“早期”類風濕性關節炎

Early Rheumatoid Arthritis

10.6200/TCMJ.2007.4.9.19

吳彥林(Yen-Lin Wu)

類風濕性關節炎 ； 抗環瓜胺酸胜肽抗體 ； 腫瘤壞死因子阻斷劑 ； 抗風濕病藥物 ； rheumatoid arthritis ； antibodies to cyclic citrullinated peptides ； TNF blocker ； disease-modifying antirheumatic drugs

北市醫學雜誌

4卷9_S期（2007 / 12 / 01）

946 - 954

繁體中文

類風濕性關節炎是一種慢性持續發炎的疾病。目前已經發現，儘早積極使用改善病程之抗風濕病藥物(disease-modifying antirheumatic drugs, DMARDs)，可以改善病人的預後，避免關節破壞。不過，在病患初期因為關節炎就醫時，卻宥於診斷未能確立，以及有些關節症狀會自行緩解的考量，我們未必就會立即投與DMARD。因此，如果能找到一些和預後有相關的標記，我們就可以針對這群較容易發生關節破壞的病患，給予更積極的治療，改善其預後。最近研究發現，有一些基因與關節破壞急遽惡化有關；而一些血清學的檢驗，尤其是抗環瓜胺酸胜肽抗體(anti-cyclic citrullinated peptide antibodies, anti-CCP)，可用來早期診斷類風濕性關節炎；有些放射線學的檢查，也可以早期發現滑膜炎與骨頭侵蝕。在治療方面，同時合併methotrexate與生物製劑，特別是腫瘤壞死因子阻斷劑(TNF blocker)，更可有效降低疾病的活性。接下來，如何篩檢出特定的病患族群，根據其病程及對藥物的反應，採取更適切的治療方式，將是將來研究的一大課題。

Rheumatoid arthritis is a chronic inflammatory disease in which early aggressive therapy with disease-modifying antirheumatic drugs (DMARDs) can improve outcome and prevent joint damage. The application of these drugs, however, can be limited by diagnostic uncertainty in patients with early inflammatory arthritis and concerns about treatment of patients whose disease would remit spontaneously. It is therefore important to identify prognostic markers of early disease and to determine the role of aggressive treatment strategies in inducing remission in such patients. Recent research has provided new information on genetic markers predicting rapid progression of joint destruction; the role of serology, in particularly, antibodies to cyclic citrullinated peptides (anti-CCP) in diagnosing rheumatoid arthritis; the utility of radiographic techniques in detecting both early synovitis and bone erosion; and the value of combination therapy in controlling signs, symptoms and radiographic progression. Combination of methotrexate with a biological agent, especially a TNF blocker, has attained impressive efficacy in reducing disease activity. While current treatment approaches can produce significant benefits in patients with early arthritis, future investigation is needed to target therapy more selectively and to determine which patients respond best to various agents or combinations.