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*For medical professionals to read and review
history, look forward to the future, see pioneers in the rheumatology industry teach and share treatment experience
.
Rheumatology immunology is the youngest clinical discipline
in China.
In 1985, the Rheumatology Branch of the Chinese Medical Association was established, and immediately carried out the popularization
and improvement of rheumatology knowledge throughout the country.
For more than 30 years, pioneers in the field of rheumatology and immunology have forged ahead and worked hard to write a new chapter
in the development of the discipline.
Professor Wan Weiguo from the Department of Rheumatology and Immunology of Huashan Hospital affiliated to Fudan University has been committed to the treatment of
rheumatic immune diseases for many years.
From a resident doctor to a mainstay in the rheumatology community, Bai Ju looked back on his career, and Professor Wan has many things to share
with us in the treatment of rheumatic diseases.
In 1996, the Department of Rheumatology and Immunology of Huashan Hospital affiliated to Fudan University was established
.
Under the leadership of Professor Zou Hejian, the department is engaged in the medical, teaching and research of rheumatology and immunology, and has achieved fruitful results
in the research of gout, hyperuricemia and systemic sclerosis.
"Gout and hyperuricemia are common diseases, and systemic sclerosis is a rare disease, which is the research direction
of our rheumatology and immunology department.
These two types of diseases have soaked our hearts and minds, and of course, the achievements are also very remarkable
.
Regarding the development of the department, Professor Wan added, "In terms of inflammatory arthritis represented by psoriatic arthritis, our department also has a lot of research, and has won many national natural science foundations, including myself also taking psoriatic arthritis as the research direction
.
Our department is committed to the diagnosis and treatment of all diseases in the Department of Rheumatology and Immunology, including common diseases such as lupus erythematosus and dermatomyositis, and strives to bring good news
to all patients.
Talking
about his original intention to become a rheumatologist in China, Professor Wan recalled: "At that time, only Renji Hospital in Shanghai established a formal rheumatology and immunology department, and Changhai Hospital, Zhongshan Hospital and the First People's Hospital were all a group under other departments, so the whole Shanghai lacked rheumatology and immunology doctors
.
" 。 In the absence of awareness of rheumatic diseases and the lack of specialist guidance of patients, we have no hesitation in devoting ourselves to the profession of
rheumatoid immunity.
In fact, many of the pioneers in the rheumatology and immunology field were transferred from other systems in internal medicine
.
At the snap of my fingers, I went from being a resident to retiring in a few years
.
"
Clinical and scientific research are like two carriages that drive rheumatology and immunology forward
.
Professor Wan also has his own experience on how to balance clinical diagnosis and treatment with scientific research, "The best doctor should be both an excellent clinician and a very good scientist
.
For me personally, it's more clinical, but that doesn't mean the work isn't important
.
Professor Wan further explained, "The prerequisite for leading professional development is scientific achievements
.
Clinicians should do their job well first, and then do scientific research when they are able, including applying for various funds, guiding students in scientific research, and participating in drug clinical trials
of multinational companies.
”
At present, the diagnosis and treatment of RA in clinical practice follows the principle
of "the longer the delay, the worse the prognosis".
As early as 1992, Dawes and Professor Symmons proposed the concept of RA treatment "time window", that is, to alleviate the disease before irreversible damage is caused to the
joint.
In the following years, the concept was widely used in the RA field [2].
"The significance of the existence of the time window is to show that RA needs early diagnosis and early treatment
.
" Professor Wan said, "Generally speaking, when a patient develops symptoms, within three months, no more than half a year, he should be adequately diagnosed and treated[3].
The reason why the concept of early arthropathy was proposed was to hope that clinical treatment could be intervened
earlier.
"
In general, if RA is not diagnosed and treated in time, patients can develop irreversible bone and joint destruction within 2 years of onset, eventually leading to joint deformity and loss of function and even disability [4].
In addition, RA can cause serious damage
to multiple organs and systems throughout the body.
For the "time window" of RA treatment, Professor Wan explained its clinical significance to us in detail, "Now for the treatment of RA, it is no longer just that the joint is not painful and swollen, our more important task is to prevent the destruction of the joint, so as not to form disability
in the later stage.
