老年人发病的类风湿关节炎:特征和治疗选择
Slavica Pavlov-Dolijanovic1, Milan Bogojevic2, Tatjana Nozica-Radulovic3
1University of Belgrade, Faculty of Medicine, Institute of Rheumatology, 11000 Belgrade, Serbia.
Medicina (Kaunas, Lithuania)
|October 28, 2023
概括
由于对老年人的安全性存在担忧,老年风湿性关节炎 (EORA) 需要早期使用疾病修饰性抗风湿药物 (DMARD) 而不是NSAIDs进行治疗. 个性化的DMARD策略对于最佳的EORA患者结果至关重要.
科学领域:
- 类风湿病学 类风湿病学
- 老年医学 老年医学
- 临床免疫学临床免疫学
背景情况:
- 老年风湿性关节炎 (EORA),定义为60岁以后的风湿性关节炎 (RA),具有独特的临床和免疫特征.
- EORA的特点是急性发病,体质症状,全身表现,大关节参与,炎症标志物升高和患者残疾增加.
- 关节炎包括重叠的子集,包括经典的关节炎,多肌痛类风湿性表型和缓解的阴性血清对称突炎与胀综合征.
研究的目的:
- 为了突出EORA独特的临床特征.
- 强调非类固醇抗炎药物 (NSAID) 在老年患者中使用的挑战和禁忌.
- 倡导在EORA管理中立即启动疾病修饰性抗风湿药物 (DMARDs).
主要方法:
- 对EORA的临床特征和治疗考虑的审查.
- 在老年人群中分析NSAID安全问题和禁忌.
- 对DMARD治疗的评估,包括常规,生物和有针对性的合成选择,用于EORA.
主要成果:
- 由于老年人具有显著的副作用风险和并发症,NSAIDs通常不是EORA的第一线治疗.
- 建议在EORA诊断后立即使用DMARDs,特别是甲醇.
- 生物或向合成DMARDs对抗常规DMARDs的老年患者是有效的.
结论:
- EORA需要量身定制的治疗策略,优先考虑DMARDs而不是NSAIDs.
- 未来的研究应该专注于个性化的DMARD方法,考虑疾病活性,并发症和安全性.
- 优化EORA治疗旨在改善治疗结果,减少对葡萄糖皮质激素的依赖,提高患者的生活质量.
相关概念视频
01:21Rheumatic Heart Disease III: Medical Management
11
Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...
11
01:20Rheumatic Heart Disease IV: Nursing Management
15
AssessmentA comprehensive assessment is essential in managing a patient with rheumatic heart disease (RHD). Begin with obtaining a detailed medical history, including recent streptococcal infections, a history of rheumatic fever, or previously diagnosed rheumatic heart disease. Assess the patient for symptoms such as fever, chest pain, widespread joint pain (arthralgia), tachycardia, pericardial friction rub, muffled heart sounds, heart murmurs, peripheral edema, subcutaneous nodules, and...
15
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
37
The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
37
01:23Rheumatic Heart Disease I: Introduction
14
Rheumatic heart disease or RHD is a chronic condition that results from rheumatic fever, causing permanent damage to the heart valves.Etiology and Risk FactorsIt primarily arises from rheumatic fever, an inflammatory disease that can develop after untreated or inadequately treated group A streptococcal (GAS) pharyngitis. Streptococcus spreads through direct contact with oral or respiratory secretions. While the bacteria are the causative agents, factors like malnutrition, overcrowding, poor...
14
01:20Myasthenia Gravis: Overview and Treatment
1.5K
Myasthenia gravis is a neuromuscular transmission disorder characterized by weakness and increased fatigability of skeletal muscles. It is an autoimmune disease affecting approximately one in 2000 people, where antibodies against the α1 subunit of nicotinic acetylcholine receptors are produced.
These antibodies interfere with the function of the nicotinic receptors in three ways: by binding to the receptor and disrupting acetylcholine binding; by causing cross-linking of receptors which...
These antibodies interfere with the function of the nicotinic receptors in three ways: by binding to the receptor and disrupting acetylcholine binding; by causing cross-linking of receptors which...
1.5K
01:26Atherosclerosis III: Management
11
Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
11