Why does rheumatoid arthritis have the phenomenon of "different drugs for the same disease"?

Feedback: When chatting with patients, you will find that everyone has the same disease - rheumatoid arthritis, and may see the same rheumatologist, but sometimes the medication is differen.

Rheumatoid arthritis varies clinically in different population.

low rheumatoid disease activity

The so-called "benign" rheumatoid arthritis, that is, mild clinical symptoms, remission after a single attack, and no more attacks for at least a year or a few month.

Such patients can choose a non-steroidal anti-inflammatory drug and a traditional disease-relieving anti-rheumatic dru.

rheumatoid disease active

Most of the patients have good and bad conditions and repeated attack.

Some patients respond well to treatment and can be relieved by an anti-rheumatic drug treatment, but long-term maintenance therapy is require.

Some patients are treated with an anti-rheumatic drug, but the condition cannot be completely relieved, especially those with high titer of autoantibodies and immunoglobulins in serum, need combined treatment of two or more anti-rheumatic drug.

High rheumatoid disease activity

There are also a small number of refractory rheumatoid arthritis, which is treated with two or more anti-rheumatic drugs for at least half a yea.

It is generally believed that patients with rheumatoid arthritis who have the following conditions are likely to develop refractory rheumatoid arthritis:

①HLA-DR4(+);

②High disease activity index (including the number of joint swelling, joint tenderness index, ESR, and the patient's assessment of their own health);

③ Continuously elevated CRP and high titer of rheumatoid factor (RF);

④ With subcutaneous nodules, vasculitis, thrombocytosis, anemia and other extra-articular manifestations;

⑤ Those who fail to receive reasonable anti-rheumatic treatment in the early stage;

⑥ Joint X-ray shows that the destruction of cartilage and bone is aggravatin.

For patients with refractory rheumatoid arthritis, how to treat to achieve remission, the main treatment options are as follows:

1 The application of biological agents

Biological preparations, especially anti-cytokine preparations, have been the hotspot of rheumatoid arthritis treatment research in recent year.

Compared with traditional disease-modifying anti-rheumatic drugs, biologics can more effectively control the activity of rheumatoid disease, and the adverse reactions are relatively smal.

2 Use of cyclophosphamide and cyclosporine A

In recent years, there have been reports at home and abroad that cyclophosphamide (CTX) pulse therapy has achieved satisfactory results in refractory rheumatoid arthriti.

3 Uses of steroids and corticosteroids

Some patients have obvious joint swelling and pain, the application of non-steroidal anti-inflammatory drugs is ineffective, and the onset of anti-rheumatic drugs is slo.

Before the onset of disease-modifying drugs, combined with low-dose corticosteroids, hormone pulse therapy was performed, and then a small amount of hormones was used for maintenanc.

When the joint swelling and pain are basically relieved and the anti-rheumatic drugs start to take effect, the hormone is gradually reduced to sto.

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