Altered Iron-Mediated Metabolic Homeostasis Governs the Efficacy and Toxicity of Tripterygium Glycosides Tablets Against Rheumatoid Arthritis

Rheumatoid arthritis(RA),a globally increasing autoimmune disorder,is associated with increased disability rates due to the disruption of iron metabolism.Tripterygium glycoside tablets(TGTs),a Tripterygium wilfordii Hook.f.(TwHF)-based therapy,exhibit satisfactory clinical efficacy for RA treatment.However,drug-induced liver injury(DILI)remains a critical issue that hinders the clinical application of TGTs,and the molecular mechanisms underlying the efficacy and toxicity of TGTs in RA have not been fully elucidated.To address this problem,we integrated clinical multi-omics data associated with the anti-RA efficacy and DILI of TGTs with the chemical and target profiling of TGTs to perform a systematic network analysis.Subsequently,we identified effective and toxic targets following experimental validation in a collagen-induced arthritis(CIA)mouse model.Significantly different transcriptome–protein–metabolite profiles distinguishing patients with favorable TGTs responses from those with poor outcomes were identified.Intriguingly,the clinical efficacy and DILI of TGTs against RA were associated with metabolic homeostasis between iron and bone and between iron and lipids,respectively.Particularly,the signal transducer and activator of transcription 3(STAT3)–hepcidin(HAMP)/lipocalin 2(LCN2)–tartrate-resis tant acid phosphatase type 5(ACP5)and STAT3–HAMP–acyl-CoA synthetase long-chain family member 4(ACSL4)–lysophosphatidylcholine acyltransferase 3(LPCAT3)axes were identified as key drivers of the efficacy and toxicity of TGTs.TGTs play dual roles in ameliorating CIA-induced pathology and in inducing hepatic dysfunction,disruption of lipid metabolism,and hepatic lipid peroxidation.Notably,TGTs effectively reversed“iron–bone”disruptions in the inflamed joint tissues of CIA mice by inhibiting the STAT3–HAMP/LCN2–ACP5 axis,subsequently leading to“iron–lipid”disturbances in the liver tissues via modulation of the STAT3–HAMP–ACSL4–LPCAT3 axis.Additional bidirectional validation experiments were conducted using MH7A and AML12 cells to confirm the bidirectional regulatory effects of TGTs on key targets.Collectively,our data highlight the association between iron-mediated metabolic homeostasis and the clinical efficacy and toxicity of TGT in RA therapy,offering guidance for the rational clinical use of TwHF-based therapy with dual therapeutic and toxic potential.

Clinical efficacy of tocilizumab combined with leflunomide in the treatment of rheumatoid arthritis

Objective:To study the clinical efficacy of tocilizumab combined with leflunomide in the treatment of rheumatoid arthritis.Methods:114 patients with rheumatoid arthritis admitted from May 2015 to April 2018 were randomly divided into control group(n=57)and observation group(n=57).The control group was treated with leflunomide.On the basis of this,the observation group was treated with tocilizumab for 12 weeks.Functional indicators,erythrocyte sedimentation rate(ESR),rheumatoid factor and inflammatory factors were evaluated and adverse reactions were recorded.Results:The total treatment efficiency of the observation group(89.47%)was significantly higher than that of the control group(75.44%)(P<0.05).Morning stiffness time,joint pain score,joint swelling score,ESR,serum C-reactive protein(CRP),rheumatoid factor(RF),tumor necrosis factor(TNF-α),and interleukin-1 were observed in the observation group and the control group.The levels of IL-1),IL-6,IL-8 and other indicators were lower than those before treatment.The indexes of the observation group were significantly lower than those before treatment(P<0.05),and after treatment The morning stiffness time,joint pain score,joint swelling score,ESR,CRP,RF,TNF-α,IL-1,IL-6,IL-8 and other indicators in the observation group were significantly lower than those in the control group(P<0.05).The incidence of adverse reactions in the observation group was 14%,and the incidence of adverse reactions in the control group was 17.54%.Toltuzumab combined with leflunomide in the treatment of rheumatoid arthritis did not increase the probability of adverse reactions.Conclusion:The use of tocilizumab combined with leflunomide in the treatment of rheumatoid joints has good efficacy and safety.This may be related to a significant reduction in inflammatory factors TNF-α,IL-1,IL-6,IL-8 and the like.

