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Current management of giant cell arteritis and its complications. 巨细胞动脉炎及其并发症的治疗现状。
IF 5.2 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-09-01 Epub Date: 2024-06-26 DOI: 10.1097/BOR.0000000000001029
Elena Galli, Francesco Muratore, Kenneth J Warrington

Purpose of review: This review provides an update on current management strategies for giant cell arteritis (GCA), emphasizing the need for alternative therapies to reduce disease relapses and mitigate glucocorticoid (GC)-related morbidity.

Recent findings: The standard of care for GCA has traditionally involved prolonged use of GC, and recent studies are exploring faster GC tapering regimens in an effort to reduce adverse effects while maintaining disease control. Randomized clinical trials have highlighted the efficacy of tocilizumab (TCZ), an interleukin-6 receptor inhibitor, in reducing disease flares and sparing GCs. However, the optimal treatment duration with TCZ is unknown and patients remain at risk of relapse after treatment discontinuation. An unmet therapeutic need persists for patients who are not candidates for TCZ, and for those who have inadequate response to this biologic. Therefore, investigations into alternative therapies such as targeting interleukin-17A, blocking T-cell activation or inhibiting the Janus kinase-signal transducer and activator of transcription pathway, showcase potential avenues for tailored treatments.

Summary: While GCs remain the cornerstone of therapy, TCZ emerges as a promising GC-sparing agent. Ongoing research targeting different pathways implicated in GCA pathogenesis have led to encouraging results. However, the preliminary nature of these findings necessitates larger randomized controlled trials to establish their efficacy conclusively.

综述的目的:本综述介绍了巨细胞动脉炎(GCA)目前治疗策略的最新进展,强调需要采用替代疗法来减少疾病复发并降低与糖皮质激素(GC)相关的发病率:最近的研究结果:GCA的标准治疗方法历来包括长期使用糖皮质激素,而最近的研究正在探索更快的糖皮质激素减量方案,以期在维持疾病控制的同时减少不良反应。随机临床试验强调了白细胞介素-6受体抑制剂托西珠单抗(TCZ)在减少疾病复发和节省 GCs 方面的疗效。然而,TCZ的最佳治疗时间尚不明确,患者在停止治疗后仍有复发的风险。对于不适合使用 TCZ 的患者以及对这种生物制剂反应不佳的患者来说,治疗需求仍未得到满足。因此,针对白细胞介素-17A、阻断 T 细胞活化或抑制 Janus 激酶-信号转导和激活转录途径等替代疗法的研究,为量身定制的治疗提供了潜在的途径。针对与 GCA 发病机制有关的不同途径正在进行的研究取得了令人鼓舞的成果。然而,由于这些研究结果尚属初步性质,因此有必要进行更大规模的随机对照试验,以最终确定其疗效。
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引用次数: 0
SGLT-2 inhibitors: new horizons for rheumatologists. SGLT-2 抑制剂:风湿病学家的新视野。
IF 5.2 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-09-01 Epub Date: 2024-07-24 DOI: 10.1097/BOR.0000000000001030
Katherine Chakrabarti, W Joseph McCune

Purpose of review: Sodium glucose cotransporter 2 (SGLT2) inhibitors are a class of medications initially developed for the treatment of diabetes, although their cardiac and renal protective benefits are far reaching. There has been marked interest in the rheumatology community to adopt these medications into our clinical practice, particularly for chronic kidney disease with persistent proteinuria.

Recent findings: SGLT2 inhibitors have been approved for patients with type 2 diabetes mellitus, heart failure with reduced or preserved ejection fraction, atherosclerotic cardiovascular disease in the setting of type 2 diabetes mellitus, as well as chronic kidney disease with proteinuria. Large studies on SGLT2 inhibitors have largely excluded patients with proteinuric chronic kidney disease due to autoimmune glomerulonephritis due to concerns for confounding from immunosuppression. The Dapagliflozin and Prevention of Adverse Outcomes in CKD Trial (DAPA-CKD) showed that SGLT2 inhibition decreased progression of renal disease in patients with IgA nephropathy. Expanding this to other autoimmune glomerulonephropathies, several small studies have shown improvements in proteinuria in patients with lupus nephritis treated with SGLT2 inhibitors. A study evaluating safety of SGLT2 inhibitors in patients with lupus identified no specific concerns even with concomitant use of immunosuppression.

