甲氨蝶呤联合阿达木单抗治疗类风湿关节炎疗效观察

The therapeutic effect of combination methotrexate with adalimumab in rheumatoid arthritis

目的分析甲氨蝶呤联合阿达木单抗治疗类风湿关节炎的临床疗效及不良反应。方法随机选择2012年9月-2013年8月治疗的活动性类风湿关节炎患者40例为研究对象,分为治疗组25例(甲氨蝶呤联合阿达木单抗)和对照组15例(单用甲氨蝶呤)。观测治疗前及治疗12、24周各项指标变化及不良反应。结果(1)治疗24周后,2组总有效率比较差异有统计学意义(66.0%vs.33.3%,P<0.05),除关节晨僵时间缩短率差异无统计学意义外(P>0.05),治疗组压痛减轻率、肿胀减轻率、VAS评分减少率均优于对照组(P<0.05)。(2)与治疗前比较,治疗后2组关节压痛数、关节肿胀数、晨僵时间及VAS评分在第12、24周均改善(P<0.05),除晨僵时间治疗24周时2组效果无明显差异外(P>0.05),其他指标治疗组均较对照组改善明显(P<0.05)。(3)与治疗前比较,治疗后2组ESR、CRP、RF在第12、24周均有改善(P<0.05),且第24周时治疗组优于对照组,差异有统计学意义(P<0.05)。(4)治疗12、24周后,2组DAS 28评分较治疗前均有改善(P<0.05),且治疗组优于对照组(P<0.05)。(5)2组治疗后12、24周Sharp评分较治疗前均有改善(P<0.05),且在24周时,治疗组优于对照组(P<0.05)。(6)2组不良反应发生率,治疗组低于对照组(4.0%vs.20.0%,P<0.05)。结论甲氨蝶呤联合阿达木单抗治疗类风湿关节炎疗效显著,不良反应较少,能很快缓解临床症状,值得临床推广。

Objective To investigate the therapeutic effect of combination adalimumab with methotrexate in rheuma -toid arthritis and adverse reactions .Methods Randomly selected from September 2012 to August 2013 active rheumatoid ar-thritis patients （ n =40） for the study, they were divided into treatment group with 25 cases （methotrexate adalimumab） and control group of 15 patients （methotrexate alone）.Observe before treatment, 12, 24 weeks of treatment, the indicators and adverse reactions.Results （1） After 24 weeks of treatment, there are significantly differences between the two groups＇overall efficiency （66.0%vs.33.3%, P 〈0.05）, except for joint shortening duration of morning stiffness comparison revealed no significant difference （ P 〉0.05）, the treatment group＇s reduce the rate of tenderness, swelling to reduce rates, VAS score decreased rate better than the control group （ P 〈0.05）.（2） Compared with before treatment , after treatment, 2group＇s ten-der joint count, swollen joint count, morning stiffness and VAS scores at 12 and 24 weeks were improved （ P 〈0.05）, in ad-dition to 24 weeks of treatment duration of morning stiffness revealed no significant difference （ P 〉0.05）, other indicators of the treatment group improved significantly than in the control group （ P 〈0.05）.（3） Compared with before treatment, after treatment, two groups＇ESR, CRP,RF at 12 and 24 weeks were improved （ P 〈0.05）, and when the 24 -week treatment group better than the control group , the difference was statistically significant （ P 〈0.05）.（4） 12 and 24 weeks after treat-ment, the two groups before treatment DAS 28 score were improved （ P 〈0.05）, and the treatment group better than the con-trol group （ P 〈0.05）.（5） 2, 12 and 24 weeks after treatment, sharp score were improvement than before treatment （ P 〈0.05）, and at 24 weeks, the treatment group better than the control group （ P 〈0.05）.（6） 2 groups＇incidence of adverse reactions, the treatment group better than the control group （4.0%vs.20.0%, P 〈0.05）.Conclusion Combination of the adalimumab with methotrexate has effect on treatment of rheumatoid arthritis with significantly fewer adverse reactions , can quickly relieve symptoms , worthy of promotion .