改善病情抗风湿药治疗类风湿关节炎167例临床分析

Clinical analysis on rheumatoid arthritis treated with disease modifying antirheumatic drug

目的 比较使用改善病情抗风湿药（DMARD）治疗类风湿关节炎（RA）的临床效果及对RA转归的影响，提高对DMARD治疗RA的认识和评价。方法 回顾性总结了1999年1月至2003年4月门诊有随访病历RA患者一般情况、临床症状及治疗情况。通过统计学分析比较单用、二联、三联治疗组（一联组、二联组、三联组）疾病临床缓解的差异；3组间远期疗效、双手正位X线的变化；队列比较各组中不同病程的疗效；同时比较各组药物不良反应。结果 共有256例患者初治选择了DMARD，除外89例合用激素者，共167例作为研究对象。3组近期疗效比较：红细胞沉降率和（或）C反应蛋白、缓解晨僵差异无统计学意义；对关节肿、痛，二联组和三联组优于一联组。3组近期疗效比较差异有统计学意义（x^2=9．858，P=0．002）。3组远期疗效比较差异有统计学意义（P=0．048）；远期疗效与联合治疗有关（Spearman等级相关系数rs=22843，P=0．0132；CMH非零相关统计量为6．059，P=0．014）。初诊时不同病程的远期疗效比较差异有统计学意义（P=0．019）。3组药物副作用差异无统计学意义。结论 早期联合使用DMARD治疗RA远期与近期疗效，均优于单一药物治疗。

Objective To compare the clinical outcomes of rheumatoid arthritis （RA） patients treated with different disease modifying antirheumatic drugs （DMARD） by analysing the clinical data and improve the understanding of different DMARDs. Methods The clinical data of RA patients who were treated and followed-up during Jan. 1999 to Mar. 2003 in Peking Union Medical College Hospital were retrospectively reviewed. The clinical efficacy and radiological changes were compared between patients treated with one DMARD only, 2 DMARDs combination and 3 DMARDs combination. The short-term and long-term effects among different dosage regimens in the three groups, and the long-term results of different duration of DMARD treatment were also compared. Results Three hundred and twenty-night patients had their clinical and follow-up data available for analysis. Among them, 256 patients had DMARDs as their initial treatment. Some of the patients showed corticosteroid in their treatment regimen while some patients did not have steroid. The clinical effectiveness had no significant difference between patients who had corticosteroid or not. Patients treated with 2 or more DMARDs combination had more improvement in ESR, CRP level, morning stiffness and number of swollen and tender joints compared with one DMARD alone. There was no significant difference in adverse reactions between the 3 groups treated with DMARDs. Conclusion DMARDs combination treatment can significantly and rapidly improve the symptoms and lab parameters in RA.