Leflunomide,a new disease-modifying drug for treating active rheumatoid arthritis in methotrexate-controlled phase Ⅱ clinical trial

Objective To evaluate the efficacy and safety of leflunomide in comparison with methotrexate (MTX) on patients with rheumatoid arthritis (RA) in China.Methods Five hundred and sixty-six patients with active rheumatoid arthritis were randomly assigned to receive leflunomide at 20 mg once daily or MTX at 15 mg once weekly in a controlled trial. Five hundred and four patients completed the 12-week treatment and some patients continued the treatment for 24 weeks. Results Both leflunomide and MTX could improve the symptoms,signs,and joint function,but there were no changes in X-ray observations of patients with rheumatoid arthritis. In the leflunomide group,the overall rates of effectiveness at 12 weeks and 24 weeks were 86.94% and 92.31% respectively; the rates of remarkable improvement were 64.95% and 79.81% respectively. In the MTX group,the overall rates of effectiveness at 12 weeks and 24 weeks were 84.04% and 83.15% respectively; the rates of remarkable improvement were 56.81% and 75.28% respectively. According to intent-to-treat analysis,the ACR 20% response rates at 12 weeks and 24 weeks in the leflunomide group were 62.54% and 67.18% respectively,compared with 60.08% and 61.32% respectively in MTX group. No statistical differences were shown in the efficacy between the two groups ( P >0.05). The adverse events in the leflunomide group were gastrointestinal symptoms,skin rash,alopecia,nervous system symptoms,decreased leukocyte count,and elevation of alanine aminotransferase (ALT). Most of these side effects were mild and transient. The incidence of adverse events in the leflunomide group was 16.84%,significantly lower than that in MTX group (28.17%,P =0.002).Conclusions Leflunomide is effective in the treatment of RA with less adverse events than MTX. Its efficacy is similar to MTX,but the incidence of adverse events and the rate of withdrawal due to adverse events were lower in the leflunomide group than in MTX group.

Efficacy and Safety of Tofacitinib in Chinese Patients with Rheumatoid Arthritis

Background: Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis(RA). This study assessed the efficacy and safety of tofacitinib in Chinese patients with RA enrolled in Phase 3 and long?term extension(LTE) studies.Methods: ORAL Sync was a 1?year, randomized, placebo?controlled, Phase 3 trial. Patients received tofacitinib 5 or 10 mg twice daily(BID) or placebo advanced to tofacitinib 5 or 10 mg BID at 3 or 6 months. All patients remained on ≥1 background conventional synthetic disease?modifying antirheumatic drug. ORAL Sequel is an open?label LTE study(data?cut: March 2015; data collection and analyses were ongoing, and study database was not locked at the time of analysis; study was closed in 2017). Efficacy outcomes: American College of Rheumatology(ACR) 20/50/70 response rates and Disease Activity Score in 28 joints using erythrocyte sedimentation rate(DAS28?4 [ESR]). Patient? and physician?reported outcomes: Health Assessment Questionnaire?Disability Index(HAQ?DI), Patient and Physician Global Assessment of Arthritis, and pain(visual analog scale). Safety was assessed throughout.Results: ORAL Sync included 218 patients; 192 were subsequently enrolled into ORAL Sequel. In ORAL Sync, more patients achieved ACR20(tofacitinib 5 mg BID, 67.4%; 10 mg BID, 70.6%; placebo, 34.1%) and DAS28?4(ESR) <2.6(tofacitinib 5 mg BID, 7.1%;10 mg BID, 13.1%; placebo, 2.3%) with tofacitinib versus placebo at Month 6. Mean changes from baseline in HAQ?DI were greater with tofacitinib versus placebo at Month 6. In ORAL Sequel, efficacy was consistent to Month 48. Incidence rates for adverse events of special interest in tofacitinib?treated patients were similar to the global population.Conclusions: Tofacitinib significantly reduced signs/symptoms and improved physical function and quality of life in Chinese patients with moderate?to?severely active RA up to Month 48. The safety profile was consistent with the global population.Clinical Trial Identifier: NCT00856544 and NCT00413699.