Summary: Small studies have shown that SGLT2 inhibitors can been utilized safely and efficaciously in patients with lupus nephritis. Additional research is needed to identify where these medications fit into the rheumatology treatment armamentarium.

综述目的:葡萄糖钠共转运体 2 (SGLT2) 抑制剂是一类最初为治疗糖尿病而开发的药物,但其对心脏和肾脏的保护作用十分深远。风湿病学界对在临床实践中采用这类药物,尤其是治疗伴有持续蛋白尿的慢性肾脏病有明显兴趣:SGLT2 抑制剂已被批准用于治疗 2 型糖尿病、射血分数降低或保留的心力衰竭、2 型糖尿病合并动脉粥样硬化性心血管疾病以及伴有蛋白尿的慢性肾病患者。关于 SGLT2 抑制剂的大型研究大多排除了因自身免疫性肾小球肾炎而导致蛋白尿的慢性肾病患者,因为担心免疫抑制会造成混淆。达帕格列净和预防慢性肾脏病不良后果试验(DAPA-CKD)显示,抑制 SGLT2 可减少 IgA 肾病患者的肾病进展。将这一研究扩展到其他自身免疫性肾小球肾病,几项小型研究显示,接受 SGLT2 抑制剂治疗的狼疮肾炎患者的蛋白尿有所改善。一项评估狼疮患者使用 SGLT2 抑制剂安全性的研究发现,即使同时使用免疫抑制剂,也没有特别的问题。总结:小型研究显示,狼疮肾炎患者可以安全有效地使用 SGLT2 抑制剂。还需要进行更多的研究,以确定这些药物在风湿病治疗中的适用范围。
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引用次数: 0
Updates in the care and management of children and adolescents with systemic lupus erythematosus. 系统性红斑狼疮儿童和青少年患者的最新护理和管理方法。
IF 5.2 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-09-01 Epub Date: 2024-05-15 DOI: 10.1097/BOR.0000000000001026
Clovis A Silva, Nadia E Aikawa, Eloisa Bonfa

Purpose of review: This narrative review offers an update of the most important recent articles published in the previous year of childhood-onset systemic lupus erythematosus (cSLE), focusing on care and management.

Recent findings: Age-related disparities may play a significant role in the clinical and laboratory characteristics of cSLE, as well as its performance in distinct classification criteria. Monogenic lupus is associated with higher disease damage scores and mortality rate compared to sporadic cSLE. Adolescent face unique challenges, with comorbid psychiatric diagnosis, low resilience and nonadherence posing relevant challenges. A recent international task force has outlined pivotal principles and points-to-consider for treat-to-target (T2T) in cSLE patients. While the past year did yield new randomized controlled trial for cSLE treatment, publications focused on broader management strategies, including the impact of ultraviolet radiation exposure, immunization, and strict blood pressure control. Additionally, case reports and series have evaluated the efficacy/safety profiles of both available and emerging treatments.

Summary: Current studies highlighted the various facets of cSLE, epidemiology, clinical, laboratory, classification criteria, adolescent issues, prognosis, surveillance, T2T approach and drug management. Despite notable progress, the scarcity of randomized trials emphasizes the need to delineate safer and more efficacious treatment modalities in cSLE.

