• 四川大學(xué)華西醫(yī)院老年科,成都,610041;

類風(fēng)濕性關(guān)節(jié)炎是一種慢性炎癥性疾病,以侵犯外周關(guān)節(jié)和關(guān)節(jié)周圍組織的慢性多關(guān)節(jié)炎為其特點(diǎn).針對(duì)1例類風(fēng)濕性關(guān)節(jié)炎患者,筆者進(jìn)行了證據(jù)檢索,將經(jīng)驗(yàn)治療與當(dāng)前最佳的干預(yù)措施結(jié)合起來,制定出適合該患者的治療方案:①鎮(zhèn)痛選用布洛芬;②繼續(xù)靜脈滴注甲氨蝶呤進(jìn)行抗類風(fēng)濕治療,但出院后改為甲氨蝶呤每周1次口服,療程初步確定為12個(gè)月;③奧美拉唑20 mg,qd,口服,預(yù)防消化道潰瘍的發(fā)生;④建議患者出院后使用魚油并且堅(jiān)持鍛煉.

引用本文： 岳冀蓉,郭佳,楊茗,董碧蓉. 類風(fēng)濕性關(guān)節(jié)炎的循證治療. 中國(guó)循證醫(yī)學(xué)雜志, 2004, 04(5): 351-354. doi: 復(fù)制

