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Interpretation on the 2024 Chinese Guidelines for the Diagnosis and Treatment of Rheumatoid Arthritis
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摘要:
类风湿关节炎(rheumatoid arthritis，RA)是危害我国人群健康的重大疾病，且目前我国RA的诊治现状尚存在诸多不足。《2024中国类风湿关节炎诊疗指南》针对RA诊治中的10个重要临床问题，依据国内外最新文献证据，充分考虑我国RA诊治实际情况，进行了循证医学推荐。指南全面涵盖RA的诊断、影像学检查、治疗目标、随访监测、初始治疗方案、治疗方案调整、糖皮质激素应用、药物减量、健康教育等内容，对于提高我国RA的诊治水平、改善患者预后将发挥重要推动作用。
Abstract:Rheumatoid Arthritis (RA) is a critical disease that endangers the health of the Chinese population. At present, there are still many deficiencies in the diagnosis and treatment of RA in China. The 2024 Chinese Guidelines for the Diagnosis and Treatment of Rheumatoid Arthritis addresses 10 important clinical issues in the diagnosis and treatment of RA, and provides evidence-based recommendations based on the latest domestic and international literature, with consideration of the actual situation of RA diagnosis and treatment in China. The guidelines comprehensively cover the diagnosis of RA, imaging examinations, treatment goals, follow- up monitoring, initial treatment plans, treatment adjustments, the application of glucocorticoids, drug tapering, and health education. They will promote the RA diagnosis and treatment levels and improve the prognosis of RA patients in China.
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Keywords:
- rheumatoid arthritis /
- diagnosis /
- therapy /
- guideline interpretation
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作者贡献：姜楠负责文献查阅、资料收集及论文撰写；田新平、曾小峰负责选题设计及论文审校。利益冲突：所有作者均声明不存在利益冲突
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[1] Smolen J S, Aletaha D, Barton A, et al. Rheumatoid arthritis[J]. Nat Rev Dis Primers, 2018, 4: 18001. DOI: 10.1038/nrdp.2018.1
[2] 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.
[3] Jiang N, Li Q, Li H B, et al. Chinese registry of rheumatoid arthritis (CREDIT) V: sex impacts rheumatoid arthritis in Chinese patients[J]. Chin Med J (Engl), 2022, 135(18): 2210-2217. DOI: 10.1097/CM9.0000000000002110
[4] 曾小峰, 朱松林, 谭爱春, 等. 我国类风湿关节炎疾病负担和生存质量研究的系统评价[J]. 中国循证医学杂志, 2013, 13(3): 300-307. Zeng X F, Zhu S L, Tan A C, et al. Disease burden and quality of life of rheumatoid arthritis in China: a systematic review[J]. Chin J Evid Based Med, 2013, 13(3): 300-307.
[5] 周云杉, 王秀茹, 安媛, 等. 全国多中心类风湿关节炎患者残疾及功能受限情况的调查[J]. 中华风湿病学杂志, 2013, 17(8): 526-532. DOI: 10.3760/cma.j.issn.1007-7480.2013.08.006 Zhou Y S, Wang X R, An Y, et al. A multicenter study of deformity and disability in rheumatoid arthritis patients in China[J]. Chin J Rheumatol, 2013, 17(8): 526-532. DOI: 10.3760/cma.j.issn.1007-7480.2013.08.006
[6] Zhao S P, Chen Y L, Chen H. Sociodemographic factors associated with functional disability in outpatients with rheumatoid arthritis in Southwest China[J]. Clin Rheumatol, 2015, 34(5): 845-851. DOI: 10.1007/s10067-015-2896-z
[7] 栗占国. 类风湿关节炎在我国的低认知度和高致残率不容忽视[J]. 中华医学杂志, 2009, 89(27): 1873-1875. DOI: 10.3760/cma.j.issn.0376-2491.2009.27.001 Li Z G. Facing the challenge of low recognition and high disability in rheumatoid arthritis[J]. Natl Med J China, 2009, 89(27): 1873-1875. DOI: 10.3760/cma.j.issn.0376-2491.2009.27.001
[8] Figus F A, Piga M, Azzolin I, et al. Rheumatoid arthritis: Extra-articular manifestations and comorbidities[J]. Autoimmun Rev, 2021, 20(4): 102776. DOI: 10.1016/j.autrev.2021.102776
[9] Taylor P C, Atzeni F, Balsa A, et al. The key comorbidities in patients with rheumatoid arthritis: a narrative review[J]. J Clin Med, 2021, 10(3): 509. DOI: 10.3390/jcm10030509
