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*It is not enough for medical professionals to read for reference only! A few days ago, at the 3rd Peking University Rheumatism and Immune Hotspot Forum, Professor Li Mengtao from Peking Union Medical College Hospital mainly introduced the specific standards for the treatment of rheumatoid arthritis (RA), which is a composite index composed of the following three indicators: inflammatory markers, disease Activity, patient report outcome (PRO).
Any isolated index cannot be used as the standard for the treatment of RA.
Figure 1: Introduction of Professor Li Mengtao The earlier the intervention, the higher the chance of remission after stopping the drug.
RA is a complex heterogeneous syndrome, and about 0.
5% of adults worldwide suffer from the disease.
As a disabling disease, its early diagnosis and early intervention are particularly important for the prognosis of patients.
In China, RA can be diagnosed only after one year of development, but it can be diagnosed in only three months or even two weeks abroad.
A foreign study showed that the earlier the intervention is started, the higher the chance of remission after stopping the drug.
Therefore, early diagnosis can not only control the condition, but may also prevent the condition from turning sharply and achieve clinical cure.
Figure 2: Early treatment of RA patients can benefit.
Imaging is very important for the diagnosis of RA, mainly including ultrasound and magnetic resonance imaging (MRI).
Ultrasound can assist in the early diagnosis of RA patients with negative anti-cyclic citrullinated peptide (CCP) antibodies and no bone erosion on X-ray.
In the figure below, orange represents RA patients, and blue represents non-RA patients.
It can be seen from the figure that ultrasound can effectively distinguish RA and non-RA patients.
Figure 3: Significance of ultrasound in the diagnosis of RA.
MRI has high sensitivity for early diagnosis of RA patients with negative anti-CCP antibodies and no bone erosion on X-ray.
It is better than X-ray in showing joint disease, and can detect synovial thickening and bone marrow edema at an early stage And slight erosion of the articular surface is of significance for the early diagnosis of RA. Whether RA meets the standard depends on the composite index! Professor Li Mengtao said that judging whether RA treatment meets the standards requires evaluation of composite indicators: a composite indicator composed of three indicators: inflammatory markers, disease activity, and PRO.
No isolated index can be used as the standard for the treatment of RA.
Figure 4: Inflammatory markers, disease activity and the significance of PRO to RA.
Inflammatory markers 01 disease outcome predictors.
Inflammatory markers include C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), which can be used to predict outcome and treatment reaction.
And high CRP level is one of the factors of poor prognosis of RA.
However, Professor Li Mengtao pointed out that isolated CRP cannot reflect the disease state and is not suitable as a treatment target.
Figure 5: The relationship between isolated CRP and imaging Disease activity 02 Disease activity referees Disease activity is directly related to imaging function, so DAS28, simplified disease activity index (SDAI) and clinical disease activity index ( CDAI) and other imaging techniques to evaluate disease activity.
These are the most important evaluation indicators for the treatment of RA, and are the main indicators for disease progression, dressing change, or drug withdrawal.
Professor Li Mengtao said that DAS28 is a continuous assessment, allowing patients to see a continuous change.
"The first thing I showed patients was the results of DAS28 and CRP.
Why? Because it changes the fastest! Patients can see that the results get better each time they are confident that they will reach the indicators of DAS28 and CRP first, and then look at ESR, SDAI and CDAI, in this way, the patient's treatment goals will continue to improve.
" "Sometimes I let the patient score, the best is 0, the worst is 10, the patient asks me every time: Doctor, what do you think of me? I say I I'm asking you!" Professor Li Mengtao concluded, "So it is very important to record the dynamic changes of the index.
" Similarly, the isolated joint technology cannot be used to assess the disease state.
Only the combination of multiple indicators can better predict the risk of rapid radiographic progress in RA.
Figure 6: Significance of multi-index joint assessment RRO03 The joys and sorrows of doctors and patients are not connected.
In recent years, patients' assessment of disease status has been paid more and more attention. Because the final therapeutic effect cannot be solely based on objective inflammation indicators and imaging results, but also on the subjective feelings of the patient.
