Treatment of Rheumatoid Arthritis in Combined Therapy with Methotrexate

Abstract

In 2 years study, at Rheumatologic Department of University Clinic Centre in Pristina, it was done application of combined therapy with Methotrexate (tablets Methotrexate of 15 mg weekly, Sulphasalazine 2g daily, Hydroxychloroquine 400 mg) to patients with rheumatoid arthritis. Methods: During our investigation were treated 20 patients, 18 females and 2 males, in the treated group with Methotrexate, and 20 patients 16 female and 4 male in treated group with Methotrexate (MTX), Sulphasalazine (SSZ) and Hydroxychloroquine (HCQ). The diagnosis of rheumatoid arthritis was concluded on diagnostic criteria of American Rheumatism Association (ARA). The aim of this study is to compare medical results between group I (with tablets Methotrexate), as simple therapy and group II (with MTX, SSZ and HCQ), as combined therapy of drugs that modify rheumatic diseases (DMARDs), according to laboratory analysis, subjective and objective parameters, as well as side effects of drugs that were used. During application of DMARDs we were based on principals of drug applications. Results: To the investigated patients of group I and II that were of ages (23-72 years old vs. 21-69 years old) with average (46 vs. 45). Most of the patients of group 1 and 2 belong in 1st and 2nd functional stage according to Steinbrocker. Average value of morning stiffness for group 1 and 2 was (69.5 vs. 73 minutes) in the beginning of treatment, while in the end of the treatment was (26 vs. 21minutes, p<0.01). Average value of hands grip before the medication was (67 vs. 62 mm), while after medication (85 vs. 92 mm, p<0.01). Pain to all patients of group I and II before the medication was present, but after the medication changed intensively, had no pain (5 vs. 9 patients), had light pain ( 13 vs. 10 patients), while remained patients with strong pain ( 2 vs. 1 patients). Average value of swelling on proximal interphalangeal joints in group I and II in the beginning of medication was (70 vs. 67 mm), while after the medication was (68 vs. 62 mm). Average value of erythrocytes sedimentation before the medication was (33 vs. 38) while after the medication was (19 vs. 14). The positive rheumatoid factor was found to (15 vs. 17 patients). After the medication is achieved the reduction of titer (2 vs. 4 patients), while to others, the titer value remained unchanged. After the medication with DMARDs from side effects leucopenia was founded to (2 vs. 3 patients), while in two groups, only one patient had protein in urine, thrombocytopenia and pruritus, in group I and II in two patients were manifested gastrointestinal complications: with nausea, vomiting and gastric pain, in group II diarrhea, rush and alopecia. Conclusions: According to our results we concluded efficacy of the combination of DMARDs (MTX, SSZ, HCQ) as combined therapy compared with medication of simple therapy (MTX) to the patients with rheumatoid arthritis. The combined therapy of DMARDs caused visible clinic improvement, have decreased laboratory parameters, disease activity and have improved life quality.