A Clinical Study On The Bone Protection Effect Of Iguratimod Combined With Methotrexate And Hydroxychloroquine In Patients With Rheumatoid Arthritis

Objective:To explore the effect of Iguratimod(IGU)combined with methotrexate(MTX)and hydroxychloroquine(HCQ)on bone mineral density and bone metabolism markers in patients with rheumatoid arthritis(RA),and to confirm the osteoprotective effect of IGU combined with MTX and HCQ on the RA patiens.Methods:The RA patients with a clear diagnosis and meeting the inclusion criteria were selected.IGU combined with MTX and HCQ were used for treatment.The patient’s entire drug treatment observation period was 48 weeks,and self-control before and after treatment was used.At baseline,24 and 48 weeks measuring lumbar BMD at L1-L4,left femoral neck and left hip bone mineral density and bone metabolic markers such as N-bone-gamma-carboxyglutamic acid-containing proteins(N-MID),β-C-terminal telopeptides of type Ⅰ collagen(β-CTX),total N-terminal propeptide of type Ⅰ collagen(PINP),25-hydroxy vitamin D3(25-OH-VitD3),parathyroid hormone(PTH).C-reactive protein(CRP),erythrocytes sedimentation rate(ESR),rheumatoid factor(RF),anti-cyclic citrullinate peptide antibody(anti-CCP antibody),immunoglobulin,blood routine and liver and kidney function were measured at baseline and 12,24,36,and 48 weeks of treatment.Results:1.After 48 weeks of treatment with IGU combined with MTX and HCQ,the bone mineral density of L1-L4,left femoral neck and left total hip all increased significantly(P<0.05).In particular,the bone mineral density of the left femoral neck increased significantly from baseline to week 24(P<0.05).2.After 48 weeks of treatment,β-CTX was lower than before(P<0.05),and the other bone metabolism markers were similar to baseline.The difference was not statistically significant(P>0.05).3.In terms of clinical laboratory measures,RF,CRP,ESR,and anti-CCP antibodies were significantly reduced from baseline to 48 weeks(P<0.05).However,immunoglobulin,complement C3,complement C4 and other indicators were not statistically significant compared with baseline(P>0.05).4.After 48 weeks of treatment,there was no significant difference in laboratory indicators such as white blood cell(WBC),red blood cell(RBC),platelet(PIT),etc.(P>0.05).The most common adverse reactions during treatment are gastrointestinal reactions and elevated transaminases.Conclusion:The combined treatment with IGU,MTX and HCQ can significantly improve the bone mineral density and inhibit the inflammatory response in RA patients,with satisfactory clinical efficacy.