1. ［1］Rostom A, Dube C, Wells G, Tugwell P, Welch V, Jolicoeur E,McGowan J. Prevention of chronic NSAID induced upper gastrointestinal toxicity[ M/CD]. In: The Cochrane Library,Issue 1, 2003. Oxford: Update Software.
2. ［2］Gotzsche PC, Johansen HK. Short-term low-dose corticosteroids vs placebo and nonsteroidal antiinflammatory drugs in rheumatoid arthritis ( Cochrane Review) [ M/CD]. In: The Cochrane Library, Issue 1, 2003. Oxford: Update Software.
3. ［3］Van Den Ende CH, Vliet Vlieland TP, Munneke M, Hazes JM. Dynamic exercise therapy for treating rheumatoid arthritis (Cochrane Review) [M/CD]. In: The Cochrane Library,Issue 1, 2003. Oxford: Update Software.
4. ［4］Gotzsche PC. Meta-analysis of NSAIDs: contribution of drugs,doses, trial designs, and meta-analytic techniques[J]. Scand J Rheumatol, 1993; 22(6): 255-260.
5. ［5］Moore RA, Tramer MR, Carroll D, Wiffen PJ, McQuay HJ.Quantitative systematic review of topically applied non-steroidal anti-inflammatory drugs[J]. BMJ, 1998; 316(7128): 333 -338.
6. ［6］Suarez-Almazor ME, Belseck E, Wells G, Shea B, Tugwell P.Meta-analyses of placebo controlled trails of disease-modifying antirheumatic drugs (DMARDs)for the treatment of rheumatoid arthritis(RA) [J]. Arthritis Rheum, 1998; 41 ( 12 ): s153.
7. ［7］Maetzel A, Wong A, Strand V, Tngwell P, Wells G, Bombardier C. Meta-analysis of treatment teminarion rates among rheumatoid arthritis patients receiving disease-modifying antitheimatic drugs[J]. Rheumatology (Oxford), 2000; 39(9): 975 -981.
8. ［8］Volker D, Fitzgerald P, Major G, Garg M. Efficacy of fish oil concentrate in the treatment of rheumatoid arthritis [ J ]. J Rheumatol, 2000; 27 (10) :2 343-2 346.
9. ［9］Hawkey CJ, Karrasch JA, Szczepanski L, Walker DG, Barkun A, Swannell AJ, Yeomans ND. Omeprazole compared with misoprostol for ulcers associated with nonsteroidal antiinflammatory drugs. Omeprazole versus Misoprostol for NSAID-induced Ulcer Management (OMNIUM) Study Group[J]. N Engl J Med, 1998; 338(11): 727-734.
10. ［10］Wolfe F, Hawley DJ, Cathey MA. Terminarion of slow acting antirheumatic therapy in rheumatoid arthritis: a 14-year prospective evaluation of 1017 consecutive starts [ J ]. J Rheumatol, 1990; 17(8): 994-1 002.
11. ［11］MacDonald TM, Morant SV, Robinson GC, Shield MJ,McGilchrist MM, Murray FE, McDevitt DG. Association of upper gastrointestinal toxicity of non-steroidal anti-inflammatory drugs with continued exposure: cohort study [J]. BMJ,1997; 315(7 119): 1 333 -1 337.
12. ［12］Henry D, Lim LL, Garcia Rodtiguez LA, Perez Gutthann S,Carson JL, Griffin M, Savage R, Logan R, Moride Y,Hawkey C, Hill S, Fries JT. Variability in risk of gastrointestinal complications with individual non-steroidal anti-inflammatory drugs: results of a collaborative meta-analysis [J]. BMJ,1996; 312(7 046): 1563-1566.
  1. 1. ［1］Rostom A, Dube C, Wells G, Tugwell P, Welch V, Jolicoeur E,McGowan J. Prevention of chronic NSAID induced upper gastrointestinal toxicity[ M/CD]. In: The Cochrane Library,Issue 1, 2003. Oxford: Update Software.
  2. 2. ［2］Gotzsche PC, Johansen HK. Short-term low-dose corticosteroids vs placebo and nonsteroidal antiinflammatory drugs in rheumatoid arthritis ( Cochrane Review) [ M/CD]. In: The Cochrane Library, Issue 1, 2003. Oxford: Update Software.
  3. 3. ［3］Van Den Ende CH, Vliet Vlieland TP, Munneke M, Hazes JM. Dynamic exercise therapy for treating rheumatoid arthritis (Cochrane Review) [M/CD]. In: The Cochrane Library,Issue 1, 2003. Oxford: Update Software.
  4. 4. ［4］Gotzsche PC. Meta-analysis of NSAIDs: contribution of drugs,doses, trial designs, and meta-analytic techniques[J]. Scand J Rheumatol, 1993; 22(6): 255-260.
  5. 5. ［5］Moore RA, Tramer MR, Carroll D, Wiffen PJ, McQuay HJ.Quantitative systematic review of topically applied non-steroidal anti-inflammatory drugs[J]. BMJ, 1998; 316(7128): 333 -338.
  6. 6. ［6］Suarez-Almazor ME, Belseck E, Wells G, Shea B, Tugwell P.Meta-analyses of placebo controlled trails of disease-modifying antirheumatic drugs (DMARDs)for the treatment of rheumatoid arthritis(RA) [J]. Arthritis Rheum, 1998; 41 ( 12 ): s153.
  7. 7. ［7］Maetzel A, Wong A, Strand V, Tngwell P, Wells G, Bombardier C. Meta-analysis of treatment teminarion rates among rheumatoid arthritis patients receiving disease-modifying antitheimatic drugs[J]. Rheumatology (Oxford), 2000; 39(9): 975 -981.
  8. 8. ［8］Volker D, Fitzgerald P, Major G, Garg M. Efficacy of fish oil concentrate in the treatment of rheumatoid arthritis [ J ]. J Rheumatol, 2000; 27 (10) :2 343-2 346.
  9. 9. ［9］Hawkey CJ, Karrasch JA, Szczepanski L, Walker DG, Barkun A, Swannell AJ, Yeomans ND. Omeprazole compared with misoprostol for ulcers associated with nonsteroidal antiinflammatory drugs. Omeprazole versus Misoprostol for NSAID-induced Ulcer Management (OMNIUM) Study Group[J]. N Engl J Med, 1998; 338(11): 727-734.
  10. 10. ［10］Wolfe F, Hawley DJ, Cathey MA. Terminarion of slow acting antirheumatic therapy in rheumatoid arthritis: a 14-year prospective evaluation of 1017 consecutive starts [ J ]. J Rheumatol, 1990; 17(8): 994-1 002.
  11. 11. ［11］MacDonald TM, Morant SV, Robinson GC, Shield MJ,McGilchrist MM, Murray FE, McDevitt DG. Association of upper gastrointestinal toxicity of non-steroidal anti-inflammatory drugs with continued exposure: cohort study [J]. BMJ,1997; 315(7 119): 1 333 -1 337.
  12. 12. ［12］Henry D, Lim LL, Garcia Rodtiguez LA, Perez Gutthann S,Carson JL, Griffin M, Savage R, Logan R, Moride Y,Hawkey C, Hill S, Fries JT. Variability in risk of gastrointestinal complications with individual non-steroidal anti-inflammatory drugs: results of a collaborative meta-analysis [J]. BMJ,1996; 312(7 046): 1563-1566.