Previously, the internationally recognized "time window" was within two years, but with a deeper understanding of the disease, the transition gradually became 6 months, or even within 3 months at the earliest [3].
This time period is the golden window period of RA treatment, and there are many patients in previous studies who lack professional treatment, and may not be clearly diagnosed for two or three years in the internist or general practitioner, and finally cause joint deformity, which is also a situation
that we do not want to see.
The
concept of "time window" is a revolutionary change in the concept of RA treatment, which reminds clinicians that what they need to do is far more than "repairing" after symptoms appear or joint deformation, but to constantly move their eyes along the timeline of the disease to seize the only opportunity
to achieve the reversal of the disease.
Professor Wan thus proposed the concept of T2T, that is, treat-to-target, standard treatment [5].
"This 'target' is what we have set now, such as evaluating disease activity by DAS28, SDAI, CDAI [6], and determining whether RA is in remission through the Boolean definition [7].
Now that this goal has been proposed, we must achieve
it in the shortest possible time.
That is, what I said earlier does not cause joint deformity and does not affect the patient's work and quality of life
.
Now there are many drugs for the treatment of RA to help us achieve the goal and improve the prognosis of patients, which was naturally unimaginable before 2000
.
That's why it's all the more important to grasp this window
of time.
Professor
Wan's professional answer also brought us a lot of inspiration
.
In patients with RA, the disease already exists before symptoms such as joint swelling and pain develop, and it accumulates until the body cannot withstand the symptoms
.
The time period from opening the Pandora's box of RA to developing into typical joint swelling and pain is the so-called "time window"
.
Its existence is decisive for the treatment of RA, because it can not only effectively control the disease and protect patients from unnecessary pain and torment, but also greatly reduce the burden of patients and save medical costs
.
42%, and the total number of people affected is about 5 million [8], which is obviously a very large group
.
In addition, this group also has four high characteristics: more patients (large number of patients), long course of disease (more delayed diagnosis and treatment), more moderate and severe patients (more severe cases), and more coexisting diseases (more comorbidities).
Data from the China Rheumatoid Arthritis Direct Reporting Project (CREDIT) show that the average time interval between the onset of symptoms and the definitive diagnosis of RA patients in China is more than 2 years, suggesting that most patients have not received timely and early diagnosis
.
All of this poses significant challenges to the treatment of RA [9].
of their own body joints.
The road to RA treatment is long, and only by seizing this precious "window period" can we achieve final victory
.
The expert profile
photo has received the informed consent of the expert, Professor Wan Weiguo
References: [1] HU Xiaomin, ZONG Ying, YU Shanshan, YUAN Bojun, LU Guocai, WANG Qingli.
Research and development progress and trend of rheumatoid arthritis treatment drugs[J].
China Journal of New Drugs,2017,26(01):36-43.
) [2]Burgers L E, Raza K, Van Der Helm-Van A H.
Window of opportunity in rheumatoid arthritis–definitions and supporting evidence: from old to new perspectives[J].
RMD open, 2019, 5(1): e000870.
[3]Raza K , Saber T P , Kvien T K , et al.
Timing the therapeutic window of opportunity in early rheumatoid arthritis: proposal for definitions of disease duration in clinical trials.
[J].
Annals of the Rheumatic Diseases, 2012, 71(12):1921-3.
[4] SHEN Wang,LI Haitao,YANG Wenli,ZHANG Xin.
Expression and significance of anti-CCP antibody and anti-MCV antibody in RA[J].
Modern Immunol,2019,39(03):189-194.
) [5] Mo Hong, Ma Zongbo, Wu Chenglong.
Research progress in the treatment of rheumatoid arthritis[J].
Internal Medicine,2017,12(03):334-337.
) [6]Gavrilă BI, Ciofu C, Stoica V.
Biomarkers in Rheumatoid Arthritis, what is new?.
J Med Life.
2016; 9(2):144-148.
[7]Xie W, Li G, Huang H, Zhang Z.
How to Define Boolean Low Disease Activity in Rheumatoid Arthritis: Experience from a Large Real-world Cohort.