A double-blind, double-dummy, randomized controlled, multicenter trial of ^(99)Tc-methylene diphosphonate in patients with moderate to severe rheumatoid arthritis

Background:Clinical observational studies revealed that ^(99)Tc-methylene diphosphonate(^(99)Tc-MDP)could reduce joint pain and swollenness in rheumatoid arthritis(RA)patients.This multicenter,randomized,double-blind,double-dummy study aimed to evaluate the effects of ^(99)Tc-MDP plus methotrexate(MTX)vs.MTX alone or ^(99)Tc-MDP alone on disease activity and structural damage in MTX-naïve Chinese patients with moderate to severe RA.Methods:Eligible patients with moderate to severely active RA were randomized to receive ^(99)Tc-MDP plus MTX(n=59)vs.MTX(n=59)alone or ^(99)Tc-MDP(n=59)alone for 48 weeks from six study sites across four provinces in China.The primary outcomes were the American College of Rheumatology 20%improvement(ACR20)response rates at week 24 and changes in modified total Sharp score at week 48.Results:At week 24,the proportion of participants achieving ACR20 was significantly higher in the MTX+^(99)Tc-MDP combination group(69.5%)than that in the MTX group(50.8%)or ^(99)Tc-MDP group(47.5%)(P=0.03 for MTX+^(99)Tc-MDP vs.MTX,and MTX+^(99)Tc-MDP vs.^(99)Tc-MDP,respectively).The participants in the MTX+^(99)Tc-MDP group and the ^(99)Tc-MDP group had significantly less important radiographic progression than the participants in the MTX group over the 48 weeks(MTX+^(99)Tc-MDP vs.MTX:P=0.03,^(99)Tc-MDP vs.MTX:P=0.03,respectively).There was no significant difference in terms of adverse events(AEs)among the groups.No serious AEs were observed.Conclusions:This study demonstrated that the combination of ^(99)Tc-MDP with MTX inhibited structural damage and improved disease activity in RA patients compared with MTX and ^(99)Tc-MDP monotherapies,without increasing the rate of AEs.Additional clinical studies of ^(99)Tc-MDP therapy in patients with RA are warranted.Trial Registration:Chictr.org,ChiCTR-IPR-14005684;http://www.chictr.org.cn/showproj.aspx?proj=10088.

CYP3A4基因位点多态性对托法替布治疗类风湿关节炎临床疗效及药品不良反应的影响

目的探讨CYP3A4*4,CYP3A4*18,CYP3A4*1G基因位点多态性对托法替布治疗类风湿关节炎(RA)临床疗效及药品不良反应(ADR)的影响。方法选取医院风湿免疫科2020年2月至2022年8月收治的RA患者309例作为RA组,予枸橼酸托法替布片,每日2次,每次5 mg,共治疗6个月;选取同期的健康人群165例作为对照组。采用荧光聚合酶链反应(PCR)法检测CYP3A4*4,CYP3A4*18,CYP3A4*1G基因位点多态性;根据美国风湿病学学会(ACR)制订的ACR20标准评价托法替布的临床疗效,以是否符合ACR20标准,将RA患者分为改善组(181例)和未改善组(128例);统计治疗期间RA患者与托法替布相关的ADR,采用Karch和Lasagna评定法判定因果关系,以因果关系是否判定为肯定、很可能和可能,将RA患者分为ADR组(58例)和无ADR组(251例)。结果RA组和对照组患者的CYP3A4*4,CYP3A4*18,CYP3A4*1G基因位点多态性均无显著差异(P>0.05)。改善组和未改善组患者的疾病活动度差异显著(P<0.05),CYP3A4*4,CYP3A4*18,CYP3A4*1G基因位点多态性均无显著差异(P>0.05)。ADR累及系统为实验室检验异常、皮肤系统、消化系统、呼吸系统、血液系统,分别发生27例、11例、7例、5例、3例;ADR严重程度为轻度51例,中度7例。ADR组和无ADR组患者的CYP3A4*1G基因位点多态性差异显著(P<0.05),CYP3A4*4和CYP3A4*18基因位点多态性均无显著差异(P>0.05)。结论CYP3A4*1G基因位点多态性与托法替布治疗RA的ADR有相关性。使用托法替布时,应监测患者的CYP3A4*1G基因位点多态性,必要时调整剂量,保证用药安全。

