Combination therapy of methotrexate and iguratimod for female patients with moderate to severe active rheumatoid arthritis and its impact on ovarian function
Objective:To evaluate the combined efficacy of methotrexate(MTX)and iguratimod(IGU)for female patients with moderate to severe rheumatoid arthritis(RA)and its impact on ovarian function.Methods:Eighty female patients diagnosed with moderate to severely active RA and enrolled in our department from Jan 2020 to Jan 2022 were selected and randomly divided into MTX and MTX+IGU groups,with 40 patients in each group.The swollen joint count(SJC),tender joint count(TJC),duration of morning stiffness and menstrual cycle were recorded at week 0 and week 24,respectively.The patients'rheumatoid factor(RF),liver and kidney function,and cytokines were tested,and the DSA28-ESR score was calculated.On the 3rd day of menstrual cycle,ovarian reserve indicators,anti-Mullerian hormone in serum(AMH),follicle stimulating hormone(FSH),luteotropic hormone(LH)and estradiol(E2)were measured.The antral follicle counting(AFC)and ovary volume(OV)were measured by B-ultrasound specialists.SPSS 22 was used to analyze the efficacy and ovarian function-related indicators before and after treatment in the two groups of patients.Results:After treatment,the MTX+IGU group showed more obvious relief in SJC(P<0.05),TJC(P<0.05),ESR(P<0.001)and DSA28-ESR(P<0.01)score than MTX group,and the MTX+IGU group showed lower levels of IL-1β,IL-6 after treatment as compared to MTX group(P<0.05),with statistical significance.The two groups showed significantly higher level of AMH at the end of treatment,with statistical differences in the MTX+IGU group(P<0.01),no statistical differences in the MTX group(P>0.05).However,no statistical differences were observed in other ovarian function related indicators between the two groups(P>0.05).Conclusion:The combination therapy of MTX and IGU has significantly better efficacy for female patients with moderate to severe active RA than MTX alone,with less impact on female ovarian function,and even improves ovarian reserve function in female patients through more effective control of RA activity.
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