORA相似的症状和体征,且EORA的诊断方法缺乏特异性, 所以EORA易造成误诊、漏诊。EORA患者与YORA患者具有相同的治疗目标:控制临床表现,防止结构损伤,保护关节功能,降低死亡率。由于老年人药代动力学的改变、合并肾功能不全较多、年龄相关的免疫衰老等危险因素的存在,EORA患者药物不良反应较YORA多见。目前治疗RA的药物有非甾体抗炎药(NSAIDs)、糖皮质激素(Gc)、传统的DMARDs(csDMARD)、生物DMARDs(BDMARDs)、靶向合成DMARDs(TsDMARDs)等,在选择治疗药物时,要根据患者疾病活动及合并症制定不同的治疗方案,以实现临床缓解或尽可能降低疾病活动水平,最大限度减少并发症的发生。

     

  • [1] 林进, 徐丹怡. 重视老年类风湿关节炎诊治[J]. 中华风湿病学杂志, 2017, 21(12): 859-861. doi: 10.3760/cma.j.issn.1007-7480.2017.12.018
    [2] 中华医学会风湿病学分会. 2018中国类风湿关节炎诊疗指南[J]. 中华内科杂志, 2018, 57(4): 242-251. doi: 10.3760/cma.j.issn.0578-1426.2018.04.004
    [3] YU C, LI M T, DUAN X W, et al. Chinese registry of rheumatoid arthritis (CREDIT): I. Introduction and prevalence of remission in Chinese patients with rheumatoid arthritis[J]. Clin Exp Rheumatol, 2018, 36(5): 836-840. http://europepmc.org/abstract/MED/29600939
    [4] KATO E, SAWADA T, TAHARA K, et al. The age at onset of rheumatoid arthritis is increasing in Japan: a nationwide database study[J]. Int J Rheum Dis, 2017, 20(7): 839-845. doi: 10.1111/1756-185X.12998
    [5] CROWSON C S, MATTESON E L, MYASOEDOVA E, et al. The lifetime risk of adult-onset rheumatoid arthritis and other inflammatory autoimmune rheumatic diseases[J]. Arthritis Rheum, 2011, 63(3): 633-639. doi: 10.1002/art.30155
    [6] SUGIHARA T, HARIGAI M. Targeting low disease activity in elderly-onset rheumatoid arthritis: current and future roles of biological disease-modifying antirheumatic drugs[J]. Drugs Aging, 2016, 33(2): 97-107. doi: 10.1007/s40266-015-0341-2
    [7] KOBAK S, BES C. An autumn tale: geriatric rheumatoid arthritis[J]. Ther Adv Musculoskelet Dis, 2018, 10(1): 3-11. doi: 10.1177/1759720X17740075
    [8] 王舒婷, 刘坚, 韦嵩. 老年和青年类风湿关节炎患者发病特点及治疗对比研究[J]. 中华老年医学杂志, 2017, 36(6): 665-668. doi: 10.3760/cma.j.issn.0254-9026.2017.06.015
    [9] MURATA K, ITO H, HASHIMOTO M, et al. Elderly onset of early rheumatoid arthritis is a risk factor for bone erosions, refractory to treatment: KURAMA cohort[J]. Int J Rheum Dis, 2019, 22(6): 1084-1093. doi: 10.1111/1756-185X.13428
    [10] WAKURA D, KOTANI T, TAKEUCHI T, et al. Differentiation between Polymyalgia Rheumatica (PMR) and elderly-onset rheumatoid arthritis using 18F-Fluorodeoxyglucose positron emission tomography/computed tomography: is enthesitis a new pathological lesion in PMR?[J]. PLoS One, 2016, 11(7): e158509. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934779/
    [11] SUZUKI T, YOSHIDA R, HIDAKA Y, et al. Proliferative synovitis of the shoulder bursae is a key feature for discriminating elderly onset rheumatoid arthritis mimicking polymyalgia rheumatica from polymyalgia rheumatica[J]. Clin Med Insights Arthritis Musculoskelet Disord, 2017, 10: 69376187. http://europepmc.org/abstract/MED/29242702
