류마티스 관절염 환자에서 장기간의 DMARD 치료 효과에 영향을 미치는 인자에 관한 연구

Background : Rheumatoid arthritis (RA) is a chronic long-standing disease with substantial mobidity and mortality. The effects of disease-modifying antirheumatic drug (DMARD) are not enough to induce complete remission, combination therapy is mandatory. It is unknown why some patients respond to treatment better than others. I studied factors affecting long-term effects of DMARDs in patients with RA. Methods : Thirty-two patients with rheumatoid arthritis were enrolled. Disease activity was assessed by the duration of morning stiffness, erythrocyte sedimentation rate (ESR), C-reactive protein, swollen joint counts, Ritchie index, and modified Sharp score. Patients were treated with various DMARD combinations. The treatment goal was 50 percent improvement in symptoms and signs. Result : The most frequently used DMARDs were Methotrexate+Hydroxychloroquine combination. Fifty percent improvement in disease activities was observed in 34% of patients. Duration of morning stiffness was decreased from 2.38±2.86 hour to 0.28±1.03 hour (p=0.001) in 6 months, 0.56±2.35 hour (p=0.009) in 12 months, and 0 in 24 months. The swollen joint count was reduced from 4.07±3.21 to 1.22±1.31 (p=0.000) in 6 months, 1.26±1.40 (p=0.000) in 12 months, 1.14±1.59 (p=0.001) in 24 months respectively. Ritchie index was also decreased from 5.77±5.69 to 1.42±1.79 (p=0.000) in 6 months, 1.70±2.11(p=0.000) in 12 months, 1.48±2.02 (p=0.013) in 24 months respectively. Erythrocyte sedimentation rate was decreased from 37.66±13.55 mm/hour to 25.86±18.62 mm/hour (p=0.002), 27.83±16.20 mm/hour (p=0.011), 24.35±16.60 mm/hour (p=0.004) respectively. There is no significant difference in clinical parameters and disease activity between responders and non-responders. Conclusion : The combination treatment of DMARDs had moderate effect in RA patients. No significant difference in disease activity parameters in responders and non-responders. Further investigations with the larger patient groups are needed to establish the predictors of the treatment effects. KCI Citation Count: 0