Öz
Romatoid artrit, esas olarak sinoviyal eklemleri tutan kronik, sistemik, inflamatuvar eklem hastalığıdır. Erken tanı konması, yüksek hastalık aktivitesi, otoantikor pozitifliği ve erken eklem hasarı gibi kötü prognostik faktörlere sahip hastalarda optimal terapötik başarı için anahtardır. Tedavi algoritmalarında, kompozit indeksler ile hastalık aktivitesi ölçümleri, treat-to-target tedavi stratejileri ve tedavilerin etki ve yan etkiler açısından uygun şekilde izlemleri yer alır. Remisyon veya en azından düşük hastalık aktivitesi olarak belirlenen tedavi hedefi sağlanana kadar tedavi modifikasyonları yapılmalıdır. Hedef sağlandığında ve sürdürülebildiğinde, doz azaltımına gidilebilir. Çoğu hastada tedavi yanıtları kabul edilebilir düzeylerde olsa da, mevcut tedavilere yanıt her zaman mümkün olamamaktadır. Gelecekte yapılacak daha kapsamlı çalışmalar ile bireyselleştirilmiş tedavilerin geliştirilmesi mümkün olabilecektir.
Anahtar Kelimeler
Kaynakça
- Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet 2016;388:2023-38.
- Bergstra SA, Allaart CF. What is the optimal target for treat-to-target strategies in rheumatoid arthritis? Curr Opin Rheumatol 2018;30: 282-7. Leeb BF, Brezinschek HP, Rintelen B. RADAI-5 and electronic monitoring tools. Clin Exp Rheumatol 2016; 34: 5-10.
- Gomez-Centeno A, Rubio-Romero E, Ovalles JG, et al. Clinical and therapeutic management of rheumatoid arthritis with biological disease-modifying antirheumatic drugs: RADAR study. Rheumatol Int 2019 Aug 8 doi: 10.1007/s00296-019-04378-6.
- Pincus T, Yazici Y, Bergman MJ. RAPID3, an index to assess and monitor patients with rheumatoid arthritis, without formal joint counts: similar results to DAS28 and CDAI in clinical trials and clinical care. Rheum Dis Clin North Am 2009; 35: 773-8.
- Johnson TM, Register KA, Schmidt CM, O'Dell JR, Mikuls TR, Michaud K, England BR. Correlation of the Multi-Biomarker Disease Activity Score With RheumatoidArthritis Disease Activity Measures: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken) 2019; 71: 1459-72.
- van Tuyl LH, Felson DT, Wells G, Smolen J, Zhang B, Boers M; American College of Rheumatology; European League against Rheumatism Committee to Define Remission for Clinical Trials. Evidence for predictive validity of remission on long-term outcome in rheumatoid arthritis: a systematic review. Arthritis Care Res (Hoboken) 2010; 62: 108-17.
- Bykerk VP, Massarotti EM. The new ACR/EULAR remission criteria: rationale for developing new criteria for remission. Rheumatology (Oxford) 2012; 51: 16-20.
- Misra DP, Agarwal V, Sharma A, Wakhlu A, Negi VS. 2016 update of the EULAR recommendations for the management of rheumatoid arthritis: a utopia beyond patients in low/middle income countries? Ann Rheum Dis 2017;76(11):e47. doi: 10.1136/annrheumdis-2017-211446.
- Singh JA, Saag KG, Bridges SL Jr, et al; American College of Rheumatology. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2016; 68: 1-25.
- Lau CS, Chia F, Harrison A, Hsieh TY, Jain R, Jung SM; Asia Pacific League of Associations for Rheumatology. APLAR rheumatoid arthritis treatment recommendations. Int J Rheum Dis 2015; 18: 685-713.
- Breedveld FC, Kalden JR. Appropriate and effective management of rheumatoid arthritis. Ann Rheum Dis 2004; 63: 627-33.
- Tanaka Y. Current concepts in the management of rheumatoid arthritis. Korean J Intern Med 2016; 31: 210-8.
- Olsen IC, Lie E, Vasilescu R, Wallenstein G, Strengholt S, Kvien TK. Assessments of the unmet need in the management of patients with rheumatoid arthritis: analyses from the NOR-DMARD registry. Rheumatology (Oxford) 2019; 58: 481-91.
- Gabay C, Riek M, Scherer A, Finckh A; SCQM collaborating physicians. Effectiveness of biologic DMARDs in monotherapy versus in combination with synthetic DMARDs in rheumatoid arthritis: data from the Swiss Clinical Quality Management Registry. Rheumatology (Oxford) 201; 54): 1664-72.
