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Healey L A最近提出一种针对类风湿性关节炎病人合并用药的“下梯过桥法”(Step-down bridge,见图),来取代传统的疗效欠佳的金字塔(Pyramid)疗法,以提高远期疗效。新方案采用短期(如1个月)给予皮质激素或非甾体抗炎药(NSAIDs)后,分别选择甲喋呤、金制剂、青霉胺、氯喹、羟氯喹、Sulfasalazine(柳氮磺胺吡啶)或硫唑嘌呤并用。这些药物作用各异。发生效用的时间不同。毒性作用部位也不同,无相加作用,且是可逆转的。环胞霉素和环磷酰胺虽对控制炎症极有效,但因毒性太大不宜用于早期病人。强的松和氨甲喋呤是唯一两种明显有效的
Healey LA recently proposed a “Step-down bridge” (see figure) for the combination therapy of patients with rheumatoid arthritis to replace the traditional pyramid therapy, which is far from effective Period of efficacy. The new regimen used methotrexate, gold preparations, penicillamine, chloroquine, hydroxychloroquine, sulfasalazine (sulfasalazine) in combination with NSAIDs after a short period of treatment (such as one month) Or azathioprine and use. These drugs have different effects. The time of utility is different. Toxic sites are also different, no additive effect, and is reversible. Cyclosporine and cyclophosphamide, although very effective in controlling inflammation, but not suitable for early patients because of toxicity. Prednisone and methotrexate are the only two that are clearly effective