[10] Jin S Y, Li M T, Fang Y F, et al. Chinese registry of rheumatoid arthritis (CREDIT): Ⅱ. Prevalence and risk factors of major comorbidities in Chinese patients with rheumatoid arthritis[J]. Arthritis Res Ther, 2017, 19(1): 251. DOI: 10.1186/s13075-017-1457-z
[11] GBD 2021 Rheumatoid Arthritis Collaborators. Global, regional, and national burden of rheumatoid arthritis, 1990—2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021[J]. Lancet Rheumatol, 2023, 5(10): e594-e610. DOI: 10.1016/S2665-9913(23)00211-4
[12] Li H B, Wu L J, Jiang N, et al. Treatment satisfaction with rheumatoid arthritis in patients with different disease severity and financial burden: a subgroup analysis of a nationwide survey in China[J]. Chin Med J (Engl), 2020, 133(8): 892-898. DOI: 10.1097/CM9.0000000000000749
[13] 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 Chinese Rheumatology Association. 2018 Chinese guideline for the diagnosis and treatment of rheumatoid arthritis[J]. Chin J Intern Med, 2018, 57(4): 242-251. DOI: 10.3760/cma.j.issn.0578-1426.2018.04.004
[14] 国家皮肤与免疫疾病临床医学研究中心(北京协和医院), 中国医师协会风湿免疫专科医师分会, 中国康复医学会风湿免疫病康复专业委员会, 等. 2024中国类风湿关节炎诊疗指南[J]. 中华内科杂志, 2024, 63(11): 1059-1077. DOI: 10.3760/cma.j.cn112138-20240531-00360 National Clinical Research Center for Dermatologic and Immunologic Diseases (Peking Union Medical College Hospital), Chinese Association of Rheumatology and Immunology Physicians, Rheumatology and Immunology Professional Committee of Chinese Rehabilitation Medical Association, et al. 2024 Chinese guidelines for the diagnosis and treatment of rheumatoid arthritis[J]. Chin J Intern Med, 2024, 63(11): 1059-1077. DOI: 10.3760/cma.j.cn112138-20240531-00360
[15] Van Der Heide A, Jacobs J W, Bijlsma J W, et al. The effectiveness of early treatment with "second-line" antirheumatic drugs. A randomized, controlled trial[J]. Ann Intern Med, 1996, 124(8): 699-707. DOI: 10.7326/0003-4819-124-8-199604150-00001
[16] Bukhari M A S, Wiles N J, Lunt M, et al. Influence of disease-modifying therapy on radiographic outcome in inflammatory polyarthritis at five years: results from a large observational inception study[J]. Arthritis Rheum, 2003, 48(1): 46-53. DOI: 10.1002/art.10727
[17] Van Dongen H, Van Aken J, Lard L R, et al. Efficacy of methotrexate treatment in patients with probable rheumatoid arthritis: a double-blind, randomized, placebo-controlled trial[J]. Arthritis Rheum, 2007, 56(5): 1424-1432. DOI: 10.1002/art.22525
[18] Moon S J, Kim Y S. Usefulness and limitation of 2010 ACR/EULAR classification criteria in Korean patients with early RA[J]. J Rheum Dis, 2012, 19(6): 326-333. DOI: 10.4078/jrd.2012.19.6.326
[19] Van Der Linden M P M, Knevel R, Huizinga T W J, et al. Classification of rheumatoid arthritis: comparison of the 1987 American College of Rheumatology criteria and the 2010 American College of Rheumatology/European League Against Rheumatism criteria[J]. Arthritis Rheum, 2011, 63(1): 37-42. DOI: 10.1002/art.30100
[20] Berglin E, Dahlqvist S R. Comparison of the 1987 ACR and 2010 ACR/EULAR classification criteria for rheumatoid arthritis in clinical practice: a prospective cohort study[J]. Scand J Rheumatol, 2013, 42(5): 362-368. DOI: 10.3109/03009742.2013.776103
[21] Mjaavatten M D, Bykerk V P. Early rheumatoid arthritis: the performance of the 2010 ACR/EULAR criteria for diagnosing RA[J]. Best Pract Res Clin Rheumatol, 2013, 27(4): 451-466. DOI: 10.1016/j.berh.2013.09.001
