Clinical Observation Of Tumor Necrosis Factor-α Inhibitor In Patients With Rheumatoid Arthritis Complicated With Anemia

Objective: To investigate the clinical efficacy of tumor necrosis factor-α inhibitor(TNF-α inhibitor)in the treatment of patients with rheumatoid arthritis(RA)complicated with anemia.Methods: A total of 192 RA patients hospitalized in Shaoxing Hospital of China Medical University from January 2017 to December 2019 were collected,including 135 RA patients without anemia and 57 RA patients with anemia.Among them,40 patients still suffering from anemia 3 months after initial treatment were selected as subjects.RA patients with anemia were divided into TNF-α inhibitor group and DMARDS group.TNF-α inhibitor group(n = 20)was treated with traditional disease modifying anti-rheumatic drugs(DMARDs)for more than 3 months and TNF-α inhibitor treatment was started at the same time.DMARDs group(n = 20)were treated with another or more traditional DMARDs on the basis of the initial use of traditional DMARDs for 3 months.3 months as a course of treatment,and the efficacy of 2 courses of treatment was observed.Results :(1)Among the 192 active RA patients enrolled in this study,57 cases(29.70%)were anemia,46 cases(80.70%)were mild anemia,and 11 cases(19.30%)were moderate anemia.(2)Swollen joint count(SJC),Tender joint count(TJC),erythrocytic sedimentation rate(ESR),C-reactive protein(CRP),DAS28-ESR score and DAS28-CRP score in 2 groups were improved to varying degrees after 3 months and 6 months of treatment.The scores of SJC,TJC,DAS28-ESR and DAS28-CRP in TNF-α inhibitor group at 3 and 6 months after treatment were significantly lower than those in DMARDS group(all P < 0.01).The CRP of the TNF-α inhibitor group at 3 months posttreatment was significantly lower than that of the DMARDS group(P < 0.01),and the CRP at 6months posttreatment was significantly lower than that of the DMARDS group(P <0.05).(3)Hemoglobin(Hb)and Hematokrit(Hct)increased significantly in both groups at3 and 6 months of treatment(P < 0.01 compared with baseline).At the end of the study,the mean Hb value in the TNF-α inhibitor group ranged from 100.40g/L to 120.30g/L(P< 0.01),with a mean Hb increase of 19.90g/L.The mean Hct value increased from31.50% to 37.10%(P < 0.01),and the mean Hct value increased by 5.60%.The mean Hb value of DMARDS group increased from 97.95g/L to 112.15g/L(P < 0.01),and the mean Hb value increased by 14.20g/L.The mean Hct increased from 31.00% to 35.20%(P <0.01),and the mean Hct increased by 4.20%.In addition,the anemia improvement rate of TNF-α inhibitor group(90%)was higher than that of DMARDS group(66%)after continuous treatment until 6 months,and the difference was statistically significant(P <0.05).Conclusions :(1)Anemia is one of the symptoms of prominent extrararticular action of RA.(2)For patients with active RA complicated with anemia,both TNF-α inhibitors and DMARDs can relieve joint swelling and pain symptoms to varying degrees,reduce disease activity and improve anemia status,but the combination of TNF-α inhibitors was significantly more effective than DMARDs.(3)For patients with clinically refractory RA complicated with anemia,early addition of TNF-α inhibitors has a better effect on both the disease itself and the extrarticular effect of anemia.