中重度类风湿性关节炎的联合药物治疗比较

A prospectively comparative study in moderate or severe progression of rheumatoid arthritis with combination therapy of DMARDs

目的观察氨甲蝶呤(MTX)+柳氮磺胺吡啶(SASP)和MTX+来氟米特治疗中重度类风湿性关节炎(rheumatoid arthritis,RA)患者的安全性、疗效及前瞻性比较性研究。方法将40例中重度RA患者分为MTX+SASP组18例:予MTX7.5～15mg/w,SASP1.0g/d,每周递增0.5至2～3g/d;MTX+来氟米特组22例:予MTX7.5～15mg/w,来氟米特50mg/d,连用3d后改为20mg/d维持,均治疗3个月。结果两组各项临床指标和实验室指标较治疗前均有显著改善,MTX+SASP组总有效率为83.3%,不良反应发生率为55.6%;MTX+来氟米特组总有效率为81.8%,不良反应发生率为22.7%,但二组的总有效率和不良反应率均无显著性差异(P>0.05)。结论MTX+SASP或MTX+来氟米特的联合应用治疗中重度RA患者,疗效良好;建议尽可能在RA早期即行缓解疾病的抗风湿性药物(DMARD)联合治疗,以减缓疾病进展。

Objective To evaluate the efficacy and safety of combined use of methotrexate plus sulfasalazine or leflunomide for treating patients with more severe disease of radiographic changes,and a prospective and comparative study in moderate or severe progresson of rheumatoid arthritis. Methods Forty patients with RA were divided into group A（methotrexate plus sulfasalazine, n=18）and group B（methotrexate plus leflunomide,n=22）for 3 months,each patient in both groups took oral methotrexate at the dose of 7.5 to 15mg once per week,while the patients of group A also received oral sulfasalazine at the dose of lg per day at the first and then 0.5g increased dosage by degrees every week to 2-3g per day at last,and the patients of group B also received MTX,and oral leflunomide at the dose of 50mg per day for three days,then 20mg orally per day. Results After treatment,the clinical indexes and inflammatory parameters of the patients significantly improved in both groups,with a total efficacy of 83.3% in group A and 81.8% in group B,and adverse effect of 55.6% in group A and 22.7% in group B,but there were no significant differences of total efficacy and adverse effect between group A and group B （P 〉 0. 05）. Conclusion The combination of methotrexate with sulfasalazine or leflunomide can achieve satisfactory results in moderate and severe disease of RA patients. Combination therapy of DMARDs are initiated quickly to retard disease progression as early as possible.