最新银屑病关节炎治疗指南

-----2015年美国风湿病学会年会重要进展

GRAPPA一直致力于银屑病及银屑病关节炎的研究，不断推出相关的指南及指导意见。在2015年的ACR年会上他们再次发布了银屑病关节炎治疗推荐，更好地指导临床医师诊治银屑病关节炎。指南的推荐意见如下：

1 对于未使用DMARD的周围关节型：

强推荐：DMARDs (MTX, 柳氮磺吡啶, 来氟米特), TNFi;弱推荐：NSAIDs, 口服糖皮质激素, 关节内注射糖皮质激素，PDE4i(阿普斯特);因为缺乏证据不推荐：IL12/23抑制剂, IL17抑制剂;

2 对于DMARD效果不好的周围关节型：

强推荐：TNFi, ustekinumab, PDE4i;弱推荐：NSAIDs, 口服糖皮质激素,关节内注射糖皮质激素, IL17抑制剂;

3 对于生物制剂效果不好的周围关节型：

强推荐：TNFi;弱推荐：NSAIDs, 口服糖皮质激素,关节内注射糖皮质激素, IL12/23抑制剂, IL17抑制剂, PDE4i;

4 对于未使用生物制剂的中轴关节型：

强推荐：NSAIDs, 物理治疗, 简单止痛, TNFi;弱推荐：IL17抑制剂, 糖皮质激素骶髂关节注射, 二膦酸盐(IL12/23抑制剂);强不推荐：DMARDs, IL6抑制剂, CD20抑制剂;

5 对于生物制剂效果不好的中轴关节型：

强推荐：NSAIDs, 物理治疗,简单止痛;弱推荐：TNFi, IL12/23抑制剂, IL17抑制剂;

6 附着点炎：

强推荐：TNFi, IL12/23i;弱推荐：NSAIDs, 物理治疗, 糖皮质激素(应高度注意承重部位附着点注射糖皮质激素可能导致附着点断裂), PDE4i, IL17抑制剂;因为缺乏证据不推荐： DMARDs;

7 指趾炎

强推荐：TNFi (英夫利昔单抗、阿达木单抗、戈利木单抗、赛妥珠单抗);弱推荐：糖皮质激素注射, DMARDs (MTX, 来氟米特，柳氮磺吡啶), TNFi (依那西普), IL12/23抑制剂, IL17抑制剂, PDE4i;

8 银屑病(斑块)

强推荐：热疗，光疗，DMARDs (MTX, 来氟米特，环孢素A), TNFi, IL12/23抑制剂, IL17抑制剂, PDE4i;

9 甲银屑病

强推荐：TNFi, IL12/23抑制剂;弱推荐：热疗, 程序性治疗, DMARDs (环孢素A, 来氟米特, 阿维酸A, MTX), IL17抑制剂, PDE4i。

(福建省福清市医院 俞建钰 林星 编译，全文见《风湿病与关节炎》2016，(3))

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