Rheumatol Ther.
2021; 8(1):289-301.
[8]2018 Chinese guidelines for the diagnosis and treatment of rheumatoid arthritis[J].
Chinese Journal of Internal Medicine,2018,57(04):242-251.
) [9] Wang Kai.
Early diagnosis and early treatment, vigilance against "rheumatoid" sneaking attacks on women[N].
China Women's Daily, 2021-11-03(008).
[10] Gong Xun, Jiang Quan, Cao Wei, Tang Xiaopo, Jiao Juan.
Moist heat stasis and bone erosion in active rheumatoid arthritis[J].
Journal of Traditional Chinese Medicine,2014,55(14):1189-1192.
)
history, look forward to the future, see pioneers in the rheumatology industry teach and share treatment experience
.
Rheumatology immunology is the youngest clinical discipline
in China.
In 1985, the Rheumatology Branch of the Chinese Medical Association was established, and immediately carried out the popularization
and improvement of rheumatology knowledge throughout the country.
For more than 30 years, pioneers in the field of rheumatology and immunology have forged ahead and worked hard to write a new chapter
in the development of the discipline.
Professor Wan Weiguo from the Department of Rheumatology and Immunology of Huashan Hospital affiliated to Fudan University has been committed to the treatment of
rheumatic immune diseases for many years.
From a resident doctor to a mainstay in the rheumatology community, Bai Ju looked back on his career, and Professor Wan has many things to share
with us in the treatment of rheumatic diseases.
Devoted to the development of rheumatology immunology,
"Clinical" and "scientific" go hand in hand
In 1996, the Department of Rheumatology and Immunology of Huashan Hospital affiliated to Fudan University was established
.
Under the leadership of Professor Zou Hejian, the department is engaged in the medical, teaching and research of rheumatology and immunology, and has achieved fruitful results
in the research of gout, hyperuricemia and systemic sclerosis.
"Gout and hyperuricemia are common diseases, and systemic sclerosis is a rare disease, which is the research direction
of our rheumatology and immunology department.
These two types of diseases have soaked our hearts and minds, and of course, the achievements are also very remarkable
.
Regarding the development of the department, Professor Wan added, "In terms of inflammatory arthritis represented by psoriatic arthritis, our department also has a lot of research, and has won many national natural science foundations, including myself also taking psoriatic arthritis as the research direction
.
Our department is committed to the diagnosis and treatment of all diseases in the Department of Rheumatology and Immunology, including common diseases such as lupus erythematosus and dermatomyositis, and strives to bring good news
to all patients.
Talking
about his original intention to become a rheumatologist in China, Professor Wan recalled: "At that time, only Renji Hospital in Shanghai established a formal rheumatology and immunology department, and Changhai Hospital, Zhongshan Hospital and the First People's Hospital were all a group under other departments, so the whole Shanghai lacked rheumatology and immunology doctors
.
" 。 In the absence of awareness of rheumatic diseases and the lack of specialist guidance of patients, we have no hesitation in devoting ourselves to the profession of
rheumatoid immunity.
In fact, many of the pioneers in the rheumatology and immunology field were transferred from other systems in internal medicine
.
At the snap of my fingers, I went from being a resident to retiring in a few years
.
"
Clinical and scientific research are like two carriages that drive rheumatology and immunology forward
.
Professor Wan also has his own experience on how to balance clinical diagnosis and treatment with scientific research, "The best doctor should be both an excellent clinician and a very good scientist
.
For me personally, it's more clinical, but that doesn't mean the work isn't important
.
Professor Wan further explained, "The prerequisite for leading professional development is scientific achievements
.
Clinicians should do their job well first, and then do scientific research when they are able, including applying for various funds, guiding students in scientific research, and participating in drug clinical trials
of multinational companies.
”
Seize the golden window of RA treatment to achieve disease reversal
At present, the diagnosis and treatment of RA in clinical practice follows the principle
of "the longer the delay, the worse the prognosis".
As early as 1992, Dawes and Professor Symmons proposed the concept of RA treatment "time window", that is, to alleviate the disease before irreversible damage is caused to the
joint.
