[Treatment of rheumatoid arthritis and spondylarthritis with biologics].

4区 医学 Q3 Medicine Internist Pub Date : 2022-02-01 Epub Date: 2022-01-14 DOI:10.1007/s00108-021-01248-x
Christoph Fiehn
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引用次数: 5

Abstract

Biologics are an integral part of modern strategies for treatment of rheumatoid arthritis (RA) and spondylarthritis (SpA), including psoriatic arthritis (PsA). Biologics are biotechnologically produced proteins that have inhibiting effects on humoral and cellular components of rheumatic inflammation. Substance classes used in rheumatology are tumor necrosis factor (TNF)-alpha, interleukin (IL)-1, IL‑6, IL-12, IL-17 and IL-23 inhibitors effective against cytokines as well as the T lymphocyte activation inhibitor abatacept and the B lymphocyte-depleting rituximab. There are clear recommendations for the use of biologics for RA patients inadequately responding to one or more conventional synthetic disease-modifying antirheumatic drugs and for ankylosing spondylitis (AS) and nonradiographical axial SpA patients with an inadequate response to at least two nonsteroidal antirheumatic drugs. For PsA the recommended use depends on the most prominent manifestations in each case. Treatment with biologics should follow the treat to target principle, with a defined and validated treatment target. Treatment in cases of RA and SpA should target remission or at least a low or minimum disease activity. The safety of treatment with biologics has been intensively investigated. There are very specific contraindications for individual substance classes with a focus on an increased risk of infections. The standard procedure before starting treatment with biologics includes the exclusion of latent tuberculosis and hepatitis B. The TNF-alpha inhibitors have a protective effect with respect to myocardial infarction, stroke and venous thromboembolism.

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[生物制剂治疗类风湿性关节炎和脊柱炎]。
生物制剂是治疗类风湿性关节炎(RA)和脊柱炎(SpA),包括银屑病关节炎(PsA)的现代策略的一个组成部分。生物制剂是生物技术生产的蛋白质,对风湿性炎症的体液和细胞成分有抑制作用。风湿病学中使用的物质类别包括肿瘤坏死因子(TNF)- α、白细胞介素(IL)-1、IL- 6、IL-12、IL-17和IL-23抑制剂,它们对细胞因子以及T淋巴细胞活化抑制剂阿巴接受和B淋巴细胞消耗美罗华有效。对于对一种或多种常规合成抗风湿药物反应不充分的类风湿性关节炎患者,以及对至少两种非甾体类抗风湿药物反应不充分的强直性脊柱炎(AS)和非影像学轴向SpA患者,有明确建议使用生物制剂。对于PsA,推荐的使用取决于每个病例最突出的表现。生物制剂的治疗应遵循治疗到目标的原则,有一个明确和有效的治疗目标。类风湿性关节炎和SpA的治疗应以缓解或至少降低或最小化疾病活动为目标。生物制剂治疗的安全性已经得到了深入的研究。个别物质类别有非常具体的禁忌症,重点是感染风险增加。开始生物制剂治疗前的标准程序包括排除潜伏性肺结核和乙型肝炎。tnf - α抑制剂对心肌梗死、中风和静脉血栓栓塞有保护作用。
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来源期刊
Internist
Internist 医学-医学:内科
CiteScore
1.20
自引率
0.00%
发文量
139
审稿时长
4-8 weeks
期刊介绍: Der Internist is an internationally respected journal dealing with all aspects of internal medicine. The journal serves both the scientific exchange and the continuing education of internists working in practical or clinical environments as well as of general practitioners who are particularly interested in internal medicine. The focus is on the topics of prevention, diagnostic approaches, management of complications, and current therapy strategies. Comprehensive reviews on a specific topical issue focus on providing evidenced based information on diagnostics and therapy. Case reports feature interesting cases and aim at optimizing diagnostic and therapeutic strategies. Review articles under the rubric "Continuing Medical Education" present verified results of scientific research and their integration into daily practice.
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