综述的目的:这篇叙事性综述对前一年发表的有关儿童期系统性红斑狼疮(cSLE)的最重要的最新文章进行了更新,重点关注护理和管理:最近的研究结果:与年龄有关的差异可能在系统性红斑狼疮的临床和实验室特征及其在不同分类标准中的表现中起着重要作用。与散发性狼疮相比,单基因狼疮与较高的疾病损害评分和死亡率相关。青少年面临着独特的挑战,合并精神病诊断、抗病能力差和不坚持治疗都是相关的挑战。最近,一个国际工作组概述了对系统性红斑狼疮患者进行 "靶向治疗"(T2T)的关键原则和注意事项。过去一年中,确实有新的针对系统性红斑狼疮治疗的随机对照试验,但发表的文章主要集中在更广泛的管理策略上,包括紫外线照射、免疫接种和严格血压控制的影响。此外,病例报告和系列研究还对现有治疗方法和新兴治疗方法的疗效/安全性进行了评估。摘要:当前的研究突出了系统性红斑狼疮的各个方面,包括流行病学、临床、实验室、分类标准、青少年问题、预后、监测、T2T方法和药物管理。尽管取得了显著的进展,但随机试验的稀缺性突出表明,有必要为系统性红斑狼疮确定更安全、更有效的治疗模式。
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引用次数: 0
Editorial introduction. 编辑介绍。
IF 5.2 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-09-01 Epub Date: 2024-08-01 DOI: 10.1097/BOR.0000000000001031
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引用次数: 0
Novel therapies in juvenile idiopathic arthritis. 幼年特发性关节炎的新疗法。
IF 5.2 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-09-01 Epub Date: 2024-05-22 DOI: 10.1097/BOR.0000000000001028
Anne M Sage, Sarah L N Clarke, Athimalaipet V Ramanan

Purpose of review: This review summarises the major novel treatment options for children with juvenile idiopathic arthritis (JIA) since the pandemic, reflecting not only on advancements in therapeutics but also approach to management and research.

Recent findings: Several recent international paediatric trials have been important in advancing understanding of JIA and furthering available treatment options. Biologic and small molecule agents were demonstrated to be effective and safe in recalcitrant or severe JIA (including extra-articular complications), mirroring the adult equivalent diseases.

Summary: Although joint and overall health have vastly improved for young people with JIA, ongoing international collaboration, critical review of treatment strategies and high quality research are essential to optimize outcomes.

综述目的:本综述总结了自大流行病以来针对幼年特发性关节炎(JIA)患儿的主要新型治疗方案,不仅反映了治疗方面的进展,还反映了管理和研究方法:最近的研究结果:最近进行的几项国际儿科试验对增进人们对 JIA 的了解和改进现有的治疗方案非常重要。生物制剂和小分子制剂被证明对顽固性或严重的JIA(包括关节外并发症)有效且安全,这与成人同等疾病的情况类似。总结:尽管患有JIA的年轻人的关节和整体健康状况有了很大改善,但持续的国际合作、对治疗策略的严格审查以及高质量的研究对于优化治疗效果至关重要。
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引用次数: 0
Update on antineutrophil cytoplasmic autoantibody vasculitis in children. 儿童抗中性粒细胞胞浆自身抗体血管炎的最新进展。
IF 5.2 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-09-01 Epub Date: 2024-07-10 DOI: 10.1097/BOR.0000000000001033
Jessica L Bloom, Eveline Y Wu

Purpose of review: Antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) is often organ- or life-threatening in children and impacts them during important periods of psychosocial and physical development. This review covers recent advances in the pathophysiology, diagnosis, management, and outcomes of AAV in children and highlights the ongoing need for funding and increased research collaboration.

Recent findings: Recent work has improved our understanding of AAV disease pathogenesis, potentially identifying new biomarkers and therapeutic targets. Collaborative clinical studies have also highlighted the variable manifestations in children and identified potential factors associated with poorer outcomes. Consensus-based treatment guidelines are also appearing, but clinical trials are still essential to better understanding treatment efficacy and safety in children affected by AAV. New, validated outcome measures, including those that are patient-reported, will facilitate these much-needed clinical trials in pediatric AAV.

Summary: There is a continued need for more rigorous study in pediatric AAV, however, there is certainly excitement with the increase in recent research relevant to the pediatric population.

