托法替布治疗难治性类风湿关节炎1例并文献复习

Tofacitinib in the treatment of refractory rheumatoid arthritis:A case report and literature review

类风湿关节炎是一种以对称性、多关节炎为主要表现的慢性自身免疫疾病,若经两种以上传统慢作用抗风湿药治疗超过6个月,或联合靶向生物制剂治疗超过3个月,病情仍处于高疾病活动度的类风湿关节炎则定义为难治性类风湿关节炎。难治性类风湿关节炎临床并不少见,治疗极其棘手。本文回顾了1例难治性类风湿关节炎,经甲氨蝶呤联合来氟米特或艾拉莫得,甚至生物制剂重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白均未能有效缓解疾病活动度,采用托法替布联合甲氨蝶呤后病情逐渐缓解,并实现达标治疗。本文通过文献复习慢作用抗风湿药物和生物制剂的作用机制,以及联合治疗类风湿关节炎的分子机制。并在总结本例患者的治疗经验基础上,提出托法替布是难治性类风湿关节炎治疗的一种新选择,为临床治疗该疾病提供了一种新思路。

Rheumatoid arthritis is a chronic autoimmune disease with symmetrical and polyarthritis as the main manifestation.Rheumatoid arthritis with high disease activity is defined as refractory rheumatoid arthritis if treated with more than two traditional slow-acting anti-rheumatic drugs for more than six months or in combination with targeted biological agents for more than three months.Refractory rheumatoid arthritis is common in clinical practice and is extremely difficult to treat.In this paper,we reviewed a case of refractory rheumatoid arthritis in which methotrexate combined with leflunomide or iguratimod or even the biological agent recombinant human tumor necrosis factor-αreceptorⅡ:Igg Fc fusion protein failed to effectively relieve disease activity,and the condition was gradually relieved after the use of tofacitinib combined with methotrexate,and target treatment was achieved.This paper reviewed the mechanism of action of slow-acting anti-rheumatic drugs and biological agents and the molecular mechanism of combination therapy for rheumatoid arthritis.Based on summarizing the treatment experience of this patient,it is proposed that tofacitinib is a new option for the treatment of refractory rheumatoid arthritis,providing a new idea for clinical treatment of this disease.