白芍总苷对幼年类风湿性关节炎患儿血清B细胞激活因子的影响

目的探讨白芍总苷对幼年类风湿性关节炎患儿的临床疗效及对血清B细胞激活因子的影响。方法选取中山市中医院儿科2019年8月至2021年8月收治的40例幼年类风湿性关节炎患儿为研究对象,按照随机数表法将其分为对照组(20例)与治疗组(20例)。对照组仅接受口服布洛芬缓释混悬剂,治疗组在口服布洛芬缓释混悬剂基础上同时加白芍总苷胶囊治疗。两组均进行12周持续治疗。观察两组治疗后关节发热、肿胀、晨僵等症状的消失时间,红细胞沉降率、类风湿性因子、B细胞激活因子及C反应蛋白的变化。结果治疗后,治疗组总有效率高于对照组,治疗组的关节发热、肿胀及晨僵症状消失时间均短于对照组,且红细胞沉降率、类风湿性因子、C反应蛋白水平及B细胞激活因子均低于对照组,差异有统计学意义(P<0.05);两组患儿不良反总发生率比较,差异无统计学意义(P>0.05)。结论白芍总苷用于治疗幼年类风湿性关节炎患儿,其临床疗效显著,可抑制B细胞激活因子表达,降低患儿红细胞沉降率水平及C反应蛋白水平,改善患儿类风湿关节炎的临床症状,且安全系数良好,值得临床推广使用。

补肾蠲痹汤联合甲氨蝶呤治疗老年类风湿关节炎的临床效果

目的研究补肾蠲痹汤与甲氨蝶呤联合使用对老年类风湿关节炎的治疗效果。方法回顾性选取2019年10月—2022年10月汉川市人民医院收治的118例老年类风湿关节炎患者的临床资料,以不同治疗方式分为两组,对照组(58例)给予口服甲氨蝶呤片治疗,观察组(60例)采用口服甲氨蝶呤片+补肾蠲痹汤治疗。比较两组晨僵时间及中医证候积分、视觉模拟评分法、类风湿性关节炎28个关节疾病活动评分、健康评估问卷评分、炎症因子水平、不良反应、治疗有效率。结果治疗后,观察组晨僵时间短于对照组,中医证候积分、视觉模拟评分法评分、类风湿性关节炎28个关节疾病活动评分及健康评估问卷评分低于对照组,差异有统计学意义(P均<0.05)。治疗后,观察组红细胞沉降率、类风湿因子、C反应蛋白、肿瘤坏死因子-α、白细胞介素-1β、白细胞介素-6水平低于对照组,差异有统计学意义(P均<0.05)。治疗后,两组不良反应发生率比较,差异无统计学意义(P>0.05)。观察组治疗有效率为95.00%(57/60),高于对照组的82.76%(48/58),差异有统计学意义(χ^(2)=4.505,P<0.05)。结论与单独使用甲氨蝶呤相比,补肾蠲痹汤与甲氨蝶呤联合使用在改善老年类风湿关节炎的临床症状方面具有更显著的优势,还能有效降低炎症因子水平,同时不增加不良反应的发生风险。

关节克痹丸联合甲氨蝶呤片治疗RA的效果及对临床症状与骨代谢的影响

目的观察关节克痹丸联合甲氨蝶呤片治疗类风湿关节炎(RA)的效果及对临床症状与骨代谢的影响。方法选取2020年1月—2021年1月首都医科大学附属北京中医医院风湿病科门诊就诊的RA患者73例,按照随机数字表法分为观察组36例和对照组37例。在常规治疗的基础上,对照组采用甲氨蝶呤片治疗,观察组在对照组基础上采用关节克痹丸治疗,2组均治疗2个月。比较2组治疗前后临床症状评分、骨代谢指标[骨钙素(OCN)、总维生素D(Vit-D)、β-胶原特殊序列(β-CTX)及总Ⅰ型胶原氨基端延长肽(PⅠNP)]、类风湿因子(RF)与炎性指标[C反应蛋白(CRP)、红细胞沉降率(ESR)]及不良反应。结果治疗2个月后,2组关节肿胀、关节压痛、晨僵评分较治疗前降低,且观察组低于对照组(P均<0.01);2组OCN、Vit-D、PⅠNP水平较治疗前升高,β-CTX水平较治疗前下降,且观察组升高/下降幅度大于对照组(P均<0.01);2组RF、CRP水平及ESR较治疗前下降,且观察组低于对照组(P均<0.01)。观察组不良反应总发生率为8.33%,低于对照组的27.03%(χ^(2)=4.356,P=0.036)。结论关节克痹丸联合甲氨蝶呤片治疗可明显缓解RA患者的临床症状,有效改善机体骨代谢,降低炎性指标,且不良反应发生率低。

