来源：风湿病与关节炎,2019,8（9）:19-21,45.

手腕部韵律操联合甲氨蝶呤、来氟米特治疗类风湿关节炎40例临床观察（临床研究）

余文景，梁　翼，李　敏，沙　湖，许　静，夏　琴

　　【摘　要】目的：观察手腕部韵律操联合甲氨蝶呤、来氟米特治疗类风湿关节炎的临床疗效。方法：将80例类风湿关节炎患者随机分为治疗组和对照组，每组40例。对照组采用常规抗风湿治疗（甲氨蝶呤、来氟米特），治疗组在对照组治疗基础上辅以手腕部关节韵律操的运动疗法。2组均以8周为1个疗程。观察2组临床疗效，以及治疗前后关节疼痛、关节肿胀、关节屈伸不利和晨僵等中医临床症状积分，类风湿因子（RF）、红细胞沉降率（ESR）、C-反应蛋白（CRP）等实验室指标，并计算DAS28评分。结果：治疗组临床控制10例，显效15例，有效12例，无效3例，总有效率为92.50%；对照组临床控制10例，显效15例，有效7例，无效8例，总有效率为80.00%。2组比较，差异有统计学意义（P < 0.05）。治疗后，2组关节疼痛、关节肿胀、关节屈伸不利、晨僵评分较治疗前均显著下降（P < 0.01），且治疗组低于对照组（P < 0.01）。2组RF、ESR、CRP和DAS28评分较治疗前均有改善（P < 0.01），且治疗组DAS28评分优于对照组（P < 0.05）。结论：手腕部韵律操联合甲氨蝶呤、来氟米特能有效改善患者关节肿胀、疼痛，缓解晨僵现象，明显降低中医临床症状积分及DAS28评分，提高临床疗效。

　　【关键词】　关节炎，类风湿；手腕部韵律操；甲氨蝶呤；来氟米特；临床疗效

Clinical Observation on 40 Cases of Rheumatoid Arthritis Treated by Wrist Rhythmic Gymnastics Combined with Methotrexate and Leflunomide

YU Wen-jing,LIANG Yi,LI Min,SHA Hu,XU Jing,XIA Qin

　　【ABSTRACT】Objective:To observe the clinical effect of wrist rhythmic gymnastics combined with methotrexate and leflunomide in the treatment of rheumatoid arthritis.Methods:Eighty patients with rheumatoid arthritis were randomly divided into a treatment group and a control group,40 cases in each group.The control group was treated with routine anti-rheumatism therapy（methotrexate,leflunomide）,while the treatment group was treated with wrist rhythmic gymnastics based on the treatment for the control group.Both groups were treated for 8 weeks.The clinical effects,the scores of clinical symptoms（including joint pain,joint swelling,adverse joint flexion and extension,morning stiffness）,laboratory indicators（rheumatoid factor（RF）,erythrocyte sedimentation rate（ESR）,C-reactive protein（CRP）before and after treatment of the two groups were observed,and the DAS28 scores were calculated.Results:In the treatment group,10 cases were clinically controlled,15 cases were markedly effective,12 cases were effective,3 cases were ineffective,and the total effective rate was 92.50%.In the control group,10 cases were clinically controlled,15 cases were markedly effective,7 cases were effective and 8 cases were ineffective,and the total effective rate was 80.00%.There was a significant difference between the two groups（P < 0.05）.After treatment,the scores of joint pain,joint swelling,adverse joint flexion and extension,morning stiffness in the two groups were significantly lower than those before treatment（P < 0.01）,and the scores in the treatment group were lower than those in the control group（P < 0.01）.The scores of RF,ESR,CRP and DAS28 in the two groups were improved compared with those before treatment（P < 0.01）,and the scores of DAS28 in the treatment group were better than those in the control group（P < 0.05）.Conclusion:Wrist rhythmic gymnastics combined with methotrexate and leflunomide can effectively improve joint swelling and pain,relieve morning stiffness,significantly reduce clinical symptoms score and DAS28 score,and improve clinical efficacy.

　　【Keywords】 arthritis,rheumatoid;wrist rhythm gymnastics;methotrexate;leflunomide;clinical efficacy