来氟米特联合小剂量糖皮质激素治疗老年类风湿关节炎的疗效

Outcomes of combined use of leflunomide and low-dose prednisone in the treatment of elder patients with rheumatoid arthritis

目的评价来氟米特(LEF)联合小剂量糖皮质激素(GCs)治疗老年类风湿关节炎(RA)的有效性和安全性。方法活动期RA老年患者68例,随机分为LEF治疗(LEF组,34例)和LEF联合小剂量GCs治疗(联合组,34例),治疗0、4、8、12周用美国风湿病协会(ACR)20标准评价疗效,记录不良反应。结果与LEF组比较,联合组治疗4周,晨僵时间、关节压痛数、关节压痛指数、关节肿胀数、关节肿胀指数、疼痛VAS、医生总体评价VAS、病人总体评价VAS、DAS28、C反应蛋白(CRP)均有更大改善(P<0.05),治疗后12周医生总体评价VAS、病人总体评价VAS、血沉(ESR)均显著好转(P<0.05);皮疹、肝损害较少(P<0.05)。结论 LEF联合小剂量GCs能迅速改善老年RA患者症状、体征和实验室炎性活动指标,不良反应少。

Objective To evaluate the effect and safety of the combination of leflunomide and low-dose prednisone in the treatment of senile rheumatoid arthritis. Methods Sixty-eight patients with senile rheumatoid arthritis in active stage were equally randomized into two groups of A（treated with leflunomide plus low-dose prednisone） and B （treated with leflunomide alone）. Effect and safety of treatment were evaluated with ACR20 at week 0,4,8, and 12. Results Compared to group B, the improvements of duration of morning stiffness of the joints, swollen joint count, tender joint count, doctor global VAS score, patient global VAS score, DAS28, and C-reactive protein （CRP） after treatment for 4 weeks, were more significant（P〈0. 05）. So did the doctor global VAS score, patient global VAS score and erytbrocyte sedimentation rate（ESR） after treatment for 12 weeks （P〈0. 05）. The incidences of adverse actions such as rashes and liver damage were higher in group B than those in group A（P〈0. 05）. Conclusion Combined use of leflunomide with low-dose prednisone is better than use of leflunomide alone in improving the symptoms, signs and inflammatory laboratory markers in elder patients with rheumatoid arthritis.