可单用甲氨蝶呤维持缓解，生物湿性

在入组487例症状持续时间＜1年的制剂RA患者的SWEFOT研究中，

生物制剂改变类风湿性关节炎的改变关节面貌

2011-10-23 11:00 · 李亦奇

生物制剂联合甲氨蝶呤治疗类风湿性关节炎(RA)的效果较佳。所有患者在随机分组前接受甲氨蝶呤单药治疗，类风患者被随机分入甲氨蝶呤/柳氮磺胺吡啶/羟氯喹三联治疗组或甲氨蝶呤/肿瘤坏死因子抑制剂(TNFi)二联治疗组。面貌经甲氨蝶呤治疗完全无效的生物湿性患者在加用TNFi后可获得临床和影像学改善(Lancet 2007;370:1861-74)。又减少了副作用的制剂产生。然而，改变关节结果显示，类风2组的面貌疾病活动性评分(DAS)相同。需注意的生物湿性是，X线检查发现，制剂接受甲氨蝶呤和生物制剂联合治疗的改变关节患者在获得缓解后，但影像学疾病进展仍在继续。类风

相关英文论文摘要：

Addition of infliximab compared with addition of sulfasalazine and 面貌hydroxychloroquine to methotrexate in patients with early rheumatoid arthritis (Swefot trial): 1-year results of a randomised trial

Background New treatment strategies for early rheumatoid arthritis are evolving rapidly. We aimed to compare addition of conventional disease-modifying antirheumatic drugs (sulfasalazine and hydroxychloroquine) with addition of a tumour necrosis factor antagonist (infliximab) to methotrexate in patients with early rheumatoid arthritis.

Methods We undertook a randomised trial in 15 rheumatology units in Sweden. We enrolled patients with early rheumatoid arthritis (symptom duration <1 year) and administered methotrexate (up to 20 mg per week). After 3—4 months, those who had not achieved low disease activity but who could tolerate methotrexate were randomly allocated by computer addition of either sulfasalazine and hydroxychloroquine or infliximab. Primary outcome was achievement of a good response according to European League Against Rheumatism (EULAR) criteria at 12 months. Patients were followed up to 24 months; here, we present findings at 12 months. Analysis was by intention to treat and we used non-responder imputation. The Swefot (Swedish Pharmacotherapy) study is registered in the WHO database at the Karolinska University Hospital, number CT20080004.

Findings 487 patients were initially enrolled. Of 258 who had not achieved low disease activity with methotrexate, 130 were allocated sulfasalazine and hydroxychloroquine and 128 were assigned infliximab. 32 of 130 (25%) patients allocated sulfasalazine and hydroxychloroquine achieved the primary outcome compared with 50 of 128 (39%) assigned infliximab (risk ratio 1·59 [95% CI 1·10—2·30], p=0·0160). Adverse events were balanced fairly well between the two groups and accorded with known adverse events of the drugs used. No deaths occurred in either group.

Interpretation In patients with early rheumatoid arthritis in whom methotrexate treatment failed, addition of a tumour necrosis factor antagonist to methotrexate monotherapy is clinically superior to addition of conventional disease-modifying antirheumatic drugs.

Funding Swedish Rheumatism Association, Schering-Plough.

英文论文原文：https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60944-2/fulltext#article_upsell

生物制剂联合甲氨蝶呤治疗类风湿性关节炎(RA)的效果较佳。

另一项研究显示，在甲氨蝶呤单药治疗后，

类风湿关节炎患者症状之一是骨头变形

研究显示，尽管一些患者的临床状况在甲氨蝶呤单药治疗后获得改善，

从该研究结果来看，三联治疗组的影像学进展率高于二联治疗组。患者应尽快首先试用甲氨蝶呤，这样既节省了费用，并在1~2个月内增加剂量。因此一些医生可能会急于快速完成增量过程。由于目前尚无法预测哪30%的患者可在应用甲氨蝶呤后获得临床改善，2年时的临床结果显示，在患病的最初6个月内，积极进行生物制剂治疗能够有效阻断疾病进展。及早实施生物制剂治疗有助于修复关节损伤。甲氨蝶呤单药治疗使30%的患者获得了改善。

还有研究显示，