Curative Effect of Low-dose Methylprednisolone Combined with Hydroxychloroquine and Methotrexate on Treating Rheumatoid Arthritis_West China Medical Journal

Authors：

 WANGJing-ya ,  LIULin , YANGJun-xia , GUFang , RAOYong-mei , LIMei-rong

Department of Rheumatology, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P. R. China;

Corresponding?author：

LIULin, Email: liulinup@126.com

Keywords：

Methylprednisolone; Hydroxychloroquine; Methotrexate; Rheumatoid arthritis

DOI：

10.7507/1002-0179.20150572

Video：

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Objective To observe the efficacy of low-dose methylprednisolone combined with hydroxychloroquine and methotrexate in the treatment of rheumatoid arthritis (RA). Methods Between January 2011 and May 2013, 60 RA patients on their first treatment with a disease course of less than or equal to 2 years were randomly divided to control group and treatment group Ⅰ with 30 patients in each. Patients in both the two groups were given hydroxychloroquine and methotrexate therapy, while the control group was treated with meloxicam (7.5 mg/time, 2 times/d) in addition, and the treatment group one was given methylprednisolone (4 mg/time, 2 times/d) in addition. Another 30 RA patients with a disease course of more than 5 years with no standardized treatment were designated into the treatment group Ⅱ. They accepted the same treatment scheme as treatment group Ⅰ. All the patients were evaluated one week after treatment to assess their clinical symptoms. Twelve weeks before and after treatment, the patients were evaluated on their clinical indicators and immunological indicators. Results The clinical symptoms of patients in treatment group Ⅰ and Ⅱ were rapidly relieved within one week after treatment, and the curative effect was significantly higher than that in the control group (P<0.05). Twelve weeks after treatment, the treatment groups were significantly improved compared with the control group in clinical symptoms and DSA28 (P<0.05). The improvement of clinical symptoms and immunological tests in treatment group Ⅰ was more obvious than that in treatment groupⅡ. Conclusion Low-dose methylprednisolone combined with hydroxyl chloroquine and methotrexate can quickly and effectively relieve the clinical symptoms of the patients with RA, and patients with a shorter course of the disease have better clinical efficacy.

Citation： WANGJing-ya, LIULin, YANGJun-xia, GUFang, RAOYong-mei, LIMei-rong. Curative Effect of Low-dose Methylprednisolone Combined with Hydroxychloroquine and Methotrexate on Treating Rheumatoid Arthritis. West China Medical Journal, 2015, 30(11): 2001-2004. doi: 10.7507/1002-0179.20150572 Copy

1.	Gorter SL, Bijlsma JW, Cutolo M, et al. Current evidence for the management of rheumatoid arthritis with glucocorticoids:a systematic literature review informing the EULAR recommendations for the management of rheumatoid arthritis[J]. Ann Rheum Dis, 2010, 69(6):1010-1014.
2.	Smolen JS, Landewé R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs[J]. Ann Rheum Dis, 2010, 69(6):964-975.
3.	Smolen JS, Aletaba D, Keystone E. Superior efficacy of combination therapy for rheumatoid arthritis:fact or fiction?[J]. Arthritis Rheum, 2005, 52(10):2975-2983.
4.	Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Allaart CF, et al. Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study):a randomized, controlled trial[J]. Arthritis Rheum, 2005, 52(11):3381-3390.
5.	林進, 徐丹怡. ACR/EULAR 2009年類風濕性關節炎新分類標準解讀[J]. 浙江醫學, 2010, 32(7):985-987.
6.	中華醫學會風濕病學分會. 類風濕關節炎診斷及治療指南[J]. 中華風濕病學雜志, 2010, 14(4):265-269.
7.	Van Dongen H, Van Aken J, Lard LR, et al. Efficacy of methotrexate treatment in patients with probable rheumatoid arthritis:a double-blind, randomized, placebo-controlled trial[J]. Arthritis Rheum, 2007, 56(5):1424-1432.
8.	李小峰, 張莉蕓, 牛紅青, 等. 甲氨蝶呤聯合環磷酰胺治療類風濕關節炎隨機單盲對照臨床研究[J]. 中華風濕病學雜志, 2010, 14(2):111-114.
9.	夏光濤, 許菁, 付敏, 等. 硫酸羥氯喹治療風濕病的療效評價[J]. 世界臨床藥物, 2010, 31(8):466-468.
10.	Huisman AM, Van Everdingen AA, Wenting MJ, et al. Glucocorticoid receptor downregulation in early diagnosed rheumatoid arthritis[J]. Ann N Y Acad Sci, 2002, 966:64-67.
11.	Malysheva O, Baerwald CG. Low-dose corticosteroids and disease-modifying drugs in patients with rheumatoid arthritis[J]. Clin Exp Rheumatol, 2011, 29(5, 68):S113-S115.
12.	劉冬梅, 薛紅霞, 楊麗麗, 等. 小劑量糖皮質激素聯合DMARD治療類風濕關節炎的臨床研究[J]. 實用藥物與臨床, 2012, 15(4):244-245.
13.	林恒釗. 柳氮磺吡啶聯合甲氨蝶呤及小劑量潑尼松治療類風濕關節炎42例療效觀察[J]. 河北醫學, 2012, 18(7):932-934.
14.	鄧雪蓉, 周煒, 王昱, 等. 類風濕關節炎在不同治療方案下的達標情況及影響因素分析[J]. 中華風濕病學雜志, 2014, 18(6):365-368.
15.	Wevers-De Boer K, Visser K, Heimans L, et al. Remission induction therapy with methotrexate and prednisone in patients with early rheumatoid and undifferentiated arthritis (the IMPROVED study)[J]. Ann Rheum Dis, 2012, 71(9):1472-1477.
16.	江敏, 張徐明. 不同劑量激素治療類風濕關節炎療效的比較研究[J]. 臨床合理用藥雜志, 2013, 6(18):20-21.
17.	Da Silva JA, Jacobs JW, Kirwan JR, et al. Safety of low dose glucocorticoid treatment in rheumatoid arthritis:published evidence and prospective trial data[J]. Ann Rheum Dis, 2006, 65(3):285-293.
18.	García-Gómez C, Nolla JM, Valverde J, et al. High HDL-cholesterol in women with rheumatoid arthritis on low-dose glucocorticoid therapy[J]. Eur J Clin Invest, 2008, 38(9):686-692.

