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加用低剂量托法替布对常规治疗后仍有单关节炎的类风湿关节炎患者的短期疗效
Short-term efficacy of the additional low-dose tofacitinib in persistent monoarthritis after conventional treatment in rheumatoid arthritis patients

内科 202419卷04期 页码:407-411

作者机构:皖南医学院第一附属医院风湿免疫科,安徽省芜湖市 241000

DOI:10.16121/j.cnki.cn45⁃1347/r.2024.04.11

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目的 评估在原治疗方案基础上加用低剂量托法替布对常规治疗后仍有单关节炎的类风湿关节炎(RA)患者的短期疗效。方法 选取21例经传统合成改变病情抗风湿药(csDMARDs)治疗24周后达到低疾病活动度或临床缓解但仍有单关节炎的RA患者作为研究对象,在原治疗方案基础上加用低剂量托法替布(每次5 mg,每日1次)持续治疗24周。比较患者不同时间点疗效[基线期及治疗后第4周、第12周、第24周的28个关节疾病活动度评分(DAS28)、关节疼痛视觉模拟评分法(VAS)、患者总体评估疼痛VAS、医生总体评估疼痛VAS评分,以及红细胞沉降率(ESR)、C反应蛋白(CRP)水平]和关节疼痛改善情况(治疗后第4周、第12周、第24周关节疼痛VAS评分较基线期改善20%、50%、70%以上的患者比例),记录治疗过程中出现不良反应的情况。结果 与基线期相比,治疗后第4周、第12周、第24周患者的DAS28、关节疼痛VAS、患者总体评估疼痛VAS评分,以及CRP水平均降低,治疗后第12周、第24周患者的医生总体评估疼痛VAS评分、ESR水平均降低(均P<0.05)。关节疼痛VAS评分较基线期改善20%以上的患者比例在治疗后第4周、第12周、第24周逐渐增加,较基线期改善50%、70%以上的患者比例也在3个时间点逐渐增加;与治疗后第4周相比,治疗后第12周、第24周关节疼痛VAS评分较基线期改善20%、50%以上的患者比例均增加,治疗后第24周关节疼痛VAS评分较基线期改善70%以上的患者比例增加(均P<0.05)。治疗过程中;1例次出现轻度肝功能损害,1例次出现胃肠道不适,经对症治疗后均好转。结论 加用低剂量托法替布能有效地改善经常规治疗后仍有单关节炎的RA患者的病情,且药物不良反应较少。

Objective To assess the short-term efficacy of the additional low-dose tofacitinib, based on the original regimen, in persistent monoarthritis after conventional treatment in rheumatoid arthritis (RA) patients. Methods A total of 21 RA patients who had achieved low disease activity or clinical remission after 24 weeks of treatment with conventional synthesis disease-modifying anti-rheumatic drugs (csDMARDs) but still had monoarthritis were selected as the research subjects, and they were treated with additional low-dose tofacitinib (5 mg each time, once daily) on the basis of the original regimen for 24 continuous weeks. The efficacy of patients at different time points [disease activity score in 28 joints (DAS28), visual analogue scale (VAS) score for joint pain, VAS score for patient's overall pain assessment, VAS score for doctor's overall pain assessment, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level in the baseline period, as well as at the 4th, 12th, and 24th weeks after treatment] and improvement of joint pain at different time points (proportions of patients with over 20%, 50%, and 70% increases in VAS score for joint pain from basal at the 4th, 12th, and 24th weeks after treatment) were compared, and the incidences of adverse reactions during treatment were recorded. Results Compared with the basal, patients' DAS28, VAS score for joint pain, VAS score for patient's overall pain assessment, and CRP level were lower at the 4th, 12th, and 24th weeks after treatment, and the VAS score for doctor's overall pain assessment and ESR were lower at the 12th, and 24th weeks after treatment (all P<0.05). The proportion of patients with an over 20% increase in VAS score for joint pain from basal at the 4th, 12th, and 24th weeks after treatment increased sequentially, and the proportions of patients with over 50% and 70% increases in VAS score for joint pain from basal at the three time points also increased successively; compared with those at the 4th week after treatment, the proportions of patients with over 20% and 50% increases in the VAS score for joint pain from basal were higher at the 12th and 24th weeks after treatment, and the proportion of patients with an over 70% increase in the VAS score for joint pain from basal was also higher at the 24th week after treatment (all P<0.05). During treatment, there was 1 case-time of mild liver impairment and 1 case-time of gastrointestinal discomfort, both of which improved after symptomatic treatment. Conclusion The additional low-dose tofacitinib can effectively improve the condition of persistent monoarthritis after conventional treatment in RA patients and has fewer adverse drug reactions.

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