In the following years, the concept was widely used in the RA field [2].
"The significance of the existence of the time window is to show that RA needs early diagnosis and early treatment
.
" Professor Wan said, "Generally speaking, when a patient develops symptoms, within three months, no more than half a year, he should be adequately diagnosed and treated[3].
The reason why the concept of early arthropathy was proposed was to hope that clinical treatment could be intervened
earlier.
"
In general, if RA is not diagnosed and treated in time, patients can develop irreversible bone and joint destruction within 2 years of onset, eventually leading to joint deformity and loss of function and even disability [4].
In addition, RA can cause serious damage
to multiple organs and systems throughout the body.
For the "time window" of RA treatment, Professor Wan explained its clinical significance to us in detail, "Now for the treatment of RA, it is no longer just that the joint is not painful and swollen, our more important task is to prevent the destruction of the joint, so as not to form disability
in the later stage.
Previously, the internationally recognized "time window" was within two years, but with a deeper understanding of the disease, the transition gradually became 6 months, or even within 3 months at the earliest [3].
This time period is the golden window period of RA treatment, and there are many patients in previous studies who lack professional treatment, and may not be clearly diagnosed for two or three years in the internist or general practitioner, and finally cause joint deformity, which is also a situation
that we do not want to see.
The
concept of "time window" is a revolutionary change in the concept of RA treatment, which reminds clinicians that what they need to do is far more than "repairing" after symptoms appear or joint deformation, but to constantly move their eyes along the timeline of the disease to seize the only opportunity
to achieve the reversal of the disease.
Professor Wan thus proposed the concept of T2T, that is, treat-to-target, standard treatment [5].
"This 'target' is what we have set now, such as evaluating disease activity by DAS28, SDAI, CDAI [6], and determining whether RA is in remission through the Boolean definition [7].
Now that this goal has been proposed, we must achieve
it in the shortest possible time.
That is, what I said earlier does not cause joint deformity and does not affect the patient's work and quality of life
.
Now there are many drugs for the treatment of RA to help us achieve the goal and improve the prognosis of patients, which was naturally unimaginable before 2000
.
That's why it's all the more important to grasp this window
of time.
Professor
Wan's professional answer also brought us a lot of inspiration
.
In patients with RA, the disease already exists before symptoms such as joint swelling and pain develop, and it accumulates until the body cannot withstand the symptoms
.
The time period from opening the Pandora's box of RA to developing into typical joint swelling and pain is the so-called "time window"
.
Its existence is decisive for the treatment of RA, because it can not only effectively control the disease and protect patients from unnecessary pain and torment, but also greatly reduce the burden of patients and save medical costs
.
Focusing on the current status of RA treatment,
Explore the path of "early treatment" implementation
42%, and the total number of people affected is about 5 million [8], which is obviously a very large group
.
In addition, this group also has four high characteristics: more patients (large number of patients), long course of disease (more delayed diagnosis and treatment), more moderate and severe patients (more severe cases), and more coexisting diseases (more comorbidities).
Data from the China Rheumatoid Arthritis Direct Reporting Project (CREDIT) show that the average time interval between the onset of symptoms and the definitive diagnosis of RA patients in China is more than 2 years, suggesting that most patients have not received timely and early diagnosis
.
All of this poses significant challenges to the treatment of RA [9].
The existence of a "time window" does not represent the solution of the treatment problem of RA patients, and any concept is proposed for the application
of clinical practice.
Professor Wan is obviously experienced
in how to practice "early diagnosis and early treatment".
"The achievement of this goal requires the joint efforts of both patients and doctors
.
On the one hand, there are still many patients in remote areas who cannot be clearly diagnosed because of joint pain, thus missing the best time
for diagnosis and treatment.
Some patients first choose orthopedics because of pain symptoms, and orthopedic surgeons are relatively poor in the differential diagnosis of RA
.
A variety of reasons can exacerbate
the disease.
What we need to do is to carry out clinical publicity, remind patients to pay attention to changes in their symptoms, and if they are not cured after being diagnosed by an orthopedic surgeon, they should go to the rheumatology department as soon as possible
.
