Low-dose leflunomide combined with methotrexate for elderly patients with rheumatoid arthritis
Objective To investigate the effect of low-dose leflumide combined with methotrexate for elderly patients with first-episode rheumatoid arthritis(RA).Methods One hundred and twenty elderly patients with first-episode RA admitted to Xi'an Fifth Hospital from February 2020 to February 2023 were selected for the randomized controlled trial.They were divided into a combination group and a reference group by the random number table method,with 60 cases in each group.There were 37 males and 23 females in the combination group;they were(70.22±5.29)years old;their body mass index(BMI)was(22.87±1.55)kg/m2;their disease course was(4.76±0.85)years.There were 38 males and 22 females in the reference group;they were(70.31±5.34)years old;their BMI was(22.94±1.58);their disease course was(4.82±0.87)years.The reference group were treated with methotrexate,and the combination group with low-dose leflunomide and methotrexate,for 90 d.The clinical efficacies,improvement of clinical symptoms,levels of bone metabolism indicators and serum levels of chitinase 3-like protein1(CHI3L1),soluble suppression of tumorigenicity 2(sST2),and interleukin-32(IL-32)before and after the treatment,and adverse reactions were compared between the two groups.x2 and t tests were applied.Results The total effective rate of the combination group was higher than that of the reference group[96.67％(58/60)vs.83.33％(50/60);x2=5.926,P=0.015].The joint number with tenderness,joint number with swelling,duration of morning stiffness,and grip strength of both hands in the combination group were better than those in the control group[(5.23±1.05)vs.(7.45±1.36),(4.18±0.66)vs.(6.39±0.82),(34.58±4.68)min vs.(50.40±8.21)min,and(14.03±2.55)kPa vs.(11.28±2.09)kPa;t=10.008,16.263,12.967,and 6.461;P＜0.001].After the treatment,the levels of bone gla protein(BGP),osteoprotectin(OPG),and total type Ⅰ collagen amino terminal extension peptide(T-P Ⅰ NP)in the combination group were higher than those in the reference group[(27.48±5.02)ng/L vs.(24.16±4.19)ng/L,(5.02±0.74)ng/L vs.(4.45±0.66)ng/L,and(43.17±8.59)μg/L vs.(36.92±7.33)μg/L;t=3.933,4.453,and 4.287;all P＜0.001].After the treatment,the serum levels of CHI3L1,sST2,and IL-32 in the combination group were lower than those in the reference group[(50.82±6.12)μg/L vs.(78.45±8.39)μg/L,(28.45±4.11)μg/L vs.(33.05±5.24)μg/L,and(14.32±2.01)ng/L vs.(16.85±2.77)ng/L;t=20.609,5.350,5.726;all P＜0.001].There was no statistical difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Low-dose leflunomide combined with methotrexate for elderly patients with first-episode RA is effective,and can significantly improve their bone metabolism indicators and serum levels of CHI3L1,sST2,and IL-32.
Rheumatoid arthritisLeflunomideMethotrexateChitinase 3-like protein 1Soluble matrix lysin 2Interleukin-32
万方数据
维普