汉防己甲素治疗类风湿关节炎有效性和安全性的meta分析

目的:探索汉防己甲素治疗类风湿关节炎的有效性和安全性。方法:在中国知网、维普网、万方数据、SinoMed、PubMed、Springer、Web of Science、Cochrane Central Register of Controlled Trails数据库中检索汉防己甲素治疗类风湿关节炎的随机对照临床试验。采用R 3.5.3软件对有效率、红细胞沉降率(ESR)、C反应蛋白(CRP)、类风湿因子、视觉模拟评分(VAS)、疾病活动度评分(DAS)、压痛关节计数(TJC)、肿胀关节计数(SJC)和晨僵持续时间等临床指标,以及不良事件发生率进行meta分析。结果:最终纳入10篇研究。meta分析结果显示,汉防己甲素对治疗的有效率(OR=3.27,95%CI:2.01~5.37,P<0.01)、ESR(SMD=1.12,95%CI:0.06~2.19,P<0.05)、CRP(SMD=0.75,95%CI:0.28~1.22,P<0.01)、VAS(SMD=0.64,95%CI:0.29~1.00,P<0.01)、TJC(SMD=1.16,95%CI:0.58~1.74,P<0.01)、SJC(SMD=0.85,95%CI:0.40~1.31,P<0.01)、晨僵持续时间(SMD=1.09,95%CI:0.68~1.50,P<0.01)有一定的改善作用,对类风湿因子(SMD=1.70,95%CI:-1.10~4.51,P>0.05)和DAS(SMD=0.26,95%CI:-0.59~1.11,P>0.05)的改善与对照组差异无统计学意义。汉防己甲素治疗类风湿关节炎的不良事件总发生率为20%(95%CI:12%~27%,I^(2)=60%,P<0.05),不良事件的程度较轻,患者转归良好。结论:汉防己甲素能提高药物治疗类风湿关节炎的临床效果,且不良事件程度较轻。

瘀血痹胶囊治疗血瘀证类风湿关节炎患者的疗效观察

目的 观察瘀血痹胶囊治疗血瘀证类风湿关节炎(Rheumatoid Arthritis,RA)患者的临床疗效及对其心血管事件风险因素的影响。方法 选取2020年5月—2021年12月期间中国中医科学院广安门医院收治的RA患者作为研究对象,共纳入2108例RA患者,以服用瘀血痹胶囊为暴露因素,纳入暴露组(瘀血痹胶囊+基础治疗)1082例与非暴露组(基础治疗)1026例。主要结局指标为DAS28-ESR、DAS28-CRP,分别分析基线数据及在治疗后第24周较基线的改善值的组间比较,以评估治疗后患者疾病活动度及心血管相关风险因素的改善情况。次要结局指标:(1)中医证候指标:血瘀证评分;(2)炎症指标:白细胞计数(White blood cell,WBC)、血沉(Erythrocyte sedimentation Rate,ESR)、C反应蛋白(C-reactive protein,CRP)、超敏C反应蛋白(high sensitivity C-reactive protein,hsCRP);(3)免疫指标:类风湿因子(Rheumatoid factor,RF)、血清免疫球蛋白G(Immunoglobulin G,IgG)、血清免疫球蛋白M(Immunoglobulin M,IgM)、血清免疫球蛋白A(Immunoglobulin A,IgA)、抗核抗体(Anti-Nuclear Antibody,ANA);(4)血小板计数(Platelet,PLT)、血红蛋白(Hemoglobin,HGB)及血脂指标[总胆固醇(Total cholesterol,TC)、甘油三酯(Triglyceride,TG)、高密度脂蛋白(High Density lipoprotein cholesterol,HDL-C)、低密度脂蛋白(Low density lipoprotein cholesterol,LDL-C)]。安全性指标:(1)生命体征:体温、呼吸、心率、血压;(2)不良事件或不良反应:随时观测;(3)实验室检查:谷丙转氨酶、谷草转氨酶、谷氨酰转移酶、尿素、肌酐、直接胆红素。结果 (1)在治疗第24周后,瘀血痹胶囊联合基础治疗在降低DAS28评分、ESR、CRP、RF、lgG、ANA方面显著优于单用基础治疗,提示可明显患者疼痛症状及疾病整体状态,提高日常生活能力;(2)在治疗后第24周,瘀血痹胶囊联合基础治疗在降低血瘀证评分、PLT、TG、HDL-C方面显著优于单用基础治疗,提示可降低心血管事件风险因素;(2)在肝肾功异常方面,无确定性证据表明由瘀血痹胶囊引起的肝肾功能异常,暂无证据表明瘀血痹胶囊治疗RA患者存在严重不良反应。结论 瘀血痹胶囊联合基础治疗可以提高RA患者的临床达标率,同时能改RA患者心血管风险因素相关指标,且安全性较好。

