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目的:分析糖皮质激素(GCs)治疗类风湿关节炎(RA)的临床效果,并探讨治疗RA的最佳剂量和最佳用药时间,尝试用新的方法对RA的病情及治疗效果进行评价,深化对GCs治疗RA的认识。方法:将50例早期RA患者(病史小于2年)随机分为治疗组和对照组,治疗组使用改变病情抗风湿药物(DMARD)及激素泼尼松10mg/d,对照组给予DMARDs。DMARDs用法为羟基氯喹0.2g每天二次口服,MTX10mg每周一次口服。分别记录治疗前、治疗第6周、12周、24周患者的肿痛关节数、晨僵时间、疼痛指数、急性时相反应物水平及药物相关副作用等临床指标。比较2组患者在不同治疗时间的临床缓解情况,并采用自行设计的药物治疗收益评分方法评价两组患者治疗过程中的受益及由药物副作用造成的损失情况,计算其收益指数。结果:最终44例患者完成实验,治疗组(20例)与对照组(24例)第6周的ACR20的缓解率分别为80.0%、50.0%,2组相比具有统计学意义(p<0.05),第12周的ACR20缓解率分别为90.0%、58.3%(p<0.05),第6周平均收益指数分别为(16.0±8.8)、(10.5±7.1),2组相比具有统计学意义(p<0.05),第12周平均收益指数分别为(24.0±8.0)、(17.0±7.8),2组相比具有统计学意义(p<0.05)。2组第24周ACR20缓解率和平均收益指数比较并无统计学意义。结论:激素对于早期RA患者能较快、明显的改善病情并在短期内取得良好的治疗收益。与单纯使用DMARDs相比,在12周～24周之间联合使用激素的治疗收益优势逐渐减退。
Objective: To analyze the clinical effects of glucocorticoid (GCs) in the treatment of rheumatoid arthritis (RA) and to explore the best dosage and the best medication time for the treatment of rheumatoid arthritis (RA). We try to evaluate the condition and treatment effect of RA with new methods, Deepen the understanding of GCs for the treatment of RA. Methods: Fifty patients with early stage RA (history less than 2 years) were randomly divided into treatment group and control group. DMARD and DM prednisone 10 mg / d were used in the treatment group and DMARDs in the control group. DMARDs use of hydroxychloroquine 0.2g twice daily oral, MTX10mg orally once a week. The clinical indexes including the number of swollen joints, morning stiffness, pain index, acute phase reactant levels and drug-related side effects were recorded before treatment, 6 weeks, 12 weeks and 24 weeks after treatment. The clinical remission of two groups at different treatment time was compared. The self-designed drug treatment benefit score method was used to evaluate the benefit of the two groups in the course of treatment and the loss caused by drug side effects, and the profit index was calculated. Results: The final 44 patients completed the experiment. The response rates of ACR20 in the 6th week in the treatment group (20 cases) and the control group (24 cases) were 80.0% and 50.0% respectively, with statistical significance (p <0.05 ), The rate of remission of ACR20 in the 12th week was 90.0% and 58.3% (p <0.05), and the average return index in the 6th week was (16.0 ± 8.8) and (10.5 ± 7.1) respectively. There was significant difference between the two groups (p <0.05). The average return index of the 12th week was (24.0 ± 8.0) and (17.0 ± 7.8) respectively, with statistical significance (p <0.05). There was no significant difference in ACR20 remission rate and average return index between the two groups at 24 weeks. Conclusion: The hormones can be rapid for patients with early RA, improve the condition obviously and achieve good therapeutic benefits in a short period of time. The benefits of combined treatment with hormones diminish over the 12-week to 24-week period compared with DMARDs alone.