[22] Kasturi S, Goldstein B L, Malspeis S, et al. Comparison of the 1987 American College of Rheumatology and the 2010 American College of Rheumatology/European League against Rheumatism criteria for classification of rheumatoid arthritis in the Nurses' Health Study cohorts[J]. Rheumatol Int, 2014, 34(3): 407-411. DOI: 10.1007/s00296-013-2865-2
[23] Studenic P, Aletaha D, De Wit M, et al. American College of Rheumatology/EULAR remission criteria for rheumatoid arthritis: 2022 revision[J]. Ann Rheum Dis, 2023, 82(1): 74-80. DOI: 10.1136/ard-2022-223413
[24] Ramiro S, Landewé R B, Van Der Heijde D, et al. Is treat-to-target really working in rheumatoid arthritis? A longitudinal analysis of a cohort of patients treated in daily practice (RA BIODAM)[J]. Ann Rheum Dis, 2020, 79(4): 453-459. DOI: 10.1136/annrheumdis-2019-216819
[25] Grigor C, Capell H, Stirling A, et al. Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial[J]. Lancet, 2004, 364(9430): 263-269. DOI: 10.1016/S0140-6736(04)16676-2
[26] Smolen J S, Landewé R B M, Bergstra S A, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update[J]. Ann Rheum Dis, 2023, 82(1): 3-18. DOI: 10.1136/ard-2022-223356
[27] Fraenkel L, Bathon J M, England B R, et al. 2021 American College of Rheumatology guideline for the treat-ment of rheumatoid arthritis[J]. Arthritis Rheumatol, 2021, 73(7): 1108-1123. DOI: 10.1002/art.41752
[28] Lau C S, Chia F, Dans L, et al. 2018 Update of the APLAR recommendations for treatment of rheumatoid arthritis[J]. Int J Rheum Dis, 2019, 22(3): 357-375. DOI: 10.1111/1756-185X.13513
[29] Singh J A, Hossain A, Mudano A S, et al. Biologics or tofacitinib for people with rheumatoid arthritis naive to methotrexate: a systematic review and network meta-analysis[J]. Cochrane Database Syst Rev, 2017, 5(5): CD012657.
[30] Donahue K E, Schulman E R, Gartlehner G, et al. Comparative effectiveness of combining MTX with biologic drug therapy versus either MTX or biologics alone for early rheumatoid arthritis in adults: a systematic review and network meta-analysis[J]. J Gen Intern Med, 2019, 34(10): 2232-2245. DOI: 10.1007/s11606-019-05230-0
[31] Iwami R S, Moura M D, Sorrilha F B, et al. Effectiveness and safety of oral corticosteroids in the treatment of rheumatoid arthritis: a systematic review[J]. Rev Bras Farm Hosp Serv Saude, 2022, 13(1): 749. DOI: 10.30968/rbfhss.2022.131.0749
[32] Sanmartí R, Tornero J, Narváez J, et al. Efficacy and safety of glucocorticoids in rheumatoid arthritis: systematic literature review[J]. Reumatol Clin (Engl Ed), 2020, 16(3): 222-228. DOI: 10.1016/j.reuma.2018.06.007
[33] Boers M, Hartman L, Opris-Belinski D, et al. Low dose, add-on prednisolone in patients with rheumatoid arthritis aged 65+: the pragmatic randomised, double-blind placebo-controlled GLORIA trial[J]. Ann Rheum Dis, 2022, 81(7): 925-936. DOI: 10.1136/annrheumdis-2021-221957
[34] Roubille C, Richer V, Starnino T, et al. The effects of tumour necrosis factor inhibitors, methotrexate, non-steroidal anti-inflammatory drugs and corticosteroids on cardiovascular events in rheumatoid arthritis, psoriasis and psoriatic arthritis: a systematic review and meta-analysis[J]. Ann Rheum Dis, 2015, 74(3): 480-489. DOI: 10.1136/annrheumdis-2014-206624
[35] Dixon W G, Suissa S, Hudson M. The association between systemic glucocorticoid therapy and the risk of infection in patients with rheumatoid arthritis: systematic review and meta-analyses[J]. Arthritis Res Ther, 2011, 13(4): R139. DOI: 10.1186/ar3453
