高危人群类风湿性关节炎的预防:现状与前景

IF 13 1区 医学 Q1 PHARMACOLOGY & PHARMACY
Drugs Pub Date : 2024-08-01 Epub Date: 2024-07-02 DOI:10.1007/s40265-024-02061-0
Task Toyoda, Kulveer Mankia
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引用次数: 0

摘要

早期干预一直是改善类风湿关节炎患者预后的基石。在过去的十年中,人们不断探索,试图为那些类风湿关节炎的高危人群制定有效的预防策略。核心风险因素包括血清中存在抗瓜氨酸蛋白抗体、关节痛和影像学上的亚临床炎症,这些因素对关节炎的发展具有很高的预测性。空气污染、饮食和微生物组对疾病进展的影响尚不明确。反过来,治疗重点已转移到疾病持续发展的早期关节炎前阶段,在这一阶段有可能截断临床上明显的关节炎。迄今为止,已在高危人群中开展了七项概念验证干预试验。能否真正预防类风湿关节炎仍是一个未知数。一些免疫调节疗法出现了永久性疾病调节和症状改善的良好信号,而其他疗法则不成功。要确定真正的疗效,还需要长期的跟踪观察。展望未来,我们需要更好地了解关节炎发展的自然史和潜在生物机制,并进行更准确、更有效的风险分层。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Prevention of Rheumatoid Arthritis in At-Risk Individuals: Current Status and Future Prospects.

Prevention of Rheumatoid Arthritis in At-Risk Individuals: Current Status and Future Prospects.

Early intervention has been the cornerstone of improving outcomes in patients with rheumatoid arthritis. Over the past decade, the boundaries have been pushed in an attempt to achieve effective prevention strategies in those who are at high risk of developing rheumatoid arthritis. Core risk factors including the presence of serum anti-citrullinated protein antibodies, arthralgia and subclinical inflammation on imaging are highly predictive of arthritis development. The influence of air pollution, diet and the role of microbiome on disease progression are less clear. In turn, therapeutic focus has shifted to an earlier pre-arthritis phase of the disease continuum where the clinically apparent arthritis may potentially be intercepted. Seven proof-of-concept interventional trials in at-risk individuals have been conducted so far. Whether true prevention of rheumatoid arthritis is possible remains elusive. Promising signals towards permanent disease modulation and improvement in symptom burden were seen with some immunomodulatory therapies, whilst others were unsuccessful. Long-term follow-up is required to ascertain a true effect. Looking forward, a better understanding of the natural history and underlying biological mechanisms of arthritis development and more accurate, validated risk stratification is needed.

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来源期刊
Drugs
Drugs 医学-毒理学
CiteScore
22.70
自引率
0.90%
发文量
134
审稿时长
3-8 weeks
期刊介绍: Drugs is a journal that aims to enhance pharmacotherapy by publishing review and original research articles on key aspects of clinical pharmacology and therapeutics. The journal includes: Leading/current opinion articles providing an overview of contentious or emerging issues. Definitive reviews of drugs and drug classes, and their place in disease management. Therapy in Practice articles including recommendations for specific clinical situations. High-quality, well designed, original clinical research. Adis Drug Evaluations reviewing the properties and place in therapy of both newer and established drugs. AdisInsight Reports summarising development at first global approval. Moreover, the journal offers additional digital features such as animated abstracts, video abstracts, instructional videos, and podcasts to increase visibility and educational value. Plain language summaries accompany articles to assist readers with some knowledge of the field in understanding important medical advances.
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