Professor Li Mengtao said: “We often think that we have been cured very well during the treatment process, but patients often fail to meet the standard for pain symptoms, so PRO needs to be paid attention to.
” Figure 7: The increasing status of PRO is the most important factor affecting patient scores.
It's pain.
In the past, glucocorticoids were used in the treatment of RA because of its excellent anti-inflammatory and analgesic effects and high patient satisfaction.
However, due to the side effects of hormones, long-term use of hormones is not recommended.
Therefore, after stopping the hormone within 3 to 6 months, we still need to pay attention to the central analgesic effect of the drug in addition to anti-inflammatory.
If the drugs have a synergistic effect, the patient will reach clinical remission more quickly.
Professor Li Mengtao once again emphasized: The isolated PRO cannot be used to evaluate the disease state.
If the patient cannot say that it is good, it is good, because subjective feelings are the worst for standardization.
The revolution has not yet succeeded.
Comrades still have to work hard in our country.
After three months of treatment, the real-world remission rate is about 20%; after 6 months of treatment, the real-world remission rate is about 35%.
Internationally, after one year of treatment, the clinical remission rate is above 50%.
Professor Li Mengtao said: “We are now going to carry out some health economics research, because we used a lot of hormones to treat RA patients in the past, which was very cheap, but these traditional drugs were not innovative, which made the results of the above indicators difficult to see, that is, RA treatment is not Reaching the standard.
Now is an opportunity.
We must make full use of the existing innovative drugs and national medical insurance policies to help RA patients achieve standard treatment.
"Figure 8: Summary of the treatment status of RA patients.
How can RA management reach the standard? The first is to diagnose early and seize the treatment window; the second is to grasp the treatment goals and achieve a composite index composed of three isolated indicators: inflammatory markers, disease activity, and PRO.
Any isolated index cannot be used as the standard for the treatment of RA.
Figure 9: Conference lecture summary Reference: [1]Finckh A, et al.
Arthritis Rheum.
2006;55:864-72[2]Van der Heijde D.
Nat Clin Pract Rheumatol.
2007;3: 258-59[ 3]Ji L, et al.
Clin Rheumatol.
2017;36(2);261-67.
[4] Chinese Medical Association Rheumatology Branch, Chinese Journal of Internal Medicine.
2018;57($): 242-51
Any isolated index cannot be used as the standard for the treatment of RA.
Figure 1: Introduction of Professor Li Mengtao The earlier the intervention, the higher the chance of remission after stopping the drug.
RA is a complex heterogeneous syndrome, and about 0.
5% of adults worldwide suffer from the disease.
As a disabling disease, its early diagnosis and early intervention are particularly important for the prognosis of patients.
In China, RA can be diagnosed only after one year of development, but it can be diagnosed in only three months or even two weeks abroad.
A foreign study showed that the earlier the intervention is started, the higher the chance of remission after stopping the drug.
Therefore, early diagnosis can not only control the condition, but may also prevent the condition from turning sharply and achieve clinical cure.
Figure 2: Early treatment of RA patients can benefit.
Imaging is very important for the diagnosis of RA, mainly including ultrasound and magnetic resonance imaging (MRI).
Ultrasound can assist in the early diagnosis of RA patients with negative anti-cyclic citrullinated peptide (CCP) antibodies and no bone erosion on X-ray.
In the figure below, orange represents RA patients, and blue represents non-RA patients.
It can be seen from the figure that ultrasound can effectively distinguish RA and non-RA patients.
Figure 3: Significance of ultrasound in the diagnosis of RA.
MRI has high sensitivity for early diagnosis of RA patients with negative anti-CCP antibodies and no bone erosion on X-ray.
It is better than X-ray in showing joint disease, and can detect synovial thickening and bone marrow edema at an early stage And slight erosion of the articular surface is of significance for the early diagnosis of RA. Whether RA meets the standard depends on the composite index! Professor Li Mengtao said that judging whether RA treatment meets the standards requires evaluation of composite indicators: a composite indicator composed of three indicators: inflammatory markers, disease activity, and PRO.
No isolated index can be used as the standard for the treatment of RA.
Figure 4: Inflammatory markers, disease activity and the significance of PRO to RA.
