脊柱关节炎的目标治疗推荐

Smolen J, et al. Ann Rheum Dis doi:10.1136/annrheumdis-2013-203419. 提前在线发表。

Recommendations to treat all forms of Spondyloarthritis to target

脊柱关节炎的目标治疗推荐

Overarching principles 首要原则
A.	The treatment target must be based on a shared decision between patient and rheumatologist 治疗目标应基于医患沟通后的共同决定。
B.	SpA and PsA are often complex systemic diseases; as needed, the management of musculoskeletal and extra-articular manifestations should be coordinated between the rheumatologist and other specialists (such as dermatologist, gastroenterologist, ophthalmologist) SpA和PsA大多是多系统受累的全身性疾病, 所以骨骼肌肉以及关节外受累应由风湿病医生与其他专科医生（诸如皮肤科、消化科以及眼科）协作治疗。
C.	The primary goal of treating the patient with SpA and/or PsA is to maximise long-term health related quality of life and social participation through control of signs and symptoms, prevention of structural damage, normalisation or preservation of function, avoidance of toxicities and minimisation of comorbidities SpA和/或PsA病人的首要治疗目标是, 通过控制症状和体征, 预防结构性损伤, 恢复或保留关节功能, 避免各种治疗的副作用, 并尽可能减少共患病, 以最大可能地提高健康相关的生活质量。
D.	Abrogation of inflammation is presumably important to achieve these goals 为了实现这些目标, 消除炎症应该是重要的。
E.	Treatment to target by measuring disease activity and adjusting therapy accordingly contributes to the optimisation of short term and/or long term outcomes 目标治疗, 即监测病情活动度并适时调整治疗, 有利于优化短期和/或长期结局。
Recommendations 推荐
Common items for all forms of SpA 适用于各种类型SpA的建议
1.	A major treatment target should be clinical remission/inactive disease of musculoskeletal involvement (arthritis, dactylitis, enthesitis, axial disease), taking extra-articular manifestations into consideration 主要治疗目标之一是受累骨骼肌肉(包括关节炎、指趾炎、附着点炎和中轴关节的)病情缓解或病情不活动, 同时兼顾关节外受累的改善。
2.	The treatment target should be individualised according to the current clinical manifestations of the disease 根据病人目前的临床表现, 治疗目标应个体化。
3.	Clinical remission/inactive disease is defined as the absence of clinical and laboratory evidence of significant inflammatory disease activity 临床缓解或病情不活动的定义是没有显著的临床或实验室炎症活动证据。
4.	Low/minimal disease activity may be an alternative treatment target 低度病情活动或最小活动可以作为替代的治疗目标。
5.	Disease activity should be measured on the basis of clinical signs and symptoms, and acute phase reactants 病情活动度的评估应基于临床症状、体征以及急性相反应物。
6.	The choice of the measure of disease activity and the level of the target value may be influenced by considerations of comorbidities, patient factors and drug-related risks 病情活动度评估方法以及治疗目标界值的选择应该兼顾共患病、病人自测以及药物安全性风险。
7.	Once the target is achieved, it should ideally be maintained throughout the course of the disease 一旦实现治疗目标, 应在之后的病程中维持这一理想的状态。
8.	The patient should be appropriately informed and involved in the discussions about the treatment target, and the risks and benefits of the strategy planned to reach this target 应与病人恰当地沟通病情, 并让他们参与讨论治疗目标、实现治疗目标的可能风险与获益。
9.	Structural changes, functional impairment, extra-articular manifestations, comorbidities and treatment risks should be considered when making clinical decisions, in addition to assessing measures of disease activity 在治疗决策时, 除了评估病情活动度, 还应考虑结构改变、功能受损、关节外受累、共患病和治疗风险。
Specific items for individual types of Spondyloarthritis 各种SpA亚型的特异性推荐
Axial Spondyloarthritis (including ankylosing spondylitis) 中轴型脊柱关节炎 （包括强直性脊柱炎）
10.	Validated composite measures of disease activity such as the BASDAI plus acute phase reactants or the Ankylosing Spondylitis Disease Activity Score, with or without measures of function such as BASFI, should be performed and documented regularly in routine clinical practice to guide treatment decisions; the frequency of the measurements depends on the level of disease activity 在常规诊疗中, 应该定期评估和记录病情活动度, 以指导治疗决策, 相关经验证的病情活动度评估方法包括BASDAI联合急性相反应物, 或强直性脊柱炎病情活动度评分（ASDAS）,  同时评估或不评估关节功能, 诸如BASFI；评估频率应基于病情活动度的水平。
11.	Other factors, such as axial inflammation on MRI, radiographic progression, peripheral musculoskeletal and extra-articular manifestations, as well as comorbidities may also be considered when setting clinical targets 在设定临床治疗目标时, 应该同时考虑其它因素, 诸如MRI检查中轴关节炎症、放射学评估损害、外周骨骼肌肉以及关节外受累、共患病等。
Peripheral Spondyloarthritis 外周型脊柱关节炎
10.	Quantified measures of disease activity, which reflect the individual peripheral musculoskeletal manifestations (arthritis, dactylitis, enthesitis) should be performed and documented regularly in routine clinical practice to guide treatment decisions; the frequency of the measurements depends on the level of disease activity 为了指导常规诊疗的治疗决策, 应该定期评估并记录能够反映各种受累外周骨骼肌肉（关节炎、指趾炎和附着点炎）病情活动度的定量指数; 评估频率应基于病情活动度的水平。
11.	Other factors. such as spinal and extra-articular manifestations, imaging results, changes in function/quality of life, as well as comorbidities may also be considered for decision 在治疗决策时, 应该同时考虑其它因素, 诸如脊柱和关节外表现、影像学数据、关节功能/生活质量以及共患病等。
Psoriatic arthritis 银屑病关节炎
10.	Validated measures of musculoskeletal disease activity (arthritis, dactylitis, enthesitis, axial disease) should be performed and documented regularly in routine clinical practice to guide treatment decisions; the frequency of the measurements depends on the level of disease activity; cutaneous manifestations should also be considered 为了指导常规诊疗的治疗决策, 应该采用定量指数对受累骨骼肌肉（关节炎、指趾炎和附着点炎）病情活动度进行定期评估和剂量; 评估频率应基于病情活动度的水平; 应同时考虑皮损表现。
11.	Other factors, such as spinal and extra-articular manifestations, imaging results, changes in function/quality of life, as well as comorbidities may also be considered for decision 在治疗决策时, 应该同时考虑其它因素, 诸如脊柱和关节外表现、影像学数据、关节功能/生活质量改变以及共患病等。

• BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; BASFI, Bath Ankylosing Spondylitis Functional Index; GoR, grade of recommendation; LoE, level of evidence; PsA, psoriatic arthritis; SoR, strength of recommendation (level of agreement); SpA, spondyloarthritis. BASDAI: 巴斯强直性脊柱炎病情活动度指数; BASFI: 巴斯强直性脊柱炎功能指数; GoR: 推荐级别; LoE: 证据级别; PsA: 银屑病关节炎; SoR: 推荐强度(即专家意见一致程度); SpA: 脊柱关节炎。