Curative Effect Observation Of Improvements Anti-rheumatism Medicine Cycle Combined Treatment Of Rheumatoid Arthritis(RA)and Its Effects On Peripheral Blood GITRL Expression

Objective:(1) Dynamic observation of the clinical curative effect of different DMARDs combination treatment rheumatoid arthritis, including disease activity, response rate, the stability of the clinical indicators.(2) Dynamic testing GITRL expression level of different DMARDs combination group in patients with serum;From GITRL expression level to explore possible mechanism for the different DMARDs combination treatment rheumatoid arthritis.(3) Find the optimal choice of treatment refractory rheumatoid arthritis.Method:On the basis of the prior research, our department have finished the clinical and laboratory studies of 128 RA patients take different DMARDs medicine combination therpy and follow-up of 24 weeks(93 cases). This study expand clinical research of 36 weeks and 48 weeks followed 24 weeks of rheumatoid arthritis patients treated for this treatment, between groups still continue 0 to 24 weeks of medication, recombination of MTX alone/LEF group, joint CTX to MTX/LEF group, MTX combined LEF group.Because this research is aimed at different DMARDs combination, so we will not continue to watch MTX/LEF as the key point in 36 weeks and 48 weeks, only the stability of its long-term treatment were analyzed.And enzyme linked immunosorbent(ELISA)detection GITRL levels in serum, and the GITRL level change of single drug group in 36 weeks and 48 weeks, discuss the possible relationship with disease activity.Combination group was divided into joint CTX to MTX/LEF group and MTX combined LEF group and as the key object of study, each group according to the disease activity index evaluation the using of biological agents and(or) the third kind DMARDs medicine(represented by sulfuric acid of hydroxychloroquine HCQ), the group of MTX/LEF + CTX and the group of MTX/LEF + CTX + HCQ, the group of MTX + LEF,the group of MTX + + HCQ LEF, a total of four groups, follow-up 36 weeks and 48 weeks.At all stages the American rheumatism association efficacy of standard increased by20%(ACR20) as the main curative effect, ACR50, ACR70 as secondary efficacy index,with European Union fights rheumatism(EULAR) standard to evaluate the curative effect of disease activity index, evaluation the clinical and laboratory indexes of different combination and the influence of different combination of clinical indicators control stability evaluation, and according to the scale of combination use biological agents and(or)the third kind of DMARDs to analysis which is more feasible between of the groups.Using Logistic regression to analyze factors affecting curative effect.Follow-up completed 79 cases of the treatment.With ELISA method to detect 79 cases of RA patients serum GITRL level, analysis the change of different preparation group and the different stages, discuss the possible relationship with disease activity.Result:1. Results of single drug group(1) There are 33 patients meet the remission at 12 weeks in the treatment group of single use of MTX and LEF, continue to the original plan treatment, at 36 weeks than 24 weeks obtain good efficacy, but at 48 weeks have a slightly upward trend in disease activity.(2) single drug groups of RA patients GITRL serum level at 36 weeks compared with48 weeks, found no statistical difference, cannot think RA patients GITRL serum level have different changes in the different stages of the treatment.2. Results combination group(1)Combination group of patients at 36 weeks of MTX/LEF + CTX group of 13 casesof complete medical records;MTX/LEF + CTX + HCQ group complete medical records 20cases;MTX + LEF group of 7 cases of complete medical records;MTX + LEF + HCQ set of complete medical records in 5 cases;(2) The proportion of patients with MTX/LEF+CTX than MTX + LEF at 36 weeks and 48 weeks, ACR20, ACR50, ACR70 improved significantly.(3) The contrast of DAS28 score of different combination group at 24 weeks, 36 weeks were statistically significant(p < 0.05).Different treatment group at 48 weeks results shows no statistical significance(p > 0.05),but DAS28 score shows MTX/LEF + CTX group is lower than MTX+LEF group.(4) The same combination group of patients serum GITRL levels at 36 weeks and 48 weeks no significant differences between groups in the different periods(p>0.05);Different combination group at the same time comparing GITRL level no statistical difference(p > 0.05),not sure the relationship between GITRL expression levels and the disease activity.(5) The GITRL level of MTX/LEF+ CTX group and MTX + LEF group at 36 weeks was statistically significant(p < 0.05), so that patients serum GITRL level may be related to treatment and the degree of disease control.(6) The number in patients with joint swelling, joint tenderness, pain VAS score, the subjects of the overall status of VAS score, the doctor to the overall status of VAS score,HAQ, CRp, ESR as dependent variable and GITRL levels conduct correlation analysis showed that between DAS28 score, ESR, CCp antibody and patients serum GITRL haven’t found correlation(p > 0.05).(7) In different stages of observation the relationship between curative effect index and clinical index evaluation at the 36 weeks and 48 weeks show that tenderness pain VAS score, swelling of the joints, joint number can affect DAS28 score.(8) Evaluation the relationship between efficacy index and laboratory index : joint swelling number, joint tenderness, pain VAS score, the subjects of the overall status of VAS score, the doctor to the overall status of VAS score, HAQ, CRp, ESR have correlation.(9) The same combination GITRL levels in the group of patients serum in 0, 12, 24,36 a downward trend;Treatment at 36 weeks GITRL level of MTX/LEF + CTX group was obviously lower than with MTX + LEF group, the comparison was statistically significant(p = 0.049, p < 0.05), serum level of GITRL may be related to the degree of treatment and disease control.(10) Number in patients with swelling of the joints, joint tenderness, pain VAS score,the subjects of the overall status of VAS score, the doctor to the overall status of VAS score,HAQ, CRp, ESR as dependent variable and GITRL levels do correlation analysis showed that patients with joint swelling, DAS28 score, ESR, and GITRL in serum were positively correlated(p < 0.05).Conclusion:1. MTX/LEF +CTX, MTX + LEF, and combined with biological agents and(or) the third kind of DMARDs can significantly improve the disease activity of RA patients.At 36 weeks each treatment group were superior to 24 weeks and 48 weeks, 48 weeks than 24 weeks.2. The disease activity control effect of MTX/LEF +CTX is the most significant.3.MTX/LEF + CTX,MTX + LEF, and combined with biological agents and(or) 3kinds of DMARDs can make patients achieved in the treatment of RA ACR20, ACR50,ACR70 improvement.4. MTX/LEF + CTX than MTX+LEF are less likely to reach a plateau.5. Single drug and DMARDs combinationin in the treatment of RA at 36 weeks and48 weeks, GITRL serum levels haven’t changed much, statistical significance has not been found.