1. Gorter SL, Bijlsma JW, Cutolo M, et al. Current evidence for the management of rheumatoid arthritis with glucocorticoids:a systematic literature review informing the EULAR recommendations for the management of rheumatoid arthritis[J]. Ann Rheum Dis, 2010, 69(6):1010-1014.
2. Smolen JS, Landewé R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs[J]. Ann Rheum Dis, 2010, 69(6):964-975.
3. Smolen JS, Aletaba D, Keystone E. Superior efficacy of combination therapy for rheumatoid arthritis:fact or fiction?[J]. Arthritis Rheum, 2005, 52(10):2975-2983.
4. Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Allaart CF, et al. Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study):a randomized, controlled trial[J]. Arthritis Rheum, 2005, 52(11):3381-3390.
5. 林進, 徐丹怡. ACR/EULAR 2009年類風濕性關節炎新分類標準解讀[J]. 浙江醫學, 2010, 32(7):985-987.
6. 中華醫學會風濕病學分會. 類風濕關節炎診斷及治療指南[J]. 中華風濕病學雜志, 2010, 14(4):265-269.
7. Van Dongen H, Van Aken J, Lard LR, et al. Efficacy of methotrexate treatment in patients with probable rheumatoid arthritis:a double-blind, randomized, placebo-controlled trial[J]. Arthritis Rheum, 2007, 56(5):1424-1432.
8. 李小峰, 張莉蕓, 牛紅青, 等. 甲氨蝶呤聯合環磷酰胺治療類風濕關節炎隨機單盲對照臨床研究[J]. 中華風濕病學雜志, 2010, 14(2):111-114.
9. 夏光濤, 許菁, 付敏, 等. 硫酸羥氯喹治療風濕病的療效評價[J]. 世界臨床藥物, 2010, 31(8):466-468.
10. Huisman AM, Van Everdingen AA, Wenting MJ, et al. Glucocorticoid receptor downregulation in early diagnosed rheumatoid arthritis[J]. Ann N Y Acad Sci, 2002, 966:64-67.
11. Malysheva O, Baerwald CG. Low-dose corticosteroids and disease-modifying drugs in patients with rheumatoid arthritis[J]. Clin Exp Rheumatol, 2011, 29(5, 68):S113-S115.
12. 劉冬梅, 薛紅霞, 楊麗麗, 等. 小劑量糖皮質激素聯合DMARD治療類風濕關節炎的臨床研究[J]. 實用藥物與臨床, 2012, 15(4):244-245.
13. 林恒釗. 柳氮磺吡啶聯合甲氨蝶呤及小劑量潑尼松治療類風濕關節炎42例療效觀察[J]. 河北醫學, 2012, 18(7):932-934.
14. 鄧雪蓉, 周煒, 王昱, 等. 類風濕關節炎在不同治療方案下的達標情況及影響因素分析[J]. 中華風濕病學雜志, 2014, 18(6):365-368.
15. Wevers-De Boer K, Visser K, Heimans L, et al. Remission induction therapy with methotrexate and prednisone in patients with early rheumatoid and undifferentiated arthritis (the IMPROVED study)[J]. Ann Rheum Dis, 2012, 71(9):1472-1477.
16. 江敏, 張徐明. 不同劑量激素治療類風濕關節炎療效的比較研究[J]. 臨床合理用藥雜志, 2013, 6(18):20-21.
17. Da Silva JA, Jacobs JW, Kirwan JR, et al. Safety of low dose glucocorticoid treatment in rheumatoid arthritis:published evidence and prospective trial data[J]. Ann Rheum Dis, 2006, 65(3):285-293.
18. García-Gómez C, Nolla JM, Valverde J, et al. High HDL-cholesterol in women with rheumatoid arthritis on low-dose glucocorticoid therapy[J]. Eur J Clin Invest, 2008, 38(9):686-692.

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