在GCA和PMR中疾病分层:技术现状和未来的前景
Alessandro Tomelleri1, Kornelis S M van der Geest2, Muhammad Asim Khurshid3
1Unit of Immunology, Rheumatology, Allergy and Rare diseases, IRCCS San Raffaele Hospital, Milan, Italy.
Nature reviews. Rheumatology
|June 12, 2023
概括
巨细胞动脉炎 (GCA) 和多肌痛性类风湿 (PMR) 作为一种谱系疾病 (GPSD) 联系在一起. 按临床,成像和实验室数据分层的GPSD指导个性化治疗和资源配置,以获得更好的患者结果.
科学领域:
- 类风湿病学 类风湿病学
- 免疫学 免疫学 免疫学
- 血管炎研究 血管炎研究
背景情况:
- 巨细胞动脉炎 (GCA) 和多肌痛性类风湿 (PMR) 是老年人常见的炎症性疾病.
- GCA和PMR都有共同的特征,如IL-6主导,葡萄皮质激素反应能力和慢性复发过程.
- 一个新兴的观点将GCA和PMR视为一种统一的疾病谱,称为GCA-PMR谱系疾病 (GPSD).
研究的目的:
- 突出GCA-PMR频谱疾病 (GPSD) 概念作为一个统一的框架.
- 强调GCA和PMR的非单体性质,具有不同的并发症和复发风险.
- 倡导GPSD管理的全面分层战略.
主要方法:
- 审查当前文献和对GCA和PMR的临床理解.
- 分析疾病特征,包括炎症标志物,临床表现和血管参与.
- 讨论基于临床发现,成像和实验室数据的分层方法.
主要成果:
- 建议GCA和PMR是单一疾病谱 (GPSD) 的一部分.
- GPSD呈现异质性,具有明显的缺血并发症风险,血管损伤和复发率.
- 分层识别了患有视力丧失 (头骨GCA) 风险较高的患者与患有更多复发 (大血管血管炎) 的患者.
结论:
- 建议将GCA和PMR作为GPSD的统一方法.
- 使用临床,成像和实验室数据对GPSD进行全面的分层是定制治疗的关键.
- 早期分层和适应的管理策略对于优化新出现的GPSD的结果至关重要.
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