Clinical Efficacy Obeservation And The Influences Of Iguratimod On Fibroblast Synovial Cells Proliferation And Transfer In RA

BackgroundRheumatoid arthritis(RA)is mainly manifested by chronic and invasive arthritis.It is a kind of autoimmune disease featured by sore joints and synovitis.If it is not treated formally,it might cause joint disability and dysfunction,more seriously,it might drag various visceral organs.Thereinto,the synovial tissues are the most common to be involved to form fibroblast synovial cells(FLS)which has the characteristics of "Tumor-like Properties",thus affecting RA course through secretion,proliferation,invasion,transfer and other behaviors as well as having important functions in the joint stability and RA pathogenesis.The FLS proliferation and transfer behaviors are affected by several cell factors and signal paths while a new type of rheumatoid medicine Iguratimod(T-614)can act on some common cell factors and signal paths.Therefore,this paper aims to comprehend if Iguratimod can affect the proliferation and transfer behaviors of FLS through experimental research,and conduct clinical observation to the therapeutic effect of Iguratimod in RA.Objective1.Carry out external primary culture the synovial cells of the RA patients,so as to comprehend the influences of Iguratimod to FLS proliferation and transfer functions.2.Observe the influences of different Medication methods of Iguratimod and campare them with Traditional DMARDs,in order to understand the clinical serological indicators of RA patients as well as the disease relieving conditions.MethodsCultivate the synovial cells of the RA patients in tissue explant.In aseptic conditions,the synovial tissues of RA patients are picked through arthroscopy operation and then placed in the petri dish.Then the dish is put in the cultivation box in inversion,so as to observe the cytotoxic effect of the synovial cells after 72 hours with different density of Iguratimod(100?200?400?800 ng/ml),and watch if cell apoptosis or transfer behaviors have been caused.Select 90 patients who are diagnosed as RA and in RA active period,in which 19 male and 71 female.The age scope is 21-67,with the average age of 47.23±15.62 and average disease course 4.75±3.53 years.The patients are divided into three groups in random.The joint treatment group(31 examples)is treated by Iguratimod 25mg/bid+MTX 10mg/qw.The Iguratimod group(28 examples)is treated by Iguratimod 25mg/bid.The control group(31 examples)is treated by methotrexate(MTX)10mg/qw+leflunomide(LEF)20mg/qd.Then the alter conditions of ESR,CRP,RF,CCP,PLT,patients' VAS score,doctors' VAS score DAS28-ESR,HAQ and other comprehensive indexes are observed in 0,1,3,6,12 months after medicine treatment.Gaussian distribution data in this research project are indicated by ± standard error of the mean value and abnormal distribution data are indicated by median after normality test.Then,statistical means are used to analyze the indexes of various time points before and during the treatment process,trying to figure out if these indexes have statistical significance.Afterwards,the variation conditions of each index as the time in different treatment groups are also compared in and among the groups,so as to find out if statistical significance exists.ResultsIguratimod(when the density reaches 800ng/ml)restrains the proliferation of synovium FLS through accelerating apoptosis.Iguratimod(when the density reaches 400ng/ml)restrains the proliferation of synovium FLS;The transfer of synovium FLS can be restrained(when the density reaches 200ng/ml),in a degree dependence manner.According to the clinical observation and comparison to the various indexes of each treatment group,it is visible of the statistical significance in different time points with the extension of the treatment period.Generally,the disease is tended to be improved,which indicates that the three groups of medical treatments are effective.In the Iguratimod treatment group,the ESR,CRP,RF,CCP and PLT of RA patients have been reduced.The patients' VAS score,doctors' VAS score,DAS28-ESR and HAQ scores have all been improved after treatment.If compare the three groups,it is visible that the Iguratimod combined MTX treatment group has the best efficiency,while LEF combined MTX treatment group has a no worse efficiency than Iguratimod but the medicine reactions are easily to occur.ConclusionIguratimod can restrain the proliferation and transfer of synovium FLS in the degree dependence manner.It is safe and effective in RA,which can improves inflammation index and Patient's condition.It will have a better effect if combined with MTX treatment.