甲氨蝶呤与美洛昔康联合应用对强直性脊柱炎患者晨僵、关节肿胀及胸廓活动度影响的远期效应

Long-term efficacy of methotrexate combined with meloxicam in treatment of morning stiffness,swelling of joint and activity of thorax in patients with ankylosing spondylitis

目的:观察甲氨蝶呤与美洛昔康联合应用治疗强直性脊柱炎(ankylosisingspondylitis,AS)的长期疗效和安全性。方法:研究对象为2000-07/2001-11在广州军区广州总医院门诊或住院收治的22例AS患者,甲氨蝶呤犤(14.3±2.4)mg,口服,1次/周犦和美洛昔康(7.5mg,口服,2次/d)联合治疗24个月。结果:22例AS患者治疗3,6,12,及24个月时的临床指标(晨僵、疼痛关节数)及ESR与治疗前比较,差异有显著性意义,其中治疗前及治疗后3,6,12,24个月时晨僵时间(min)分别为62.7±32.4,25.6±15.8,26.6±14.2,21.4±15.0,23.6±16.6;疼痛关节数分别为3.32±1.49,1.85±1.32,1.64±1.26,1.45±1.14,1.55±1.22;ESR(mm/h)分别为59.0±24.2,26.8±17.4,24.7±11.4,27.0±16.3,22.7±12.0(P<0.001),治疗24个月的显效率加有效率(87%)与治疗3个月时(54%)相比差异有显著性意义(P<0.05),总不良反应发生率逐渐减少。结论:甲氨蝶呤与美洛昔康联合治疗AS长期疗效良好,可显著改善患者晨僵、关节肿胀及胸廓活动度等,美洛昔康不增加甲氨蝶呤的毒性作用。

AIM:To study the long term efficacy and safety of combination therapy of ankylosing spondylitis(AS) with methotrexate and meloxicam.<METHODS:Twenty two patients with AS were selected from the outpatient or inpatient department of Guangzhou General Hospital of Guangzhou Military Area Command between July 2000 to November 2001.They received(14.3 ± 2.4) mg oral methotrexate once a week and oral meloxicam(7.5mg,twice a day) for 24 months.<RESULTS:Significant differences were found in the erythrocyte sedimentation rate(ESR) and the clinical indexes including morning stiffness and count of joint pain at 3,6,12 and 24 months after treatment.The during of morning stiffness(minute) was 62.7± 32.4, 25.6± 15.8, 26.6± 14.2, 21.4± 15.0, 23.6± 16.6 respectively before,and 3,6,12 and 24 months after treatment, the count of joint pain was 3.32± 1.49, 1.85± 1.32, 1.64± 1.26, 1.45± 1.14, 1.55± 1.22 respectively,and ESR(mm per hour) was 59.0± 24.2, 26.8± 17.4, 24.7± 11.4, 27.0± 16.3, 22.7± 12.0 (P< 0.001).There was a significant difference in the obvious effective rate plus effective rate at 24 months after treatment(87% ) from those at 3 months after treatment(54% )(P< 0.05).The incidence of total adverse effects was decreased gradually.<CONCLUSION:The combination therapy of methotrexate and meloxicam has a good long term effect on AS,and can improve morning stiffness,swelling of joint and activity of thoraxm,etc.and meloxicam can not aggravate the toxicity of methotrexate.