综述目的:抗中性粒细胞胞浆自身抗体(ANCA)相关性血管炎(AAV)通常会危及儿童的器官或生命,并在儿童心理和身体发育的重要时期对其造成影响。本综述涵盖了儿童 AAV 的病理生理学、诊断、管理和预后方面的最新进展,并强调了对资金和加强研究合作的持续需求:最新研究结果:最近的研究工作增进了我们对儿童艾滋病病毒疾病发病机制的了解,并有可能确定新的生物标志物和治疗靶点。临床合作研究也强调了儿童的不同表现,并确定了与较差预后相关的潜在因素。基于共识的治疗指南也已出现,但临床试验对于更好地了解 AAV 患儿的治疗效果和安全性仍然至关重要。新的、经过验证的结果测量方法,包括那些由患者报告的方法,将促进这些急需的儿科 AAV 临床试验。
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引用次数: 0
Calcinosis in systemic sclerosis. 系统性硬化症中的钙化。
IF 5.2 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-09-01 Epub Date: 2023-10-10 DOI: 10.1097/BOR.0000000000000900
Srijana Davuluri, Christian Lood, Lorinda Chung

Purpose of review: To provide updated information on the prevalence, pathogenesis, diagnostics, and therapeutics of calcinosis cutis associated with systemic sclerosis (SSc).

Recent findings: Observational studies show ethnic and geographical differences in the prevalence of calcinosis. In addition to clinical and serological associations, biochemical studies and in-vivo models have attempted to explain theories behind its pathogenesis, including prolonged state of inflammation, mechanical stress, hypoxia, and dysregulation in bone and phosphate metabolism. Long-term use of proton pump inhibitors may increase the risk for calcinosis in SSc. Few single center observational studies have shown mild benefit with minocycline and topical sodium thiosulfate.

Summary: Calcinosis cutis is the deposition of insoluble calcium in the skin and subcutaneous tissues. It affects up to 40% of SSc patients and causes significant morbidity. Long disease duration, features of vascular dysfunction, and osteoporosis have been associated with calcinosis. Altered levels of inorganic pyrophosphate and fibroblast growth factor-23 have been implicated in dysregulated phosphate metabolism that may lead to calcinosis in SSc. Plain radiography can help with diagnosis and quantifying the calcinosis burden. Surgical treatment remains the most effective therapy when feasible. At present, no medical therapies have proven efficacy in large randomized controlled trials.

综述目的:提供与系统性硬化症(SSc)相关的皮肤钙化症的患病率、发病机制、诊断和治疗的最新信息。最近的研究结果:观察研究显示钙化症患病率存在种族和地理差异。除了临床和血清学关联外,生化研究和体内模型还试图解释其发病机制背后的理论,包括长期炎症状态、机械应激、缺氧以及骨和磷酸盐代谢失调。长期使用质子泵抑制剂可能会增加SSc钙化的风险。很少有单中心观察性研究显示米诺环素和局部硫代硫酸钠有轻微的益处。摘要:钙化性皮肤病是指不溶性钙沉积在皮肤和皮下组织中。它影响高达40%的SSc患者,并导致显著的发病率。长期患病、血管功能障碍和骨质疏松症与钙质沉着有关。无机焦磷酸盐和成纤维细胞生长因子-23水平的改变与磷酸盐代谢失调有关,这可能导致SSc的煅烧。平片摄影可以帮助诊断和量化钙化负担。在可行的情况下,手术治疗仍然是最有效的治疗方法。目前,没有任何药物疗法在大型随机对照试验中被证明有效。
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引用次数: 0
Autoantibodies as putative biomarkers and triggers of cell dysfunctions in systemic sclerosis. 自身抗体是系统性硬化症细胞功能障碍的假定生物标志物和诱因。
IF 5.2 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-07-25 DOI: 10.1097/BOR.0000000000001035
Irene Rosa, Eloisa Romano, Bianca Saveria Fioretto, Mirko Manetti

Purpose of review: Antinuclear autoantibodies represent a serological hallmark of systemic sclerosis (SSc), with anticentromere, antitopoisomerase-I, and anti-RNA polymerase III antibodies routinely assessed for diagnosis, clinical subset classification, and prognosis. In addition, an increasing number of autoantibodies have been demonstrated to play a pathogenic role by mediating different SSc manifestations. This review aims to give an overview on autoantibodies as putative biomarkers in SSc and discuss their possible pathogenic role as triggers of cell dysfunctions.

