甲氨蝶呤和来氟米特联合治疗重症类风湿关节炎15月的临床疗效

目的:观察甲氨蝶呤和来氟米特联合治疗重症类风湿关节炎(RA)15mo后的临床疗效及不良反应。方法:62例重症RA病人分为2组,治疗组31例接受来氟米特和甲氨蝶呤联合治疗,对照组31例接受甲氨蝶呤、羟氯喹、柳氮磺吡啶联合治疗。比较2组治疗前后各项临床指标及放射学指标的变化,并比较不良反应发生率。结果:治疗后,2组ACR20,ACR50和ACR70分别为90％vs 62％,70％vs 41％,47％vs 21％,差异均有显著意义(p<0.05)。治疗组关节总Sharp评分和关节侵蚀进展均低于对照组(P<0.05)。2组病人对药物耐受性好,不良反应轻,差异无显著意义(P>0.05)。结论:2组均能有效缓解病情,对控制关节破坏效果也较明显,甲氨蝶呤和来氟米特联合作用更为显著。对于重症类风湿关节炎病人,应尽早予以甲氨蝶呤和来氟米特联合治疗。

Methotrexate combined with lefluomide for a 15-month treatment of severe rheumatoid arthritis

AIM: To explore the clinical efficacy and adverse reactions of patients with severe rheumatoid arthritis (RA) treated with a 15-month of methotrexate (MTX) plus lefluomide (Lef) . METHODS: Sixty-two patients with severe RA were divided into 2 groups, study group (n = 31) treated with MTX plus Lef and control group (n = 31) with the triple combination of MTX, hydroxychloroquine (HCQ) , and sulfasalazine (SSZ) . The clinical and radiological indices between the two groups before therapy and 15-months after therapy were compared correlatively. RESULTS: The rates of reaching ACR20, 50, and 70 after treatment for the two groups were 90 % vs 62 %, 70 % vs 41 %, and 47 % vs 21 % respectively, showing significant difference (P < 0.05) . The study group also showed significantly lower progression on joint erosion scores and total Sharp scores in comparing with the control (P < 0.05) . All of the patients were well tolerated throughout the treatment with no significant difference in adverse reaction between the two groups (P > 0.05) . CONCLUSION: Both of the combined therapy regimens could effectively relieve the clinical illness and retard joint damage; but the combination of MTX and Lef provides better efficacy and should be recommended to the early treatment for severe RA.