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

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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.	林进, 徐丹怡. ACR/EULAR 2009年类风湿性关节炎新分类标准解读[J]. 浙江医学, 2010, 32(7):985-987.
6.	中华医学会风湿病学分会. 类风湿关节炎诊断及治疗指南[J]. 中华风湿病学杂志, 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, 张莉芸, 牛红青, 等. 甲氨蝶呤联合环磷酰胺治疗类风湿关节炎随机单盲对照临床研究[J]. 中华风湿病学杂志, 2010, 14(2):111-114.
9.	夏光涛, 许菁, 付敏, 等. 硫酸羟氯喹治疗风湿病的疗效评价[J]. 世界临床药物, 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.	刘冬梅, 薛红霞, 杨丽丽, 等. 小剂量糖皮质激素联合DMARD治疗类风湿关节炎的临床研究[J]. 实用药物与临床, 2012, 15(4):244-245.
13.	林恒钊. 柳氮磺吡啶联合甲氨蝶呤及小剂量泼尼松治疗类风湿关节炎42例疗效观察[J]. 河北医学, 2012, 18(7):932-934.
14.	邓雪蓉, 周炜, 王昱, 等. 类风湿关节炎在不同治疗方案下的达标情况及影响因素分析[J]. 中华风湿病学杂志, 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, 张徐明. 不同剂量激素治疗类风湿关节炎疗效的比较研究[J]. 临床合理用药杂志, 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. 林进, 徐丹怡. ACR/EULAR 2009年类风湿性关节炎新分类标准解读[J]. 浙江医学, 2010, 32(7):985-987.
6. 中华医学会风湿病学分会. 类风湿关节炎诊断及治疗指南[J]. 中华风湿病学杂志, 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, 张莉芸, 牛红青, 等. 甲氨蝶呤联合环磷酰胺治疗类风湿关节炎随机单盲对照临床研究[J]. 中华风湿病学杂志, 2010, 14(2):111-114.
9. 夏光涛, 许菁, 付敏, 等. 硫酸羟氯喹治疗风湿病的疗效评价[J]. 世界临床药物, 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. 刘冬梅, 薛红霞, 杨丽丽, 等. 小剂量糖皮质激素联合DMARD治疗类风湿关节炎的临床研究[J]. 实用药物与临床, 2012, 15(4):244-245.
13. 林恒钊. 柳氮磺吡啶联合甲氨蝶呤及小剂量泼尼松治疗类风湿关节炎42例疗效观察[J]. 河北医学, 2012, 18(7):932-934.
14. 邓雪蓉, 周炜, 王昱, 等. 类风湿关节炎在不同治疗方案下的达标情况及影响因素分析[J]. 中华风湿病学杂志, 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, 张徐明. 不同剂量激素治疗类风湿关节炎疗效的比较研究[J]. 临床合理用药杂志, 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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Curative Effect of Low-dose Methylprednisolone Combined with Hydroxychloroquine and Methotrexate on Treating Rheumatoid Arthritis

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