Recent findings: Over the years, different autoantibodies have been proposed as biomarkers aiding in diagnosis, disease subtype classification, disease progression prediction, organ involvement, as well as in understanding treatment response. Increasing literature also indicates functional autoantibodies as direct contributors to SSc pathogenesis by exerting agonistic or antagonistic activities on their specific cognate targets.

Summary: In SSc, search and validation of novel autoantibodies with higher diagnostic specificity and more accurate predictive values are increasingly needed for early diagnosis and specific follow-up, and to define the best therapeutic option according to different disease subsets. Moreover, since autoantibodies are also emerging as functional pathogenic players, a better unraveling of their possible pathomechanisms becomes essential to identify new targets and develop promising therapeutic agents able to neutralize their effects.

综述的目的:抗核自身抗体是系统性硬化症(SSc)的血清学标志,抗中心粒抗体、抗异构酶Ⅰ抗体和抗RNA聚合酶Ⅲ抗体是诊断、临床亚组分类和预后的常规评估指标。此外,越来越多的自身抗体被证实通过介导不同的 SSc 表现而发挥致病作用。本综述旨在概述作为 SSc 潜在生物标志物的自身抗体,并讨论它们作为细胞功能障碍诱因可能发挥的致病作用:多年来,不同的自身抗体被认为是有助于诊断、疾病亚型分类、疾病进展预测、器官受累以及了解治疗反应的生物标志物。越来越多的文献还表明,功能性自身抗体通过对其特定的同源靶点发挥激动或拮抗作用,直接促进了 SSc 的发病机制。总结:在 SSc 中,越来越需要寻找和验证诊断特异性更高、预测值更准确的新型自身抗体,以便进行早期诊断和特定随访,并根据不同的疾病亚型确定最佳治疗方案。此外,由于自身抗体也正在成为功能性致病因子,因此更好地揭示其可能的病理机制对于确定新的靶点和开发能够中和其作用的治疗药物至关重要。
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引用次数: 0
Disease modification in axial spondyloarthritis - still a controversy? 轴性脊柱关节炎的疾病改变--仍有争议吗?
IF 5.1 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-07-01 Epub Date: 2024-05-07 DOI: 10.1097/BOR.0000000000001025
Manouk de Hooge, Désirée van der Heijde

Purpose of review: This review evaluates recent advancements in disease-modifying therapies for axial spondyloarthritis (axSpA).

Recent findings: A recent study could not demonstrate an additional effect of NSAID therapy on golimumab [Tumor Necrosis Factor-α inhibitor (TNFi)] on structural progression; however, this might be due to the fact that the study was underpowered. While DMARDs have shown promise in suppressing inflammation, their impact on structural progression remains uncertain. A well powered trial showed no difference in spinal progression between secukinumab [Interleukin17A inhibitor (IL17Ai)] and adalimumab-biosimilar (TNFi). Preliminary data on Janus kinase inhibitors (JAKi) focus on MRI findings but lack evidence on radiographic spinal progression. While some studies suggest promising outcomes, others reveal limitations and inconclusive findings.

Summary: Recent studies explore the effectiveness of NSAIDs, biological disease-modifying antirheumatic drugs like TNFi and IL-17i, as well as JAK inhibitors in axSpA. Conflicting evidence surrounds these therapies' ability to impede structural progression, with challenges in study design and interpretation. Moreover, changes in demographics and treatment methods underscore the importance of examining trends over time when assessing disease outcomes. Ultimately, ongoing research could benefit from new imaging tools when evaluating therapeutic strategies for modifying disease progression in axSpA.

