COMPARISON OF THE THERAPEUTIC EFFICACY BETWEEN METHOTREXATE BASED DUAL & TRIPLE THERAPY IN RHEUMATOID ARTHRITIS

Abstract

BACKGROUND: Rheumatoid arthritis (RA) is a systemic chronic inflammatory disease that mainly affects the synovial joints. Historically, RA has been treated using a multitiered Bpyramid^ strategy, beginning with symptom-relieving nonsteroidal anti-inflammatory drugs and/or corticosteroids, and subsequently with more potent disease-modifying antirheumatic drugs (DMARDs), such as methotrexate (MTX), salphasalazine, hydroxychloroquin, lefnulomide.

AIMS: 1.Comparison of the therapeutic efficacy between methotrexate based dual & triple
therapy in Rheumatoid Arthritis. 2.To study the Methotrexate, Sulfasalazine, Hydroxychloroquine, in Rheumatoid Arthritis

MATERIAL AND METHODS: The present study was conducted in 60 consecutive RA  patients, who attended Out Patient Department or were admitted in the department of Internal Medicine at R.G.Kar Medical College and Hospital, Kolkata, West Bengal, India. Group A consists of 30 patients receiving Methotrexate and salphasalazine. Group B consists of 30 patients receiving MTX, Salphasalazine, Hydroxychloroquin.

RESULTS: In group-A, 21(70.0%) patients had female and 9(30.0%) patients had male. In group-B, 18(60.0%) patients had female and 12(40.0%) patients had male.

In group-A, the mean age (mean± s.d.) of patients was 48.6000 ± 11.2145 years. In group-B, the mean age (mean± s.d.) of patients was 48.4667 ± 10.3881 years.

We found that, the mean DAS 28 baseline (mean± s.d.)  were 5.4667 ±1.3322, 5.6000 ± 1.3287 in group A, B respectively. Difference of mean DAS 28 baseline vs. group was not statistically significant (p=0.6993). The mean DAS 28 6 months follow-up (mean± s.d.)  were 3.9333 ± .9072, 3.2667 ± .9444 in group A,B respectively. Difference of mean DAS 28 6 months follow-up vs. group was statistically significant (p=0.0072). The mean DAS 28 12 months follow-up (mean± s.d.) were 2.6667 ± .6065, 2.2000 ± .7144 in group A,B respectively.. Difference of mean DAS 28 12 months follow-up vs. group was statistically significant (p=0.0084).

CONCLUSIONS: We found that CRP, RA, DAS-28 score, Anti-CCP and ESR levels were more decreased in triple therapy during follow-up period. In Rheumatoid arthritis patients with Methotrexate based dual therapy vs triple therapy, the latter was found to be significantly more durable.

KEY WORDS: RA (Rheumatoid arthritis), MTX (Methotrexate), DMRD (Disease modifying anti rheumatic drug), DAS (Disease activity score), CRP (C reactive protein), Anti CCP (anti-Cyclic Citrullinated Peptide), ESR                        ( erythrocyte sedimentation rate)