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目的观察小剂量甲泼尼龙联合羟氯喹、甲氨蝶呤治疗类风湿关节炎(RA)的疗效。方法 2011年1月-2013年5月将60例病程≤2年的初治RA患者随机分为对照组和治疗1组,两组各30例;两组均给予羟氯喹、甲氨蝶呤治疗,对照组加用美洛昔康(7.5 mg/次,2次/d),治疗1组加用甲泼尼龙(4 mg/次,2次/d)。另选30例病程≥5年的未曾规范治疗的RA患者为治疗2组,采用和治疗1组同样的治疗方案。所有患者在治疗后1周评估临床症状控制情况,治疗前和治疗后12周均评估临床指标和检测免疫学指标。结果治疗1组和治疗2组临床症状在1周内迅速缓解,疗效较对照组明显(P<0.05);12周后治疗1组和治疗2组在临床症状、28个关节疾病活动指数评分等方面较治疗前明显改善(P<0.05);治疗1组与治疗2组相比临床症状及免疫学检查方面改善更明显。结论小剂量甲泼尼龙联合羟氯喹、甲氨蝶呤可快速有效缓解RA患者的临床症状,病史短者疗效更好。
Objective To observe the curative effect of low dose methylprednisolone combined with hydroxychloroquine and methotrexate on rheumatoid arthritis (RA). Methods From January 2011 to May 2013, 60 patients with newly diagnosed RA with duration ≤2 years were randomly divided into control group and treatment group 1, 30 cases in each group. Both groups were given hydroxychloroquine and methotrexate The patients in the control group were treated with meloxicam (7.5 mg / time, twice daily) for 1 month and methylprednisolone (4 mg / time, twice daily). Another 30 patients with a history of 5 years or longer who did not receive standard treatment were treated with the same treatment regimen. All patients were evaluated for clinical symptom control one week after treatment, and clinical and immune parameters were assessed before and 12 weeks after treatment. Results The clinical symptoms in treatment group 1 and treatment group 2 were relieved rapidly in 1 week, and the curative effect was more obvious than that in control group (P <0.05). After 12 weeks treatment group 1 and treatment group 2 had clinical symptom scores and 28 joint disease activity index scores (P <0.05). The improvement of clinical symptoms and immunological examination in treatment group 1 and treatment group 2 were more obvious. Conclusions Small doses of methylprednisolone combined with hydroxychloroquine and methotrexate can quickly and effectively relieve the clinical symptoms of patients with RA, and the short duration of treatment is better.