Overarching principles

首要原則

A.

The treatment target must be based on a shared decision between patient and rheumatologist

治療目標應基于醫(yī)患溝通后的共同決定。

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大多是多系統(tǒng)受累的全身性疾病, 所以骨骼肌肉以及關節(jié)外受累應由風濕病醫(yī)生與其他專科醫(yī)生（諸如皮膚科、消化科以及眼科）協(xié)作治療。

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病人的首要治療目標是, 通過控制癥狀和體征, 預防結構性損傷, 恢復或保留關節(jié)功能, 避免各種治療的副作用, 并盡可能減少共患病, 以最大可能地提高健康相關的生活質量。

D.

Abrogation of inflammation is presumably important to achieve these goals

為了實現這些目標, 消除炎癥應該是重要的。

E.

Treatment to target by measuring disease activity and adjusting therapy accordingly contributes to the optimisation of short term and/or long term outcomes

目標治療, 即監(jiān)測病情活動度并適時調整治療, 有利于優(yōu)化短期和/或長期結局。

Recommendations

推薦

Common items for all forms of SpA

適用于各種類型SpA的建議

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

主要治療目標之一是受累骨骼肌肉(包括關節(jié)炎、指趾炎、附著點炎和中軸關節(jié)的)病情緩解或病情不活動, 同時兼顧關節(jié)外受累的改善。

2.

The treatment target should be individualised according to the current clinical manifestations of the disease

根據病人目前的臨床表現, 治療目標應個體化。

3.

Clinical remission/inactive disease is defined as the absence of clinical and laboratory evidence of significant inflammatory disease activity

臨床緩解或病情不活動的定義是沒有顯著的臨床或實驗室炎癥活動證據。

4.

Low/minimal disease activity may be an alternative treatment target

低度病情活動或最小活動可以作為替代的治療目標。

5.

Disease activity should be measured on the basis of clinical signs and symptoms, and acute phase reactants

病情活動度的評估應基于臨床癥狀、體征以及急性相反應物。

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

病情活動度評估方法以及治療目標界值的選擇應該兼顧共患病、病人自測以及藥物安全性風險。

7.

Once the target is achieved, it should ideally be maintained throughout the course of the disease

一旦實現治療目標, 應在之后的病程中維持這一理想的狀態(tài)。

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

應與病人恰當地溝通病情, 并讓他們參與討論治療目標、實現治療目標的可能風險與獲益。

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

在治療決策時, 除了評估病情活動度, 還應考慮結構改變、功能受損、關節(jié)外受累、共患病和治療風險。

Specific items for individual types of Spondyloarthritis

各種SpA亞型的特異性推薦

Axial Spondyloarthritis (including ankylosing spondylitis)

中軸型脊柱關節(jié)炎 （包括強直性脊柱炎）

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

在常規(guī)診療中, 應該定期評估和記錄病情活動度, 以指導治療決策, 相關經驗證的病情活動度評估方法包括BASDAI聯(lián)合急性相反應物, 或強直性脊柱炎病情活動度評分（ASDAS）,? 同時評估或不評估關節(jié)功能, 諸如BASFI；評估頻率應基于病情活動度的水平。

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

在設定臨床治療目標時, 應該同時考慮其它因素, 諸如MRI檢查中軸關節(jié)炎癥、放射學評估損害、外周骨骼肌肉以及關節(jié)外受累、共患病等。

Peripheral Spondyloarthritis

外周型脊柱關節(jié)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

為了指導常規(guī)診療的治療決策, 應該定期評估并記錄能夠反映各種受累外周骨骼肌肉（關節(jié)炎、指趾炎和附著點炎）病情活動度的定量指數; 評估頻率應基于病情活動度的水平。

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

在治療決策時, 應該同時考慮其它因素, 諸如脊柱和關節(jié)外表現、影像學數據、關節(jié)功能/生活質量以及共患病等。

Psoriatic arthritis

銀屑病關節(jié)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

為了指導常規(guī)診療的治療決策, 應該采用定量指數對受累骨骼肌肉（關節(jié)炎、指趾炎和附著點炎）病情活動度進行定期評估和劑量; 評估頻率應基于病情活動度的水平; 應同時考慮皮損表現。

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

在治療決策時, 應該同時考慮其它因素, 諸如脊柱和關節(jié)外表現、影像學數據、關節(jié)功能/生活質量改變以及共患病等。