隔药灸联合中医五行手指操治疗寒湿痹阻型类风湿关节炎的疗效观察

目的探讨隔药灸联合中医五行手指操改善寒湿痹阻型类风湿关节炎(rheumatoid arthritis,RA)的临床疗效。方法将90例寒湿痹阻型RA患者随机分为对照组和观察组,每组45例。对照组予以来氟米特片、艾拉莫德片、塞来昔布胶囊口服;观察组在对照组基础上行隔药灸联合中医五行手指操,其中隔药灸选取脾俞、阳陵泉、腰阳关、命门及手阳明大肠经、手少阳三焦经、手太阳小肠经上的阿是穴,每日1次,每次30 min。两组均治疗10 d。分别于治疗前后观察两组患者的疼痛视觉模拟评分(visual analogue scale,VAS)、炎症指标红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP)、焦虑自评量表(self-rating anxiety scale,SAS)、健康评估问卷(health assessment questionnaire,HAQ)、中医证候积分,并于治疗后评定两组患者的临床疗效。结果治疗后,两组患者的VAS、ESR、CRP、SAS、HAQ及中医证候积分均较治疗前降低(P<0.05,P<0.01),且观察组上述指标均低于对照组(P<0.05,P<0.01)。观察组总有效率为80.00%,高于对照组的55.56%(P<0.01)。结论隔药灸联合中医五行手指操能改善寒湿痹阻型RA患者临床症状,提高患者生存质量。

清热逐风合剂联合甲氨蝶呤治疗湿热痹阻型类风湿关节炎临床观察

目的:研究清热逐风合剂联合甲氨蝶呤对湿热痹阻型类风湿关节炎(RA)患者的临床疗效。方法:将72例湿热痹阻型RA患者随机分为治疗组和对照组各36例,对照组患者口服甲氨蝶呤片和叶酸片;治疗组患者在对照组基础上服用清热逐风合剂,疗程均为12周。比较两组患者治疗前后及治疗4、8、12周后的疗效、症状和体征、中医证候积分、DAS28评分及健康评价调查表(HAQ)、ESR、CRP、RF、CCP的变化,以及不良反应情况。结果:治疗组患者临床治疗总有效率(91.4%,32/35)高于对照组(73.5%,25/34)(P<0.05);治疗组患者中医证候疗效总有效率(85.7%,30/35)高于对照组(61.8%,21/34)(P<0.05);两组患者治疗后关节压痛数、肿胀数、VAS评分、中医证候积分、DAS28评分、HAQ评分较治疗前降低(P<0.05),治疗组患者治疗后关节压痛数、肿胀数、VAS评分、中医证候积分、DAS28评分、HAQ评分均低于对照组(P<0.05);两组患者治疗后ESR、CRP、RF、CCP水平较治疗前降低(P<0.01),除治疗组患者CCP在治疗第4周时与对照组患者比较差异无统计学意义(P>0.05)外,治疗组患者在治疗后ESR、CRP、RF水平均低于对照组患者(P<0.05);治疗组患者不良反应发生率低于对照组患者(P>0.05)。结论:清热逐风合剂联合甲氨蝶呤对湿热痹阻型类风湿关节炎患者临床疗效良好,可减轻患者炎症反应、风湿免疫因子和抗环瓜氨酸肽抗体,且不良反应少。

共享门诊管理模式在类风湿关节炎患者中的应用研究

目的评价共享门诊管理模式在类风湿关节炎(rheumatoid arthritis,RA)患者中的应用效果。方法便利选取2023年2-6月在上海市光华中西医结合医院关节内科门诊就诊的94例RA患者,按随机数字表法分为观察组和对照组各47例。观察组采用共享门诊管理模式,对照组采用常规门诊护理,比较实施前后2组患者疾病知识掌握水平、自我效能及抑郁水平。结果实施3个月后,观察组疾病知识掌握得分和自我效能得分均高于对照组(P<0.001),抑郁水平低于对照组(P<0.001),差异均有统计学意义。结论应用共享门诊管理模式可有效提高RA患者的疾病知识水平、自我效能,减轻患者的抑郁情绪。

