| ABSTRACT Objective:To investigate the clinical efficacy of tacrolimus combined with methotrexate in the treatment of refractory rheumatoid arthritis. Methods: 80 cases of patients with refractory rheumatoid arthritis were randomly divided into the observation group and the control group, 40 cases in each group. The observation group were given tacrolimus combined with methotrexate treatment, while the control group were treated with cyclophosphamide and methotrexate treatment; the two groups were treated for 24 week to observe the changes of joint swelling index, the joint pain index and the time of morning stiffness before and after treatment. The joint visual analogue scores (VAS score) were recorded to assess the patient's pain before and after treatment, as well as the laboratory indexes including erythrocyte sedimentation rate (ESR), C reactive protein (CRP), tumor necrosis factor alpha (TNF alpha) and vascular endothelial growth factor (VEGF) levels to evaluate the clinical efficacy in the two groups after treatment. Results: The total remission rate in the observation group was 100.00%, significantly higher than that in the control group 67.50% (P<0.05). In the two groups after treatment, joint pain index, swelling index, morning stiffness and VAS scores were significantly lower than before treatment (P<0.05), which in the observation group were significantly lower than the control group (P<0.05). After the treatment, the two groups’ ESR, CRP, TNF alpha and VEGF were significantly lower than those before treatment (P<0.05), which in the observation group were significantly lower (P<0.05). Conclusion: Tacrolimus combined with methotrexate was effective and safe in the treatment of refractory rheumatoid arthritis. Its mechanism might be related to the reduction of inflammatory reaction in patients and down regulation of VEGF levels. |
