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。
Rheumatoid arthritis(RA)is a systemic autoimmune disease that mainly manifests as symmetrically,continuously and erosive polyarthriti multiple arthritis mainly involving small joints such as the proximal interphalangeal joints,metacarpophalangeal joints,and wrist joints of both hands.Elderly patients with RA refers to patients with this disease with an age ed over 60 years.Elderly patients with RA are classified into two clinical subsets,namely,elderly-onset RA(EORA)and younger-onset elderly RA(YORA).The population of elderly with RA is expanding because of the aging of populations and increased life expectancy.EORA seems to have an epidemiological character and a clinical pattern different from that of YORA.A prompt diagnosis of true RA is important to implement early treatment.The diagnosis of EORA from other rheumatological disorders,such as polymyalgia,gouty arthritis and osteoarthritis,which are prevalent in this stratum of the population,are different.The method for diagnosing EORA lacks specificity.In addition,this disease exhibits symptoms similar to EORA,which makes diagnosis more difficult at the early stage.The treatment of EORA aims to achieve the same objectives as in the treatment of YORA,that is,to control clinical manifestations,prevent structural damage,preserve functions and decrease excess mortality.Owing to pharmacokinetics changes,high renal insufficiency,age-related immunosenescence and other risk factors,the management of patients with EORA is challenging.Currently,the drugs used to treat RA include Nonsteroidal anti-inflammatory drug(NSAIDs),glucocorticoid,traditional disease-modifying anti-rheumatic drugs(csDMARD),biological DMARDs(BDMARDs)and targeted synthetic DMARDs(TsDMARDs).Patients with EORA should be carefully monitored because of high risk of adverse events associated with treatment.A tailored approach that aims to achieve clinical remission should be adopted on the basis of disease severity and risk profiles of patients with EORA.
作者
宋梦婷
王振杰
郭培霞
李君茹
程海华
SONG Meng-ting;WANG Zhen-jie;GUO Pei-xia;LI Jun-ru;CHENG Hai-hua(Department of Rheum atology and Immunology,Puyang Peoples Hospital,Xinxiang Medical College,Puyang,Henan 451000,China)
出处
《中华全科医学》
2021年第4期648-652,共5页
Chinese Journal of General Practice
基金
河南省卫健委科研基金项目(2018020795)。
关键词
类风湿关节炎
老年
流行病学
诊治
Rheumatoid arthritis
Old age
Epidemiology
Diagnosis and treatment
