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Bulletin on the rheumatic diseases最新文献

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The use of low-dose prednisone in the management of rheumatoid arthritis. 小剂量强的松在类风湿关节炎治疗中的应用。
Bulletin on the rheumatic diseases
Pub Date : 2001-01-01
S S Lim, D L Conn

Low doses of prednisone are safe and effective in the management of RA. Yet, some clinicians continue to manage their RA patients with glucocorticoid doses that are too high or avoid them altogether. Glucocorticoids in low doses have proven to be very effective in suppressing the inflammation associated with RA. In addition, there is good evidence that low doses of prednisolone retard bony erosions of RA. Potential side effects of low doses of glucocorticoids can be anticipated and avoided with prudent preventative measures and appropriate management. Therefore, prednisone should be initiated as early as possible in the treatment of RA usually with another DMARD. Treatment of the inflammation in RA should not exceed 10 mg/day and often may need to be given in daily divided doses (5 mg BID). Supplemental daily calcium at 800-1,000 mg/day and vitamin D at 400-800 units/day should always be initiated with treatment. Tapering of prednisone should be done slowly using 1 mg decrements every couple weeks to a month. One should not deem it a failure to hold the patient on the lowest effective dose of prednisone.

低剂量强的松治疗类风湿性关节炎是安全有效的。然而，一些临床医生继续用糖皮质激素剂量过高或完全避免使用它们来管理他们的RA患者。低剂量的糖皮质激素已被证明对抑制与类风湿性关节炎相关的炎症非常有效。此外，有充分的证据表明，低剂量强的松龙可以延缓类风湿性关节炎的骨质侵蚀。低剂量糖皮质激素的潜在副作用可以通过谨慎的预防措施和适当的管理来预测和避免。因此，强的松应尽早开始治疗RA，通常与另一种DMARD同时使用。类风湿性关节炎炎症的治疗不应超过10mg /天，通常可能需要每天分次服用(BID 5mg)。每日补充钙800- 1000毫克/天，维生素D 400-800单位/天，应始终与治疗一起开始。强的松的逐渐减量应该每两周到一个月减少1毫克。我们不应该认为用最低有效剂量的强的松治疗病人是失败的。
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引用次数: 0
Sensible approach to low back pain. 合理处理腰痛。
Bulletin on the rheumatic diseases
Pub Date : 2001-01-01
S M Helfgott
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引用次数: 0
Update on reactive arthritis. 反应性关节炎的最新进展。
Bulletin on the rheumatic diseases
Pub Date : 2001-01-01
L H Sigal
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引用次数: 0
Getting to the heart of the matter in systemic lupus and rheumatoid arthritis. 进入系统性狼疮和类风湿性关节炎的核心问题。
Bulletin on the rheumatic diseases
Pub Date : 2001-01-01
S Manzi, M C Wasko
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引用次数: 0
Sex and arthritis. 性和关节炎。
Bulletin on the rheumatic diseases
Pub Date : 2000-07-01
R S Panush, G D Mihailescu, M T Gornisiewicz, S H Sutaria, D J Wallace
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引用次数: 0
Adult-onset Still's disease. 成人发病的斯蒂尔氏病。
Bulletin on the rheumatic diseases
Pub Date : 2000-01-01
J J Cush
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引用次数: 0
Lyme disease and the Lyme disease vaccines. 莱姆病和莱姆病疫苗。
Bulletin on the rheumatic diseases
Pub Date : 1999-04-01
L H Sigal

Both OspA vaccines, with or without adjuvant, are effective and safe. People must receive repeated doses of the vaccine, however, to receive effective protection. If the vaccines are to be part of a Lyme disease prevention strategy, doctors and patients must pay attention to booster shot timing. Maximum public health benefit can be achieved only if the Lyme disease vaccines are integrated into broad individual and community-based efforts to prevent Lyme disease and other tick-borne diseases. Only people at significant risk of contracting Lyme disease should consider vaccination, and vaccination should merely complement--not replace--personal precautions for avoiding tick bites.

两种OspA疫苗，无论是否有佐剂，都是有效和安全的。然而，人们必须多次接种疫苗才能获得有效保护。如果疫苗是莱姆病预防策略的一部分，医生和患者必须注意加强注射的时机。只有将莱姆病疫苗纳入广泛的个人和社区努力，以预防莱姆病和其他蜱传疾病，才能实现最大的公共卫生效益。只有极有可能感染莱姆病的人才应考虑接种疫苗，而接种疫苗应只是补充——而不是取代——避免蜱虫叮咬的个人预防措施。
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引用次数: 0
Lupus for the non-rheumatologist. 非风湿病专家的狼疮。
Bulletin on the rheumatic diseases
Pub Date : 1999-01-01
D J Wallace
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引用次数: 0
Update on fibromyalgia syndrome. 纤维肌痛综合征的最新进展。
Bulletin on the rheumatic diseases
Pub Date : 1999-01-01
D J Wallace, S Shapiro, R S Panush
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引用次数: 0
Tumor necrosis factor inhibitors for rheumatoid arthritis. 类风湿关节炎肿瘤坏死因子抑制剂。
Bulletin on the rheumatic diseases
Pub Date : 1999-01-01
R E Jones, L W Moreland

Tumor necrosis factor antagonists such as infliximab and etanercept represent a new and powerful approach to managing RA. In studies published to date, TNF antagonists appear to be safe and effective agents for short-term therapeutic use in RA. Defining when in the course of RA to use TNF antagonists and determining the effectiveness of combinations of these biologic agents with DMARDs or other cytokine antagonists are areas of current and future studies. Other cytokine antagonists that may be promising subjects for further study are IL-1 antagonists. Like TNF, IL-1 is a member of the inflammatory cascade, but may play a different role in the development of inflammatory arthritis. In animal models, inhibition of TNF suppressed the inflammatory response while IL-1 antagonism prevented joint destruction (2). These results imply that combination therapy providing inhibition of both IL-1 and TNF might be an effective treatment in humans with RA, but clinical trials in humans have not yet been performed. Studies are underway in people with early RA to determine if the new TNF inhibitors are more effective or safer than currently available therapies, such as methotrexate. Other agents that inhibit TNF activity are also being tested at this time in people with RA.

肿瘤坏死因子拮抗剂如英夫利昔单抗和依那西普是治疗类风湿性关节炎的一种新的有效方法。在迄今为止发表的研究中，TNF拮抗剂似乎是安全有效的RA短期治疗药物。确定在类风湿关节炎过程中何时使用TNF拮抗剂以及确定这些生物制剂与dmard或其他细胞因子拮抗剂联合使用的有效性是当前和未来研究的领域。其他细胞因子拮抗剂可能是有希望进一步研究的对象是IL-1拮抗剂。与TNF一样，IL-1也是炎症级联反应的一员，但可能在炎性关节炎的发展中发挥不同的作用。在动物模型中，TNF的抑制抑制了炎症反应，而IL-1的拮抗作用阻止了关节破坏(2)。这些结果表明，同时抑制IL-1和TNF的联合治疗可能是治疗人类RA的有效方法，但尚未进行人体临床试验。目前正在对早期RA患者进行研究，以确定新的TNF抑制剂是否比目前可用的治疗方法(如甲氨蝶呤)更有效或更安全。其他抑制肿瘤坏死因子活性的药物目前也在RA患者身上进行测试。
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