类风湿性关节炎的预防与治疗。

IF 4.1 Q2 IMMUNOLOGY
Immunotherapy advances Pub Date : 2023-08-29 eCollection Date: 2023-01-01 DOI:10.1093/immadv/ltad016
Lars Klareskog, Lars Alfredsson
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引用次数: 0

摘要

对于类风湿性关节炎(RA)这种无法治愈的慢性疾病,究竟是应该预防,还是应该将现有资源集中用于治疗,这是一个传统的难题。与大多数其他慢性疾病的情况类似,研究和临床实践的重点一直放在治疗已确诊的疾病上,结果是药物能有效消除大部分关节损伤,但无法治愈疾病或停止对疾病的持续治疗。在确定和实施疾病预防方法方面所做的努力较少。我们在这篇综述中认为,有关主要的 "血清阳性 "RA亚群纵向发展的知识现在已经到了这样一个阶段,即预防应该成为研究议程的一个重要部分,我们应该准备将预防作为RA临床实践的一部分。我们简要介绍了以公共卫生为基础的广泛预防以及 "精准预防 "策略的知识基础。在后者中,我们将对RA高危人群进行识别、监测,并最终提供如何改变生活方式/环境的建议,或给予能够延缓并最终阻止RA发展的药物治疗。这种精准预防RA的潜力是否会改变更广泛的临床实践,将取决于对疾病诱导免疫的特异性和持久性干扰,即最终的 "耐受疗法",是否会成为现实。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Prevention vs treatment of rheumatoid arthritis.

Prevention vs treatment of rheumatoid arthritis.

Whether a yet chronic and not curable disease like rheumatoid arthritis (RA) can be subject to prevention or whether available resources should be focused on treatment is a classical dilemma. Similar to the case in most other chronic diseases, the focus in research as well as in clinical practice has been on the treatment of established diseases, resulting in drugs that are efficient in eliminating most joint damage but not able to cure the disease or stop needs for continuous treatment of the disease. Less effort has been spent on identifying and implementing ways to prevent the disease. We argue in this review that knowledge concerning the longitudinal evolvement of the major, 'seropositive' subset of RA has now come to a stage where prevention should be a large part of the research agenda and that we should prepare for prevention as part of clinical practice in RA. We describe briefly the knowledge basis for broad public health-based prevention as well as for a 'precision prevention' strategy. In the latter, individuals at high risk for RA will be identified, monitored, and ultimately provided with advice on how to change lifestyle/environment or be given treatment with drugs able to delay and ultimately stop the development of RA. Whether this potential of precision prevention for RA will change the broader clinical practice will depend on whether specific and long-lasting interference with disease-inducing immunity, ultimately 'tolerance therapy', will become a reality.

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