The Comparison Of Glucocorticoids And Biological Agents On Disease Activity And Bone Mineral Density For Early Active Rheumatoid Arthritis

?Objective?To compare the effects of glucocorticoids and biological agents on disease activity and bone mineral density in patients with early active rheumatoid arthritis.?Methods?115 patients with early active rheumatoid arthritis were collected by retrospective analysis and divided into 3 groups: 42 patients in glucocorticoids group were treated with low-dose glucocorticoids with prednison 15mg/d as the starting dose,gradually reduced and stopped within half a year.In addition,35 patients in the biological agents group were treated with infliximab 200 mg every time for 6 times,while 38 patients in the control group were treated with traditional disease modifying anti-rheumatic drugs(DMARDs).Compare the changes of erythrocyte sedimentation rate(ESR),C reactive protein(CRP),rheumatoid factor(RF),anti cyclic citrullinated peptide(CCP)antibody and 28 joint disease activity scores(DAS28-ESR,DAS28-CRP),as well as clinical disease activity index(CDAI)and simplified disease activity index(SDAI)between the three groups before and after 24 weeks,48weeks treatment.Compare the changes of bone mineral density which were measured by dual energy X-ray absorptiometry in lumbar spine,femoral neck,greater trochanter and Waugh area before and after 48 weeks treatment.?Result? 1.Comparison of ESR,CRP,RF,the anti CCP antibody :(1)Glucocorticoids group before and after treatment:After 24 weeks of treatment,ESR,CRP,RF,the anti CCP antibody in glucocorticoids group were significantly lower than before(P < 0.05) and after 48 weeks of treatment,ESR,CRP,anti CCP antibody was significantly lower than before(P < 0.05).(2)Biological agents group before and after treatment: After 24 weeks of treatment in biological agents group,ESR,CRP,RF were significantly lower than before(P < 0.05),and after 48 weeks ESR,CRP,RF,anti CCP antibody were significantly lower than before treatment(P < 0.05).(3)Comparison of three groups after24 weeks of treatment:After 24 weeks of treatment,CRP and RF in glucocorticoids group were significantly lower than that in control group(P < 0.05),and RF in biological agents group was significantly lower than that in control group(P < 0.05).There was no statistically significant difference between glucocorticoids group and the biological agents group in ESR,CRP,RF,anti CCP antibody(P > 0.05).(4)Comparison of three groups after 48 weeks of treatment:After 48 weeks of treatment,RF in glucocorticoids group and biological agents group was significantly lower than that in control group.RF in biological agents group was significantly lower than that in glucocorticoids group(P > 0.05).There was no significant difference among ESR,CRP,anti CCP antibody in three groups(P > 0.05).2.Comparison of disease activity:(1)Comparison of glucocorticoids group and biological agents group before and after treatment:After 24 weeks and 48 weeks of treatment,the levels of CDAI,SDAI,DAS28-ESR,DAS28-CRP were significantly lower than before in glucocorticoids group and biological agents group(P <0.05).(2)Comparison of three groups after 24 weeks of treatment:After 24 weeks of treatment,the levels of DAS28-ESR,DAS28-CRP in glucocorticoids group were significantly lower than that in control group(P < 0.05),and the levels of CDAI,SDAI,DAS28-ESR,DAS28-CRP in glucocorticoids group were significantly lower than that in biological agents group and in control group(P < 0.05).(3)Comparison of three groups after 48 weeks of treatment:After 48 weeks of treatment,CDAI,SDAI,DAS28-CRP in the glucocorticoids group and biological agents group were significantly lower than that in the control group(P < 0.05),but there was no statistically significant difference between glucocorticoids group and biological agents group(P > 0.05).3.Comparison of bone mineral density:(1)Comparison of glucocorticoids groups before and after treatment:After 48 weeks of treatment,the bone mineral density of the lumbar spine(L2,L3,L4),femoral neck,greater trochanter and Waugh area in glucocorticoids group were significantly lower than before treatment(P <0.05).(2)Comparison of biological agents groups before and after treatment:After 48 weeks of treatment,the bone mineral density of the femoral neck in biological agents group was significantly lower than before treatment(P < 0.05).(3)Comparison of three groups after 48 weeks of treatment:the bone mineral density of the lumbar spine(L2,L3,L4),femoral neck,greater trochanter and Waugh area in glucocorticoids group were significantly lower than that in control group and biological agents group(P <0.05).And the bone mineral density of the lumbar spine(L2,L3,L4)in biological agents group were higher than those of the control group(P < 0.05).?Conclusion? 1.The application of both low dose glucocorticoids and biological agents could significantly reduce the disease activity of patients with early active rheumatoid arthritis.The application of biological agents to control disease activity is more rapid and significant than glucocorticoids,but the long-term effect of both drugs may be equal.2.Low dose glucocorticoids could significantly decrease bone mineral density in early rheumatoid arthritis patients,while biological agents could improve bone metabolism and increase bone mineral density.