[36] 中国医师协会风湿免疫科医师分会, 中华医学会风湿病学分会, 中华医学会骨质疏松和骨矿盐疾病分会, 等. 2020版中国糖皮质激素性骨质疏松症防治专家共识[J]. 中华内科杂志, 2021, 60(1): 13-21. DOI: 10.3760/cma.j.cn112138-20201102-00914 Chinese Association of Rheumatology and Immunology Physicians, Chinese Rheumatology Association, Chinese Society of Bone and Mineral Research, et al. Chinese consensus on the prevention and treatment of glucocorticoid induced osteoporosis (2020)[J]. Chin J Intern Med, 2021, 60(1): 13-21. DOI: 10.3760/cma.j.cn112138-20201102-00914
[37] Hughes C D, Scott D L, Ibrahim F, et al. Intensive therapy and remissions in rheumatoid arthritis: a systematic review[J]. BMC Musculoskelet Disord, 2018, 19(1): 389. DOI: 10.1186/s12891-018-2302-5
[38] Roodenrijs N M T, Kedves M, Hamar A, et al. Diagnostic issues in difficult-to-treat rheumatoid arthritis: a systematic literature review informing the EULAR recommendations for the management of difficult-to-treat rheumatoid arthritis[J]. RMD Open, 2021, 7(1): e001511. DOI: 10.1136/rmdopen-2020-001511
[39] Watanabe R, Hashimoto M, Murata K, et al. Prevalence and predictive factors of difficult-to-treat rheumatoid arthritis: the KURAMA cohort[J]. Immunol Med, 2022, 45(1): 35-44. DOI: 10.1080/25785826.2021.1928383
[40] Nagy G, Roodenrijs N M, Welsing P M, et al. EULAR definition of difficult-to-treat rheumatoid arthritis[J]. Ann Rheum Dis, 2021, 80(1): 31-35. DOI: 10.1136/annrheumdis-2020-217344
[41] De Hair M J H, Jacobs J W G, Schoneveld J L M, et al. Difficult-to-treat rheumatoid arthritis: an area of unmet clinical need[J]. Rheumatology (Oxford), 2018, 57(7): 1135-1144.
[42] Nagy G, Roodenrijs N M T, Welsing P M J, et al. EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis[J]. Ann Rheum Dis, 2022, 81(1): 20-33. DOI: 10.1136/annrheumdis-2021-220973
[43] Conran C, Kolfenbach J, Kuhn K, et al. A review of difficult-to-treat rheumatoid arthritis: definition, clinical presentation, and management[J]. Curr Rheumatol Rep, 2023, 25(12): 285-294. DOI: 10.1007/s11926-023-01117-6
[44] Verhoef L M, Tweehuysen L, Hulscher M E, et al. bDMARD dose reduction in rheumatoid arthritis: a narrative review with systematic literature search[J]. Rheumatol Ther, 2017, 4(1): 1-24. DOI: 10.1007/s40744-017-0055-5
[45] Van Mulligen E, De Jong P H P, Kuijper T M, et al. Gradual tapering TNF inhibitors versus conventional synthetic DMARDs after achieving controlled disease in patients with rheumatoid arthritis: first-year results of the randomised controlled TARA study[J]. Ann Rheum Dis, 2019, 78(6): 746-753. DOI: 10.1136/annrheumdis-2018-214970
[46] Van Mulligen E, Weel A E, Hazes J M, et al. Tapering towards DMARD-free remission in established rheumatoid arthritis: 2-year results of the TARA trial[J]. Ann Rheum Dis, 2020, 79(9): 1174-1181. DOI: 10.1136/annrheumdis-2020-217485
[47] Van Mulligen E, Weel A E, Kuijper T M, et al. Two-year cost effectiveness between two gradual tapering strategies in rheumatoid arthritis: cost-utility analysis of the TARA trial[J]. Ann Rheum Dis, 2020, 79(12): 1550-1556. DOI: 10.1136/annrheumdis-2020-217528
[48] Emery P, Burmester G R, Bykerk V P, et al. Evaluating drug-free remission with abatacept in early rheumatoid arthritis: results from the phase 3b, multicentre, randomised, active-controlled AVERT study of 24 months, with a 12-month, double-blind treatment period[J]. Ann Rheum Dis, 2015, 74(1): 19-26. DOI: 10.1136/annrheumdis-2014-206106
[49] Aguilar-Lozano L, Castillo-Ortiz J D, Vargas-Serafin C, et al. Sustained clinical remission and rate of relapse after tocilizumab withdrawal in patients with rheumatoid arthritis[J]. J Rheumatol, 2013, 40(7): 1069-1073. DOI: 10.3899/jrheum.121427
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