    [12] 邓雪蓉, 耿研, 张卓莉. 不同时期痛风性关节炎的超声特征比较[J]. 中华风湿病学杂志, 2016, 20(1): 23-27. doi: 10.3760/cma.j.issn.1007-7480.2016.01.006
    [13] 田哲, 刘佳, 李英梅, 等. 高频超声在鉴别类风湿性和痛风性跖趾关节炎骨质侵蚀中的临床意义[J]. 中国实用医药, 2019, 14(7): 18-20. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSSA201907008.htm
    [14] 中华医学会风湿病学分会. 2016中国痛风诊疗指南[J]. 中华内科杂志, 2016, 55(11): 892-899. doi: 10.3760/cma.j.issn.0578-1426.2016.11.019
    [15] PERAZELLA M A, ERAS J. Are selective COX-2 inhibitors nephrotoxic?[J]. Am J Kidney Dis, 2000, 35(5): 937-940. doi: 10.1016/S0272-6386(00)70266-6
    [16] 孟瑞, 王菊宁. 糖皮质激素性骨质疏松的防治进展[J]. 中国骨质疏松杂志, 2019, 25(1): 123-126. doi: 10.3969/j.issn.1006-7108.2019.01.023
    [17] 王晓燕. 小剂量泼尼松联合甲氨蝶呤或来氟米特治疗老年类风湿关节炎的临床疗效[J]. 中国保健营养, 2019, 29(27): 284. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYU201404020.htm
    [18] 刘翠莲, 蔡文虹. 雷公藤多苷联合甲氨蝶呤对老年类风湿关节炎患者血清中细胞因子水平的影响[J]. 中国处方药, 2019, 17(6): 93-94. doi: 10.3969/j.issn.1671-945X.2019.06.057
    [19] 戴小娜, 林进. 老年起病类风湿关节炎研究进展[J]. 中国实用内科杂志, 2019, 39(6): 562-567. https://www.cnki.com.cn/Article/CJFDTOTAL-SYNK201906021.htm
    [20] EBINA K, MIYAMA A, TSUBOI H, et al. The add-on effectiveness and safety of iguratimod in patients with rheumatoid arthritis who showed an inadequate response to tocilizumab[J]. Mod Rheumatol, 2019, 29(4): 581-588. doi: 10.1080/14397595.2018.1486939
    [21] 孟岩, 李明远, 罗德梅, 等. 艾拉莫德片联合甲氨喋呤片治疗老年类风湿关节炎的临床研究[J]. 中国临床药理学杂志, 2017, 33(12): 1098-1101. https://www.cnki.com.cn/Article/CJFDTOTAL-GLYZ201712008.htm
    [22] 田新平, 曾小峰. 戈利木单抗治疗类风湿关节炎的进展[J]. 中华风湿病学杂志, 2019, 23(6): 423-425. doi: 10.3760/cma.j.issn.1007-7480.2019.06.014
    [23] OKAZAKI M, KOBAYASHI H, SHIMIZU H, et al. Safety, effectiveness, and treatment persistence of Golimumab in elderly patients with rheumatoid arthritis in real-world clinical practice in Japan[J]. Rheumatol Ther, 2018, 5(1): 135-148. doi: 10.1007/s40744-018-0101-y
    [24] TAKAHASHI N, KOJIMA T, KIDA D, et al. Clinical effectiveness and long-term retention of abatacept in elderly rheumatoid arthritis patients: results from a multicenter registry system[J]. Mod Rheumatol, 2019, 29(6): 910-918. doi: 10.1080/14397595.2018.1525019
    [25] WESTHOVENS R, TAYLOR P C, ALTEN R, et al. Filgotinib (GLPG0634/GS-6034), an oral JAK1 selective inhibitor, is effective in combination with methotrexate (MTX) in patients with active rheumatoid arthritis and insufficient response to MTX: results from a randomised, dose-finding study (DARWIN 1)[J]. Ann Rheum Dis, 2017, 76(6): 998-1008. doi: 10.1136/annrheumdis-2016-210104
  • 加载中
计量
  • 文章访问数:  23
  • HTML全文浏览量:  5
  • PDF下载量:  5
  • 被引次数: 0
出版历程
  • 收稿日期:  2020-05-15
  • 网络出版日期:  2022-02-16

目录

    /

    返回文章
    返回