托法替布联合氨甲蝶呤治疗类风湿关节炎患者的效果

目的:观察托法替布联合氨甲蝶呤治疗类风湿关节炎(RA)患者的效果。方法:回顾性分析2020年5月至2023年6月该院收治的60例RA患者的临床资料,按照治疗方法不同将其分为对照组和研究组各30例。对照组采用氨甲蝶呤治疗,研究组在对照组基础上联合托法替布治疗,两组均连续治疗3个月。比较两组临床疗效,治疗前后临床症状(关节肿胀、疼痛、晨僵)评分、骨代谢指标[Ⅰ型前胶原氨基末端肽(PⅠNP)、β-胶原降解产物(β-CTX)、N端中段骨钙素(N-MID)、骨保护素(OPG)]水平、炎性指标[白细胞介素-8(IL-8)、簇集蛋白(CLU)、C反应蛋白(CRP)、壳多糖酶3样蛋白1(CHI3L1)]水平,以及不良反应发生率。结果:研究组治疗总有效率为93.33%(28/30),高于对照组的73.33%(22/30),差异有统计学意义(P<0.05);治疗后,研究组关节肿胀、疼痛、晨僵评分均低于对照组,差异有统计学意义(P<0.05);治疗后,研究组PⅠNP、N-MID、OPG水平高于对照组,β-CTX、IL-8、CRP、CHI3L1、CLU水平低于对照组,差异均有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:托法替布联合氨甲蝶呤治疗RA患者可提高治疗总有效率,改善骨代谢指标水平,降低临床症状评分和炎性指标水平,效果优于单纯氨甲蝶呤治疗。

壮医临证施护联合水蛭疗法治疗类风湿关节炎短期疗效的研究

目的:观察壮医临证施护联合水蛭疗法在类风湿关节炎活动期中的短期抗炎止痛及减轻疾病活动度的效果。方法:纳入类风湿关节炎活动期患者120例,采用随机数字表法将患者分为对照组与观察组,每组60例。对照组采用双氯芬酸钠双释放肠溶胶囊治疗,观察组采用壮医临证施护联合水蛭疗法,疗程14 d。观察两组患者治疗前、治疗1周后、治疗2周后关节疼痛评分(目测模拟标尺法VAS)、肿胀评分、DAS28评分及血清学指标(CRP、RF、ESR、PT、PLT)及治疗后临床疗效。结果:治疗后,两组患者关节疼痛(VAS)、关节肿胀数、DAS28评分及血清学指标(CRP、RF、ESR、PT、PLT)均较治疗前明显改善(P<0.05),且观察组与对照组相比明显改善(P<0.05);观察组临床总有效率(93.33%)明显高于对照组(53.33%),差异有统计学意义(P<0.05)。结论:壮医临证施护联合水蛭疗法在治疗类风湿关节炎活动期患者时,短期内展现出显著的抗炎止痛效果,并能减轻疾病活动度。

鹿瓜多肽注射液联合常规西药治疗类风湿关节炎的Meta分析

目的:系统评价鹿瓜多肽注射液联合常规西药治疗类风湿关节炎的疗效,为临床治疗提供循证依据。方法:计算机检索PubMed、The Cochrane Library、Embase、Web of Science、中国知网、万方、维普、中国生物医学文献服务系统等数据库,搜集鹿瓜多肽注射液联合常规西药治疗类风湿关节炎的随机对照试验,检索时限均为建库至2023年1月5日,由2名研究人员进行文献筛选和资料提取后,采用RevMan 5.3进行偏倚风险评价和Meta分析。结果:共纳入14篇文献,1 285例患者。Meta分析结果显示,试验组关节视觉模拟评分法(Visual Analogue Scale,VAS)评分[MD=-2.58,95%CI(-5.02,-0.13)]、关节肿胀数目[MD=-2.08,95%CI(-3.25,-0.91)]、握力[MD=1.63,95%CI(0.31,2.96)]、晨僵时长[MD=-0.61,95%CI(-1.05,-0.18)]、红细胞沉降率[MD=-2.15,95%CI(-3.72,-0.58)]、C反应蛋白[MD=-1.42,95%CI(-2.74,-0.11)]、类风湿因子[MD=-4.39,95%CI(-7.95,-0.82)]均优于对照组,且不良反应较少,P <0.05,差异有统计学意义。结论:鹿瓜多肽注射液联合常规西药治疗类风湿关节炎疗效佳,值得临床推广应用。