综述的目的:本综述评估了轴性脊柱关节炎(axSpA)疾病修饰疗法的最新进展:最近的一项研究未能证明非甾体抗炎药物治疗对戈利木单抗(肿瘤坏死因子-α抑制剂(TNFi))结构进展的额外影响;不过,这可能是由于该研究的力量不足。虽然DMARDs在抑制炎症方面已显示出前景,但其对结构性进展的影响仍不确定。一项动力充足的试验显示,secukinumab(白细胞介素17A抑制剂(IL17Ai))与阿达木单抗生物类似物(TNFi)在脊柱进展方面没有差异。有关Janus激酶抑制剂(JAKi)的初步数据侧重于核磁共振成像结果,但缺乏脊柱放射学进展方面的证据。虽然一些研究表明结果很有希望,但另一些研究则显示出局限性和不确定的结果:最近的研究探讨了非甾体抗炎药、TNFi 和 IL-17i 等生物改变病情抗风湿药以及 JAK 抑制剂对 axSpA 的疗效。关于这些疗法是否能阻止结构性进展的证据相互矛盾,在研究设计和解释方面也存在挑战。此外,人口统计学和治疗方法的变化也凸显了在评估疾病预后时研究随时间变化趋势的重要性。最终,在评估改变axSpA疾病进展的治疗策略时,新的成像工具将使正在进行的研究受益匪浅。
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引用次数: 0
Sacroiliitis in inflammatory bowel disease. 炎症性肠病中的骶髂关节炎。
IF 5.1 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-07-01 Epub Date: 2024-04-30 DOI: 10.1097/BOR.0000000000001017
Fardina Malik, Michael H Weisman

Purpose of review: This review summarizes the recent evidence regarding the epidemiology of inflammatory bowel disease (IBD) associated sacroiliitis, including the prevalence, pathogenesis, role of imaging, and therapeutic challenges.

Recent findings: Sacroiliitis is an underappreciated musculoskeletal manifestation of IBD, a chronic inflammatory condition of the gut affecting the younger population. Untreated sacroiliitis can lead to joint destruction and chronic pain, further adding to morbidity in IBD patients. Recent publications suggest sacroiliitis can be detected on abdominal imaging obtained in IBD patients to study bowel disease, but only a small fraction of these patients were seen by rheumatologists. Early detection of IBD-associated sacroiliitis could be achieved by utilization of clinical screening tools in IBD clinics, careful examination of existing computed tomography and MRI studies, and timely referral to rheumatologist for further evaluation and treatment. Current treatment approaches for IBD and sacroiliitis include several targeted biologic therapies, but IBD-associated sacroiliitis has limited options, as these therapies may not overlap in both conditions.

Summary: With the advances in imaging, sacroiliitis is an increasingly recognized comorbidity in IBD patients. Future studies focusing on this unique patient population will expand our understanding of complex pathophysiology of IBD-associated sacroiliitis and lead to identification of novel targeted therapies for this condition.

综述的目的:本综述总结了与炎症性肠病(IBD)相关的骶髂关节炎的流行病学最新证据,包括发病率、发病机制、影像学作用和治疗挑战:骶髂关节炎是 IBD 的一种未得到充分重视的肌肉骨骼表现,IBD 是一种影响年轻人群的慢性肠道炎症。未经治疗的骶髂关节炎会导致关节破坏和慢性疼痛,进一步增加 IBD 患者的发病率。最近的出版物表明,IBD 患者的腹部成像可检测到骶髂关节炎,以研究肠道疾病,但这些患者中只有一小部分由风湿免疫科医生诊治。通过在 IBD 诊所使用临床筛查工具、仔细检查现有的计算机断层扫描和核磁共振成像检查结果,以及及时转诊至风湿免疫科医生进行进一步评估和治疗,可以及早发现与 IBD 相关的骶髂关节炎。目前治疗 IBD 和骶髂关节炎的方法包括几种靶向生物疗法,但 IBD 相关性骶髂关节炎的选择有限,因为这些疗法在这两种疾病中可能并不重叠。未来针对这一特殊患者群体的研究将拓展我们对 IBD 相关性骶髂关节炎复杂病理生理学的认识,并最终确定治疗这种疾病的新型靶向疗法。
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引用次数: 0
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Current opinion in rheumatology
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