defining remission in rheumatoid arthritis：定义在类风湿关节炎缓解

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1、DefiningRemissioninRheumatoidArthritisPart1:Whyisanewremissiondefinitioninrheumatoidarthritisneeded?BackgroundIncreasingnumbersofpatientsreachremissionAbundanceofremissiondefinitions‘strict’definitions:AmericanRheumatismAssociation(Pinals);SDAI/CDAI‘loose’definitions:DAS/DAS28;mARA;

2、SJC0/TJC0/ESR10;MDANeedforauniformdefinition(RAtrials,practice)EtymologyRemittere(L):tosendback;todecrease;torelax...Remission(meddictionary):anabatementorlesseningofthemanifestationsofadisease(Wiki):thestateofabsenceofdiseaseactivityinpatientswithachronicillness,withthepossibi

3、lityofreturnofdiseaseactivityConcept:KeyPointsRemissionisastate,notchangeortransitionAbsenceofdiseaseactivityConcept:RemissionRelatedbutnotidenticaltoremission:Cure:diseasedoesnotreturnArrest:diseaseprogressionisstoppedIntermission:periodofnoactivitybetweentwoperiodsofactivedisease

4、Remissionisantitheticaltothefollowing:Relapse:returnofdiseaseactivityFlare:substantialincreaseofdiseaseactivityCurrentDefinitions:AmericanRheumatismAssociation*5ormoremustbefulfilledforatleast2consecutivemonths:Morningstiffnessnotexceeding15minutesNofatigueNojointpain(byhistory)No

5、jointtendernessorpainonmotionNosofttissueswellinginjointsortendonsheathsESR(W)<30mm/h(f);<20mm/h(m)*PinalsRS,etal.ArthritisRheum1981;24:1308-15.ARA(Pinals)3groupsofRApatientsclassifiedaccordingtotherheumatologist:completeremissionpartialremissionactivediseaseSensitivity72%;Specif

6、icity90%(againstpartialremission)ProblemswithARA(Pinals)DefinitionDependsonmeasuresnotwidelyassessednowinRAtrials:Morningstiffness(absentinmanypatientswithactiveRA)TendonsheathswellingVerystrictdefinitionAttainmentveryrareinRAtrialsThusunrealistictargetfortreatmentsuccessManyunvali

7、datedmodificationsinuseDAS/DAS28ThresholdforRemission*DAS:Ritchiejointindexand44swollenjointctDAS28:28tender&swollenjointcountESR/CRPversionsBothusea‘generalhealth’VAS(0-100)DAS28remission:<2.6DASremission:<1.6*FransenJetal.Rheumatology2004;43:1252-5.DAS/DAS28RemissionValidationaga

8、instARA(Pinals)crit