Treatment Of Rheumatoid Arthritis And Ankylosing Spondylitis With Etanercept Combined With DMARDs

Rheumatoid Arthritis (RA) and Ankylosing Spondylitis (AS) are both chronic inflammatory diseases that affect joints and other tissues, and they are both have a wide clinical spectrum. RA is characterized by inflammation of multiple and symmetric joints, especially small joints. It chiefly affects synovial membrane of multiple joints, sometimes other tissues, eg plasma membrane,blood vessels,nerves and so on.. The prevalence in general population is 0.34%-0.36% in China, female patients outnumber males. The deformity is very common, the rate is high to 50% in two years for RA patients without treatment, and 70% in three years. If there is deformity of joint, it cannot be healing. Ankylosing Spondylitis is a chronic inflammatory disease of joints of the axial skeleton, manifested clinically by pain and progressively stiffness of the spine and limitation of back motion. Sometimes arthritis of peripheral joints ,ophthalmitis and limitation of chest expansion occur in part cases.As the disease advances,the entire spine become fused, allowing no motion in any diretion.The mechanisms of RA and AS are not clear, but some researches about animal models and samples of human tissues display that tumor necrosis factor (TNF) is a key of the progression of these diseases.It mediates numerous inflammatory and immnoregulatory activities,and the progession of diseases stops after blocking TNF.At present, the drugs for RA and AS are mainly including non-steroiod anti-inflammatory drugs (NSAIDs), glucocorticosteroid, disease modifying anti-rheumatic drugs (DMARDs) and TNF blockade. NSAIDs and glucocoticosteroid are allopathic drugs, without help for modifying prognosis. DMARDs is a kind of drugs may interfere the advancement of diseases and progression of immunopathogenesis. But the chronic efficacy and adverse reaction make it an unperfect drug. methotrexate (MTX) and leflunomide (LEF) are currently the most used DMARDs. TNF blockade is an new therapy option, which is due to the important role of TNF in the development of RA and AS. It can make TNF lose its biological effect by blocking the binding of TNF and receptors. Currently, there are three TNFαantagonists licensed for clinical use : two monoclonal antibodies [adalimumab (ADA) and infliximab (INF)] and a soluble receptor [etanercept (ETA)]. ETA, Soluble TNFRII-human Fc fusion protein,is the most widely used TNF antagonist.It is reported that MTX can increase the efficacy and decrease the toxicity of infliximab in the treatment of RA patients. So in this article, we compare with ETA only and ETA combined with DMARDs respectively, in order to certificate it's short term therapeutic efficacy in the treatment of RA and AS. .This article is a retrospective clinical observation of medical therapeutic efficacy. 43 RA patients and 41 AS patients are divided into four groups respectively, given ETA only(A group), ETA combined with LEF (B group) , ETA combined with MTX (C group) and ETA combined with LEF and MTX respectively, and observes therapeutic efficacy both in a short time(8 weeks).Results:1. 2 weeks after treatment, over 40% RA patients in each group achieved an ACR20 response, and over 70% RA patients in each group achieved an ACR20 response in the 8th week. the ACR20 response rate of A group is the lowest (70%), the highest in C group (81.8%),but there is no significant difference with among groups(P>0.05). 4 weeks after treatment, the accumulated remmision rate of AS patients in four groups is over 80%, the accumulated remmision rate of A group is the lowest(77.8%), but there is no significant difference with among groups(P>0.05). 8 weeks after treatment, the accumulated remmision rate of each group is high to 90%, there is no significant difference among groups (P>0.05).2. 4 weeks and 8 weeks after treatment, the decreasing leucocyte and platelet is significant (P<0.05),but in normal extent , and has no significant difference among four groups.3. Damage of liver function(8.3%), infection of respiratory tract (5.9%) are mainly seen in the trial, but damage of liver function is only seen in groups of ETA combining with DMARDs. Adverse reaction in injection site, hypersensitiveness and decreasing of leucocyte are also seen..Conclusions:1. Both ETA only and ETA combined with DMARDs can get nice efficacy in the treatment of RA and AS in a short time. But there is no difference among four groups.2. Both ETA only and ETA combined with DMARDs can affect the counts of leucocyte and platelet in peripheral bood, but the counts will be not below the lower limit.3. The incidence rate of adverse reactions, such as, damage of liver function, infection of respiratory tract is higher than others. And damage of liver function is only seen in ETA combined with DMARDs groups.