Study Of Combination Methotrexate Or Leflunomide With Cyclophosphamide On Th17and IL-21in Patients With Rheumatoid Arthritis

Objective:1. To detecte the Th17and IL-21in patients with RA.2. To detecte the Th17and IL-21in patients with RA who received MTX, LEF, MTX+LEF, MTX/LEF+CTX treatment at0、12,24weeks.Methods:1. Th17cells in37patients with RA and10healthy controls were detected by flow cytometry. The level of serum IL-21was detected by ELISA.2.37patients of RA who are in multicenter clinical study protocol, were divided into MTX group, LEF group at baseline. After12weeks if DAS28≤2.6, the patients continued to use the original treatment, otherwise were divided into MTX+LEF group, MTX or LEF+CTX group. Discuss the change of Th17, IL-21in original therapy and combination therapy at different check points (0、12W、24W).3. To analyse the correlation of Th17and IL-21with ESR, CRP, DAS28in RA patients.4. To analyse the correlation of IL-21with Th17in RA patients.Results:1. At baseline, Th17and IL-21of patients with RA were higher than the healthy control group (P<0.05). But the comparison between the four groups has no statistical significance (P<0.05).2. Compared with the baseline, the level of Th17and IL-21of the four groups decreased at12and24weeks significantly (P<0.05). Original therapy group had no significant statistical difference (P>0.05). In combination therapy groups, Thl7and IL-21decreased most in MTX or LEF combined with CTX group (P<0.05).3. Th17is not distinctly positive-correlated with ESR, CRP or DAS28in RA patients, the same as IL-21.4. IL-21is positive-correlated with Th17cell in RA patients.Conclusion:There is significant difference in Th17, IL-21between RA patients and healthy people. After treatment24week, Original therapy group has no indifference. In combination therapy group, Th17and IL-21decrease most in MTX or LEF combined with CTX group. IL-21is corrlated with Th17. Detected Th17and IL-21of patients with RA can evaluate the severity of disease activity and direct the treatment.