Abstract:

Objective The study aimed to explore and analyze the effects of different doses of tofacitinib combined with methotrexate on patients with rheumatoid arthritis（RA）and its effect on the levels of serum factors. Methods A total of 90 RA patients who were diagnosed and treated in Harrison International Peace Hospital from July 2019 to April 2021 were randomly assigned at a 1∶1 ratio into two groups：low⁃dose combination group（n = 45）and high ⁃dose combination group（n = 45）. Patients in both groups were treated with methotrexate（10 mg， once per week）. Patients in low⁃dose combination group were given additional low⁃dose tofacitinib treatment（5 mg， once per day），and patients in high⁃dose combination group were given additional high⁃dose tofacitinib treatment （5 mg，twice per day）. Both groups were treated with continuous treatment and observation for 3 months. The mean visual analogue score（VAS），disease activity score（DAS28），the levels of C ⁃ reactive protein（CRP）， erythrocyte sedimentation rate（ESR），serum factors（IL⁃35，IL⁃17，IL⁃6 and IFN⁃γ）and adverse drug reaction were compared between two groups before and after treatment. Results After treatment，the VAS scores，DAS28 scores，levels of CRP and ESR of the two groups after treatment were lower than those before treatment（P < 0.05），and these above⁃mentioned indexes in the high⁃dose combination group were significantly lower than those in the low⁃dose combination group. The levels of IL⁃17，IL⁃6 and IFN⁃γ in both groups after treatment were lower than those before treatment，while the level of IL⁃35 was higher than that before treatment（P < 0.05）. In addition to IL⁃35，the levels of other serum factors（IL⁃17，IL⁃6 and IFN⁃γ）in the high⁃dose combination group were sig⁃ nificantly lower than those in the low ⁃ dose combination group. The commonly adverse drug reactions of the two groups were vomiting，nausea，diarrhea and leukopenia，etc. There was no significant difference in the adversedrug reactions between the two groups（P > 0.05）. Conclusion Compared with low ⁃ dose tofacitinib combined with methotrexate，high ⁃ dose tofacitinib combined with methotrexate could effectively improve the clinical symp⁃ toms of RA patients，reduce the levels of CRP and ESR，upregulate the level of IL⁃35 whereas downregulate the levels of IL⁃17，IL⁃6 and IFN⁃γ，and it does not increase the occurrence of adverse reactions.

Key words:

tofacitinib, dose, rheumatoid arthritis, serum factor, methotrexate