Lacki J K, Klama K, Samborski W, Mackiewicz S, Mackiewicz U, Muller W
Hochrhein Institute for Rheumatism Research and Prevention, Bad Sackingen, Germany.
Mater Med Pol. 1995 Apr-Jun;27(2):47-51.
We sought to investigate an influence of immunosuppressive drugs on acute phase response (APR) in rheumatoid arthritis (RA). Ninety-six patients (pts) were treated with methotrexate (MTX), or with cyclophosphamide (CTX) (9-intravenously, 19-orally), or with cyclosporin A (CSA). C-reactive protein (CRP), alpha-1-acid glycoprotein (AGP), and alpha-1 antichymotrypsin (ACT) serum levels were measured by rocket immunoelectrophoresis. AGP and ACT microheterogenities evaluated using immunoelectrophoresis were expressed as reactivity coefficient (RC). Clinical improvement was observed in 71.4% MTX pts, 77.8% CTX intravenously pts, 36.8% CTX orally pts, 60.0% CSA pts. The number of side effects was the highest in CTX oral group (57.9% left the study). CRP, AGP, and ACT serum levels were increased in all groups of RA pts as compared to healthy controls. CRP level decreased only after MTX and CTX intravenous treatment. Moreover, a decrease in ACT was observed in CTX intravenously treated pts. AGP-RC was lower in the initial population of RA pts as compared to healthy control. After 6 months of treatment RC became significantly higher in MTX pts only. In opposite ACT-RC in RA pts was found to be elevated as compared to controls. After the treatment it fell down. The decrease was found to be significant only in pts treated with MTX. From our study we can conclude that MTX is the safest and the most effective agent among immunosuppressive drugs applied in RA. CTX given orally causes a number of adverse reactions, which frequently make continuous and effective treatment impossible. CTX intravenously and CSA are attractive in the treatment of the patients with severe and refractory RA. A lack of clinical benefit is reflected in the absence of acute markers changes.
我们试图研究免疫抑制药物对类风湿关节炎（RA）急性期反应（APR）的影响。96例患者接受甲氨蝶呤（MTX）、环磷酰胺（CTX）（9例静脉注射，19例口服）或环孢素A（CSA）治疗。通过火箭免疫电泳法测定血清C反应蛋白（CRP）、α-1-酸性糖蛋白（AGP）和α-1抗糜蛋白酶（ACT）水平。采用免疫电泳评估的AGP和ACT微异质性以反应系数（RC）表示。观察到71.4%的MTX治疗患者、77.8%的静脉注射CTX患者、36.8%的口服CTX患者、60.0%的CSA患者临床症状改善。副作用发生率在口服CTX组最高（57.9%退出研究）。与健康对照相比，所有RA患者组的CRP、AGP和ACT血清水平均升高。仅在MTX和静脉注射CTX治疗后CRP水平下降。此外，静脉注射CTX治疗的患者ACT水平下降。与健康对照相比，RA患者初始人群的AGP-RC较低。治疗6个月后，仅MTX治疗患者的RC显著升高。相反，RA患者的ACT-RC与对照相比升高。治疗后其下降。仅在MTX治疗的患者中下降显著。从我们的研究可以得出结论，在用于RA的免疫抑制药物中，MTX是最安全、最有效的药物。口服CTX会引起许多不良反应，这常常使持续有效的治疗无法进行。静脉注射CTX和CSA对重症和难治性RA患者的治疗具有吸引力。缺乏临床益处体现在急性标志物变化的缺失上。
