Study On The Protective Effect Of Iguratimod On Bone Of Rheumatoid Arthritis Patients With Low Bone Mass

ObjectiveRheumatoid arthritis is a chronic progressive autoimmune disease with bone loss very common.Iguratimod is a small molecule antirheumatic drug,which can be used for the treatment of RA.To explore the therapeutic effect and mechanism of Iguratimod on patients with active RA complicated with low bone mass,and to provide theoretical basis for the treatment of RA with bone protection drugs.MethodsFrom July 2018 to July 2019,60 patients with RA complicated with low bone mass were collected and treated inpatient department of Immunorheumatology of Qingdao Municipal Hospital,affiliated to Qingdao University Medical College.They were divided into control group and observation group according to random number method,with 30 cases in each group.One group was treated with MTX,called MTX group.The other group was treated with MTX combined with Iguratimod,called MTX combined with Iguratimod group.Each group was treated for 6 months.Flow cytometry was used to measure the changes of Th17 and Treg in peripheral blood of the two groups before and after treatment.CLIA was used to measure the CTX-1,P1NP,25（OH）D₃ and PTH Levels.ELISA was used to measure the ANKL,OPG,IL-10,IL-17,TGF-βand TNF-αlevels in peripheral blood of the two groups f patients before and after treatment.According to the ESR,the DAS28 was calculated.Results1.After treatment,the levels of serum CTX-1 and RANKL in MTX combined with Iguratimod group were significantly lower than those in MTX group,and the difference was statistically significant（P<0.05）.The serum OPG level of patients in MTX combined with Iguratimod group was significantly higher than that in MTX group,the difference was statistically significan t（P<0.05）.2.After treatment,the levels of serum DAS28 and IL-17 in MTX combined with iguratimod group were significantly lower than those in MTX group,and the difference was statistically significant（P<0.05）.3.After treatment,the expression level of Th17 cells in MTX combined with Iguratimod group was significantly lower than that in MTX group,and the difference was statistically significant（P<0.05）.The expression level of Treg cells in MTX combined with iguratimod group was significantly higher than that in MTX group,and the difference was statistically significant（P<0.05）.4.After treatment,the percentage of Treg cells in MTX combined with iguratimod group was positively correlated with OPG（P<0.05）,and the percentage of Th17 cells was positively correlated with RANKL（P<0.05）.MTX group has no such correlation.ConclusionIguratimod is a new slow-acting antirheumatic drug for RA.It can not only regulate immune response,inhibit the production of various inflammatory cytokines,improve clinical symptoms of patients,but also protect bone.At the same time,this study shows that Iguratimod may play anti-inflammatory and bone protective roles by acting on Th17 and Treg cell balance to regulate OPG/RANKL/RANK signaling pathway.