Clinical Observation On Treatment Of Resistant Rheumatoid Arthritis With Short-term Tocilizumab

Objective: To study the short-term efficacy and safety of tocilizumab with anti-rheumatic agents(conventional synthetic disease-modifying antirheumatic drugs,csDMARDs)in treating patients with active and resistant rheumatoid arthritis(RRA).Methods: Patients with resistant rheumatoid arthritis in our hospital were divided into experience group(Tocilizumab+csDMARDs)30 cases and control group(csDMARDs)30 cases.The experience group received intravenous tocilizumab every four weeks,each dose is 8 mg / kg(3 times of infusion),at the same time,the experience group was treated with csDMARDs,while the control group was treated with csDMARDs only.The two groups were followed up for 6 months.Main experience indicators: The number of tender joint,swollen joints,ESR,VAS score and the number of tender joints of 28 counted(DAS28)in baseline group,1-month,2-month,3-month and 6-month visit points;Grading results: the proportion of patients with disease activity score DAS28?3.2?DAS28<2.6.Results: 1.Compared with baseline group,the number of tender joint,swollen joints,ESR,VAS and DAS28 in the experience group were significantly lower than those in the baseline group at 1-month,2-month,3-month and 6-month(P < 0.05).In the experience group,comparison of 1-month and 2-month,2-month and 3-month of the experience group,all the indexes except ESR(P > 0.05)were significantly improved compared with the previous follow-up(P < 0.05).The number of tender joint,swollen joints,ESR,VAS score and DAS28 in 6-month were higher than those in 3-month(P < 0.05).2.Compared with the control group,the number of tender joint,swollen joints,ESR,VAS and DAS28 in the control group were lower than those in the baseline group(P < 0.05).3-momth compared with 1-month,except ESR(P > 0.05),all other indexes were improved(P < 0.05).6-month indicators improved from 3-month(P < 0.05).3.At the site of 1-month visit points,there was no significant difference in the number of tender joint,swollen joints between the experience group and the control group(P > 0.05),but the ESR,VAS score and DAS28 in the experience group were lower than those in the control group(P < 0.05).At the 3-month visit points,compared with the control group,each index of the experience group was lower than the control group(P < 0.05).At the 6-month visit points,there was no significant difference except VAS score(P > 0.05),all other indexes in the experience group were lower than those in the control group(P < 0.05).4.At the 1-month visit points,the experience group had 1 cases achieved low disease activity and no remission in two groups,two groups of DAS28 ? 3.2 and the proportion of subjects showed no significant difference(P > 0.05);At the 3-month visit point of view,50% of the patients in the experience group reached low disease activity,39.3% of the patients achieved DAS28<2.6.Only 3.3% of the patients in the control group reached the low disease activity of disease and no disease relief patients,the difference was statistically significant(P < 0.05).At the 6-month visit points,the proportion of low disease activity in the experience group was about 28.5%,the number of patients with remission dropped to about 7%.In the control group,6.7% of the patients reached the low disease activity and no disease relief patients.The difference between the two groups is statistically significant(P < 0.05).Conclusion: 1.The therapeutic effect of Tocilizumab combined with csDMARDs in the treatment of refractory RA was significantly better than that of csDMARDs.The therapeutic effect was increased with the prolongation of the treatment time of the Tocilizumab,and the rate of reaching the standard of RA can be increased significantly.2.Patients with short course of use of Tocilizumab still benefited,allowing them to reach lower disease activity faster,relieve symptoms,improve quality of life,enhance confidence and compliance in treatment.However,the long-term effect may be not satisfactory.We recommend extending the treatment of RA with Tocilizumab as long as conditions permit.3.The safety and tolerance of Tocilizumab are good.