Inflammatory markers 01 disease outcome predictors.
Inflammatory markers include C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), which can be used to predict outcome and treatment reaction.
And high CRP level is one of the factors of poor prognosis of RA.
However, Professor Li Mengtao pointed out that isolated CRP cannot reflect the disease state and is not suitable as a treatment target.
Figure 5: The relationship between isolated CRP and imaging Disease activity 02 Disease activity referees Disease activity is directly related to imaging function, so DAS28, simplified disease activity index (SDAI) and clinical disease activity index ( CDAI) and other imaging techniques to evaluate disease activity.
These are the most important evaluation indicators for the treatment of RA, and are the main indicators for disease progression, dressing change, or drug withdrawal.
Professor Li Mengtao said that DAS28 is a continuous assessment, allowing patients to see a continuous change.
"The first thing I showed patients was the results of DAS28 and CRP.
Why? Because it changes the fastest! Patients can see that the results get better each time they are confident that they will reach the indicators of DAS28 and CRP first, and then look at ESR, SDAI and CDAI, in this way, the patient's treatment goals will continue to improve.
" "Sometimes I let the patient score, the best is 0, the worst is 10, the patient asks me every time: Doctor, what do you think of me? I say I I'm asking you!" Professor Li Mengtao concluded, "So it is very important to record the dynamic changes of the index.
" Similarly, the isolated joint technology cannot be used to assess the disease state.
Only the combination of multiple indicators can better predict the risk of rapid radiographic progress in RA.
Figure 6: Significance of multi-index joint assessment RRO03 The joys and sorrows of doctors and patients are not connected.
In recent years, patients' assessment of disease status has been paid more and more attention. Because the final therapeutic effect cannot be solely based on objective inflammation indicators and imaging results, but also on the subjective feelings of the patient.
Professor Li Mengtao said: “We often think that we have been cured very well during the treatment process, but patients often fail to meet the standard for pain symptoms, so PRO needs to be paid attention to.
” Figure 7: The increasing status of PRO is the most important factor affecting patient scores.
It's pain.
In the past, glucocorticoids were used in the treatment of RA because of its excellent anti-inflammatory and analgesic effects and high patient satisfaction.
However, due to the side effects of hormones, long-term use of hormones is not recommended.
Therefore, after stopping the hormone within 3 to 6 months, we still need to pay attention to the central analgesic effect of the drug in addition to anti-inflammatory.
If the drugs have a synergistic effect, the patient will reach clinical remission more quickly.
Professor Li Mengtao once again emphasized: The isolated PRO cannot be used to evaluate the disease state.
If the patient cannot say that it is good, it is good, because subjective feelings are the worst for standardization.
The revolution has not yet succeeded.
Comrades still have to work hard in our country.
After three months of treatment, the real-world remission rate is about 20%; after 6 months of treatment, the real-world remission rate is about 35%.
Internationally, after one year of treatment, the clinical remission rate is above 50%.
Professor Li Mengtao said: “We are now going to carry out some health economics research, because we used a lot of hormones to treat RA patients in the past, which was very cheap, but these traditional drugs were not innovative, which made the results of the above indicators difficult to see, that is, RA treatment is not Reaching the standard.
Now is an opportunity.
We must make full use of the existing innovative drugs and national medical insurance policies to help RA patients achieve standard treatment.
"Figure 8: Summary of the treatment status of RA patients.
How can RA management reach the standard? The first is to diagnose early and seize the treatment window; the second is to grasp the treatment goals and achieve a composite index composed of three isolated indicators: inflammatory markers, disease activity, and PRO.
Any isolated index cannot be used as the standard for the treatment of RA.
Figure 9: Conference lecture summary Reference: [1]Finckh A, et al.
Arthritis Rheum.
2006;55:864-72[2]Van der Heijde D.
Nat Clin Pract Rheumatol.
2007;3: 258-59[ 3]Ji L, et al.
Clin Rheumatol.
2017;36(2);261-67.
[4] Chinese Medical Association Rheumatology Branch, Chinese Journal of Internal Medicine.
2018;57($): 242-51