On the other hand, as rheumatologists, we can certainly confirm and quickly diagnose
patients with typical symptoms of RA, such as proximal interphalangeal, metacarpophalangeal joint, wrist joint pain in both hands, positive rheumatoid factor, and positive CCP antibodies.
However, for patients who are all negative for rheumatoid factor, CCP antibody or other specific antibodies, it is necessary to make full use of existing advanced technologies, such as high-frequency joint ultrasound, magnetic resonance imaging (MRI), etc.
, among which MRI shows synovial hyperplasia even earlier than the patient's clinical manifestations [10].
Through early drug intervention of DMARDs after diagnosis, inflammation can be eliminated, joint function can be restored as soon as possible, and treatment time can be shortened.
"
of their own body joints.
The road to RA treatment is long, and only by seizing this precious "window period" can we achieve final victory
.
The expert profile
photo has received the informed consent of the expert, Professor Wan Weiguo
- Chief physician of the Department of Rheumatology, Huashan Hospital Affiliated to Fudan University, master tutor
- Executive Deputy Director of Department of Rheumatology, Huashan Hospital Affiliated to Fudan University (presiding)
- Director of Shanghai Medical Association
- Member of Rheumatology and Immunology Branch of Shanghai Medical Association
- Member of Rheumatology Specialist Committee of Shanghai Medical Association
- Member of the Rheumatology Professional Committee of the Chinese Association of Integrative Medicine
- Member of Rheumatology Branch of Shanghai Association of Integrative Medicine
- Member of the Rheumatology and Immunology Expert Committee of the Cross-Strait Medical and Health Exchange Association
- Expert of Shanghai Medical Malpractice Appraisal Committee, special editor of Chinese Journal of Clinicians, editorial board member of Journal of Occupational Health and Emergency Rescue, editorial board member of Journal of Environmental and Occupational Medicine
References: [1] HU Xiaomin, ZONG Ying, YU Shanshan, YUAN Bojun, LU Guocai, WANG Qingli.
Research and development progress and trend of rheumatoid arthritis treatment drugs[J].
China Journal of New Drugs,2017,26(01):36-43.
) [2]Burgers L E, Raza K, Van Der Helm-Van A H.
Window of opportunity in rheumatoid arthritis–definitions and supporting evidence: from old to new perspectives[J].
RMD open, 2019, 5(1): e000870.
[3]Raza K , Saber T P , Kvien T K , et al.
Timing the therapeutic window of opportunity in early rheumatoid arthritis: proposal for definitions of disease duration in clinical trials.
[J].
Annals of the Rheumatic Diseases, 2012, 71(12):1921-3.
[4] SHEN Wang,LI Haitao,YANG Wenli,ZHANG Xin.
Expression and significance of anti-CCP antibody and anti-MCV antibody in RA[J].
Modern Immunol,2019,39(03):189-194.
) [5] Mo Hong, Ma Zongbo, Wu Chenglong.
Research progress in the treatment of rheumatoid arthritis[J].
Internal Medicine,2017,12(03):334-337.
) [6]Gavrilă BI, Ciofu C, Stoica V.
Biomarkers in Rheumatoid Arthritis, what is new?.
J Med Life.
2016; 9(2):144-148.
[7]Xie W, Li G, Huang H, Zhang Z.
How to Define Boolean Low Disease Activity in Rheumatoid Arthritis: Experience from a Large Real-world Cohort.
Rheumatol Ther.
2021; 8(1):289-301.
[8]2018 Chinese guidelines for the diagnosis and treatment of rheumatoid arthritis[J].
Chinese Journal of Internal Medicine,2018,57(04):242-251.
) [9] Wang Kai.
Early diagnosis and early treatment, vigilance against "rheumatoid" sneaking attacks on women[N].
China Women's Daily, 2021-11-03(008).
[10] Gong Xun, Jiang Quan, Cao Wei, Tang Xiaopo, Jiao Juan.
Moist heat stasis and bone erosion in active rheumatoid arthritis[J].
Journal of Traditional Chinese Medicine,2014,55(14):1189-1192.
)
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