医学
类风湿性关节炎
痹症科
语句(逻辑)
内科学
抗风湿药
关节炎
家庭医学
重症监护医学
物理疗法
法学
政治学
作者
Masayo Kojima,Takahiko Sugihara,Yutaka Kawahito,Toshihisa Kojima,Yuko Kaneko,Hajime Ishikawa,Asami Abe,Kazuo Matsui,Shintaro Hirata,Mitsumasa Kishimoto,Eiichi Tanaka,Akio Morinobu,Motomu Hashimoto,Isao Matsushita,Toshihiko Hidaka,Toshihiro Matsui,Keiichiro Nishida,S. Asai,Hiromu Ito,Ryozo Harada,Masayoshi Harigai
摘要
ABSTRACT Objectives Late-onset rheumatoid arthritis (LORA), which has been increasing in recent years, lacks evidence for initial treatment. Japanese rheumatology experts recognized this gap and addressed it by developing consensus statements on the first clinical application of LORA. Methods These statements were created following an introductory discussion about treatment fundamentals, which included a review of existing literature and cohort data. The steering committee created a draft, which was refined using a modified Delphi method that involved panel members reaching a consensus. The panel made decisions based on input from geriatric experts, clinical epidemiologists, guideline developers, patient groups, and the LORA Research Subcommittee of the Japan College of Rheumatology. Results The consensus identified four established facts, three basic approaches, and six expert opinions for managing LORA. Methotrexate was recommended as the primary treatment, with molecular-targeted agents being considered if treatment goals cannot be achieved. An emphasis was placed on assessing the lives of older patients due to challenges in risk management and methotrexate accessibility caused by comorbidities or cognitive decline. Conclusions The experts substantiated and refined 13 statements for the initial treatment of LORA. To validate these claims, the next is to conduct a registry study focusing on new LORA cases.
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