- Mease PJ. Adalimumab in the treatment of arthritis. Ther Clin Risk Manag 2007; 3: 133-48.
Öz
Rheumatoid is a chronic, systemic, inflammatory disorder that primarily involves synovial joints. Early diagnosis is important for the therapeutic success in patients with poor prognostic factors such as high disease activity, high titers of autoantibodies and joint injury in early stages of disease. Algorithms for treatment include using composite indexes, disease activity measures, treat-to-target strategies and appropriate follow-up for effects and side effects. Modifications for treatment should be made until reaching the goal as determined before to be remission or at least low disease activity. When the goal is reached and sustained, dose reduction could be applied. Although for most of the patients, the goal of the therapy is achieved, the results are not always acceptable. Therefore, more detailed studies should be planned for developing individualized therapies.
Anahtar Kelimeler
Kaynakça
- Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet 2016;388:2023-38.
- Bergstra SA, Allaart CF. What is the optimal target for treat-to-target strategies in rheumatoid arthritis? Curr Opin Rheumatol 2018;30: 282-7. Leeb BF, Brezinschek HP, Rintelen B. RADAI-5 and electronic monitoring tools. Clin Exp Rheumatol 2016; 34: 5-10.
- Gomez-Centeno A, Rubio-Romero E, Ovalles JG, et al. Clinical and therapeutic management of rheumatoid arthritis with biological disease-modifying antirheumatic drugs: RADAR study. Rheumatol Int 2019 Aug 8 doi: 10.1007/s00296-019-04378-6.
- Pincus T, Yazici Y, Bergman MJ. RAPID3, an index to assess and monitor patients with rheumatoid arthritis, without formal joint counts: similar results to DAS28 and CDAI in clinical trials and clinical care. Rheum Dis Clin North Am 2009; 35: 773-8.
- Johnson TM, Register KA, Schmidt CM, O'Dell JR, Mikuls TR, Michaud K, England BR. Correlation of the Multi-Biomarker Disease Activity Score With RheumatoidArthritis Disease Activity Measures: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken) 2019; 71: 1459-72.
- van Tuyl LH, Felson DT, Wells G, Smolen J, Zhang B, Boers M; American College of Rheumatology; European League against Rheumatism Committee to Define Remission for Clinical Trials. Evidence for predictive validity of remission on long-term outcome in rheumatoid arthritis: a systematic review. Arthritis Care Res (Hoboken) 2010; 62: 108-17.
- Bykerk VP, Massarotti EM. The new ACR/EULAR remission criteria: rationale for developing new criteria for remission. Rheumatology (Oxford) 2012; 51: 16-20.
- Misra DP, Agarwal V, Sharma A, Wakhlu A, Negi VS. 2016 update of the EULAR recommendations for the management of rheumatoid arthritis: a utopia beyond patients in low/middle income countries? Ann Rheum Dis 2017;76(11):e47. doi: 10.1136/annrheumdis-2017-211446.
- Singh JA, Saag KG, Bridges SL Jr, et al; American College of Rheumatology. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2016; 68: 1-25.
- Lau CS, Chia F, Harrison A, Hsieh TY, Jain R, Jung SM; Asia Pacific League of Associations for Rheumatology. APLAR rheumatoid arthritis treatment recommendations. Int J Rheum Dis 2015; 18: 685-713.
- Breedveld FC, Kalden JR. Appropriate and effective management of rheumatoid arthritis. Ann Rheum Dis 2004; 63: 627-33.
- Tanaka Y. Current concepts in the management of rheumatoid arthritis. Korean J Intern Med 2016; 31: 210-8.
- Olsen IC, Lie E, Vasilescu R, Wallenstein G, Strengholt S, Kvien TK. Assessments of the unmet need in the management of patients with rheumatoid arthritis: analyses from the NOR-DMARD registry. Rheumatology (Oxford) 2019; 58: 481-91.
- Gabay C, Riek M, Scherer A, Finckh A; SCQM collaborating physicians. Effectiveness of biologic DMARDs in monotherapy versus in combination with synthetic DMARDs in rheumatoid arthritis: data from the Swiss Clinical Quality Management Registry. Rheumatology (Oxford) 201; 54): 1664-72.
- Mease PJ. Adalimumab in the treatment of arthritis. Ther Clin Risk Manag 2007; 3: 133-48.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Olgu Sunumu |
| Yazarlar | |
| Yayımlanma Tarihi | 20 Ocak 2021 |
| Gönderilme Tarihi | 6 Nisan 2020 |
| Yayımlandığı Sayı | Yıl 2021 |