类风湿关节炎的早期识别及规范治疗探究

分析类风湿关节炎早期识别情况以及规范治疗的方法和效果。选择滨州医学院附属医院2022年7月—2023年6月收治的134例类风湿关节炎患者为研究对象,将其随机分成对照组和观察组两组。对照组(n=67)患者应用甲氨蝶呤联合来氟米特治疗,观察组患者联合应用甲氨蝶呤与枸橼酸托法替布片治疗,比较两组患者治疗效果。结果显示,与对照组相比,观察组临床疗效更佳(P<0.05)。治疗前,两组患者的临床症状对比无显著差异(P>0.05);治疗后,观察组肿胀关节及压痛关节更少,晨僵时间更短(P<0.05)。治疗前,两组患者的炎性指标水平比较无显著差异(P>0.05);治疗后,观察组C反应蛋白(CRP)、血沉(ESR)及类风湿因子(RF)水平均更低(P<0.05)。观察组与对照组不良反应总发生率差异无统计学意义(P>0.05)。治疗后,观察组HAQ评分明显更高(P<0.05)。研究发现,早期识别类风湿关节炎并实施有效治疗能够改善患者预后,给予患者甲氨蝶呤联合枸橼酸托法替布片治疗可提升患者的生活质量。

云克联合治疗对类风湿关节炎的临床及实验室指标的影响

目的:观察云克(99Tc-MDP)联合甲氨蝶呤、来氟米特对类风湿关节炎的临床疗效及实验室指标的变化。方法:将57例类风湿关节炎患者随机分为两组:治疗组30例采用静脉滴注云克联合口服甲氨蝶呤、来氟米特治疗;对照组27例采用单纯口服药物治疗。观察治疗前后关节症状、实验室指标变化以及症状改善时间。结果:治疗组显效7例,有效20例,无效3例,总有效率90%,对照组显效3例,有效l5例,无效9例,总有效率66.67%,2组相比P<0.05,有统计学差异;云克组在改善晨僵、减少关节压痛数、关节肿胀数和、改善ESR、CRP等方面均有统计学差异(P<0.05～0.01)。结论:云克治疗可快速明显改善类风湿关节炎的临床症状和实验室指标,且使用安全,不良反应少。

健脾化湿通络法治疗类风湿关节炎贫血的临床研究

目的观察健脾化湿通络法治疗类风湿关节炎(rheumatoidarthritis,RA)贫血患者的临床疗效并探讨其作用机制。方法40例类风湿关节炎贫血患者随机分为3组新风胶囊治疗组20例(口服新风胶囊)、雷公藤治疗组10例(口服雷公藤多苷片)和甲氨蝶呤治疗组10例(口服甲氨蝶呤片)。3组均连续服药3个月。观察各组患者的临床疗效。比较治疗前后各组患者全身和关节症状、贫血、血清铁、C反应蛋白、类风湿因子、免疫球蛋白、白细胞介素10、肿瘤坏死因子α及红细胞生成素(erythropoietin,EPO)的变化,以及不良反应。结果新风胶囊治疗组在治疗总有效率、改善类风湿关节炎贫血患者关节症状及部分实验室检查指标(血沉、类风湿因子、C反应蛋白、免疫球蛋白)方面,与甲氨蝶呤治疗组和雷公藤治疗组相似;但在改善类风湿关节炎贫血患者全身症状、血红细胞计数、血红蛋白含量以及上调白细胞介素10、下调肿瘤坏死因子α、升高血清铁及调节血清EPO水平方面均优于甲氨蝶呤治疗组和雷公藤治疗组。结论依据从“脾”论治原则研制的具有健脾化湿通络功效的中药新风胶囊,能明显改善类风湿关节炎贫血患者的全身及贫血症状、缓解患者的关节症状,其机制与调整细胞因子平衡、调节血清EPO的水平及升高血清铁含量相关。