Clinical Evaluation Of Iguratimod Combined With Leflunomide In The Treatment Of Elderly Onset Rheumatoid Arthritis

Objective:To observe the comparison of the efficacy of Iguratimod combined with leflunomide,methotrexate combined with leflunomide and leflunomide on EORA,evaluating the treatment of EORA by Iguratimod combined with leflunomide and analyzing its safety.Methods:In this experiment,180 cases of EORA were selected from the Rheumatology and Hematology department,including outpatients and inpatients who were in the Affiliated Hospital of Youjiang Medical University for Nationalities from January 2017 to September2019(Part of the data comes from the previous collection of our group),all of which met the relevant diagnostic criteria of the(Europe League Against Rheumatism,EULAR/American College of Rheumatology,ACR)2010 RA.According to the random number table,they were divided into 3 groups of A,B,and C,each with 60 cases,group A was the experimental group.It was given 25 mg of Iguratimod(Xiansheng Simcere),twice daily+leflunomide(Suzhou Changzheng)50 mg daily in the first 3 days,and then the maintenance dose of 20mg.It was given methotrexate(Shanghai Xinyi)15 mg once a week+leflunomide(Suzhou Changzheng)50 mg daily in the first 3 days,and then maintenance dose of 20 mg in group B.Patients in group C were treated with leflunomide(Suzhou Changzheng)50 mg daily in the first 3 days,and then the maintenance dose of 20 mg.The treatment period was 12 weeks.During the experiment,there were 2 cases of shedding,1 case in group A,1 case in group B,and no case in group C.Recording erythrocyte sedimentation rate(ESR),C reactive protein(CRP),rheumatoid factor(RF),complement C3,complement C4,disease activity Score-28(DAS28),visualanaloguescale(VAS),patient global assessment(PGA),physician global assessment(PHGA),health assessment questionnaire(HAQ),side-effect during the treatment,the percentage of American College of Rheumatology 20(ACR20),American College of Rheumatology 50(ACR50),compared the efficacy and side-effect of the three groups after these treatments and used SPSS for statistical analysis.Results:(1)There was no statistically significant difference in gender,age,course of disease,disease activity classification among three groups(P>0.05).(2)There was no statistically significant difference in ESR,CRP,complement C3,complement C4,DAS28,VAS,PGA,PHGA,HAQ among three groups before these treatments(P>0.05).Compared ESR,CRP,RF,complement C3,complement C4,DAS28,VAS,PGA,PHGA,HAQ before and after treatment in each group.There was statistically significant difference in ESR,CRP,RF,complement C3,complement C4,DAS28,VAS,PGA,PHGA,HAQ in group A after treatment(P<0.05),There was statistically significant difference in ESR,CRP,complement C3,DAS28,VAS,PGA,PHGA,HAQ in group B and group C after treatment(P<0.05),complement C4 was not statistically different(P>0.05).(3)After treatment,Compared ESR,CRP,RF,complement C3,complement C4,DAS28,VAS,PGA,PHGA,HAQ among three groups.There was no statistically significant difference in complement C3 and complement C4(P>0.05),there was statistically significant difference in ESR,CRP,RF,DAS28,VAS,PGA,PHGA,HAQ(P<0.05).Further comparison between two groups,there was statistically significant differences in ESR,CRP,RF,DAS28,VAS,PGA,PHGA,HAQ(P<0.05).The ESR,CRP,RF,DAS28,VAS,PGA,PHGA,HAQ indicators of group C were higher than those of group A and group B,and the reduction before the treatment was lower than that in group A and B,the effect was worse than that of group A and group B,The indicators of ESR,CRP,RF,DAS28,VAS,PGA,PHGA,HAQ in group A after treatment were all lower than those of group B and C,and the effect was the best.(4)Compared the disease activity classification of DAS28 in the three groups after treatment,and the difference was statistically significant(P<0.05).Further comparison between groups,there was no statistically significant difference in the disease activity classification of DAS28 among group A and group B(P>0.05),There was statistically significant difference in disease activity classification of DAS28 between group A and group C,group B and group C(P<0.05),disease activity classification of DAS28 in group A and group B was superior to that in group C.(5)There was statistically significant difference in the percentage of ACR20 and ACR50among three groups(P<0.05).Further comparison between groups,there was no statistically significant difference in the percentage of ACR20 and ACR50 between group A and group B(P>0.05),there was statistically significant difference in the percentage of ACR20 and ACR50 between group A and group C,group B and group C(P<0.05),the percentage of ACR20 and ACR50 in group A and group B was superior to that in group C.(6)There were 4 cases of side-effect during the treatment,of which 1 case had mild liver damage in group A,the liver function recoveried after adjusting the dosage of Iguratimod,2 cases of gastrointestinal reactions in group B,and 1 case skin rash in group C,symptoms were all relieved after symptomatic treatment.There was no statistically significant difference in side-effect between the three groups(P=0.769,x~2=0.525).After treatment,There was no obvious abnormality in blood,renal function and urine routine.Conclusion:(1)Combination of the chemical drugs(Iguratimod+Leflunomide,Methotrexate+Leflunomide)is more effective than single medicine(Leflunomide)on EORA.(2)Iguratimod combined with leflunomide can improve complement C3 and complement C4 in the treatment of EORA.Methotrexate combined with leflunomide and leflunomide only can improve complement C3.(3)Iguratimod combined with leflunomide can improve the condition and control the progress of the disease effectively.Compared to traditional treatment(Methotrexate+Leflunomide),Methotrexate combined with leflunomide improves indicators of ESR,CRP,RF,DAS28,VAS,PGA,PHGA,HAQ better,but the effect of reducing disease activity classification of DAS28,meeting the standards of ACR20 and ACR50 is about the same.(4)Iguratimod combined with leflunomide is safe in the treatment of EORA.