‘젤잔즈’ - health.kr

1 [ ] (Xeljanz) (intracellular kinase pathway) (Janus Kinase, JAK) (Rheumatoid Arthritis, RA) (small molecule) JAK . (Biologic agent) .. , , . 2015 (American College of Rheumatology, ACR) RA DMARD . , , . 1. ( ) , , 2/15 RA(Rheumatoid Arthritis).

2 , , , , . 10~20 , 70% 2 , 1 RA . , , , , (NSAID) , , DMARD (pyramidal approach) . , , , (treat-to-target approach) . RA.

3 RA , , RA(Rheumatoid Arthritis) ? RA ? RA ? , 3/15 , . (American College of Rheumatology, ACR) response criteria, (European League Against Rheumatism, EULAR) response criteria . HAQ(Health Assessment Questionnaire) for arthritis .. MRI . RA ( ) ACR(%) . ACR 20 20% . RA EULAR (DAS 28, Disease Activity Score in 28 joints) . DAS 28 3 . 28 (Tender Joint Count, TJC) (Swollen Joint Count, SJC), (General Health, GH).

4 DAS 28 DAS 28> (high disease activity), <DAS 28 (moderate disease activity), DAS 28 (low disease activity), DAS 28< (remission) . DAS Aletaha Smolen clinical disease activity index(CDAI), simplified disease activity index(SDAI) . RA (Nonsteroidal anti-inflammatory Drug, NSAID), (Glucocorticoid, GCC), (Immunosuppressant), (Disease-Modifying Antirheumatic Drug, DMARD) . 1) (Nonsteroidal anti-inflammatory Drug, NSAID) (NSAID) DMARD . NSAID.

5 RA ? , 4/15 65 , , COX-2 . 2) (Glucocorticoid, GCC) (GCC) .. , DMARD . , . , NSAID DMARD RA . (prednisone ) , (40 60mg/day) .. 3 4 . 3) (Immunosuppressant) RA cyclophosphamide( : ), azathioprine( : ) (cytotoxic drug) cyclosporin( : ), mizoribine( : ).

6 DMARD . , . tacrolimus( : ) calcineurin RA . 4) (Disease-Modifying Antirheumatic Drug, DMARD) DMARD DMARD(synthrtic DMARD, sDMARD) DMARD(biological DMARD, bDMARD . sDMARD DMARD(conventional synthetic DMARD, csDMARD) DMARD(target synthetic DMARD, tsDMARD) , bDMARD , 5/15 DMARD(biological original DMARD, boDMARD) DMARD(biosimilar DMARD, bsDMARD) . sDMARD sDMARD (non-biologic) DMARD , , methotrexate(MTX, : ) hydroxychloroquine( : ), sulfasalazine( : ).

7 SDMARD MTX , , sDMARD , . MTX . sDMARD 2-3 . leflunomide( : ) , leflunomide pyrimidine , . iguratimod( : ) immunoglobulin inflammatory cytokine . sDMARD NSAID RA 2~3 . RA sDMARD . sDMARD , NSAID . sDMARD .. RA hydroxychloroquine, sulfasalazine , (Rheumatoid Factor, RF) , , RA MTX.

8 BDMARD bDMARD RA , 6/15 , . ( ) (proinflammatory cytokine) (anti-inflammatory cytokine) . (targeted therapy) (Tumor Necrosis Factor, TNF)-alpha . TNF 1960 , . 1990 , TNF TNF-alpha TNF-alpha (monoclonal antibody, mab) infliximab( : ) . bDMARD T . i) ( ) RA TNF, interleukin-1(IL-1), interleukin-6(IL-6).

9 TNF monoclonal antibody infliximab adalimumab( : , certolizumab( : ), golimumab( : ) , type II TNF receptor-Fc fusion protein etanercept( : ) , soluble cytokine neutralization( ) . IL-6 tocilizumab( : ) . ii) T (T ) RA T , , B , . T CD28-CD80/CD86 , CTLA-4(Cytotoxic T Lymphocyte Antigen-4)-Ig fusion protein abatacept( : ) T , 2 , 7/15 TNF RA . iii) (B ) B HLA-Class II molecule T (Antigen Presenting Cell, APC).

10 RA B RA B premature B cell activated mature B cell CD20 anti-CD20 chimeric monoclonal antibody rituximb( : ) . 1990 bDMARD MTX , MTX , . bDMARD . , .. bDMARD monoclonal antibody soluble fusion protein . (extracellular cytokine) . tsDMARD JAK JAK-STAT (intracellular signaling) (Targeted therapy) ?