Background The primary goal of treating the patient with rheumatoid arthritis (RA) is to maximise long-term health-related quality of life (1). The functional limitation caused by disease activity is reversible in RA patients, caused by joint structure damage is irreversible (2). The progressive structural damage contributes the life-long disability in RA patients (3).
Objectives The current study was conducted to investigate whether the combination therapy of Double Filtration Plasmapheresis (DFPP), Leflunomide and Methotrexate improves bone erosion found through magnetic resonance imaging (MRI) in patients with long-standing rheumatoid arthritis (RA).
Methods Seventy-two RA patients with high active disease of >3 years' duration were randomized to receive DFPP in combination with leflunomide and methotrexate (DFPP group), and leflunomide plus methotrexate (no-DFPP group). The primary end point was the improvement in MRI-detected bone erosion over 12 months. Secondary end points include subclinical remission by MRI and clinical remission in DAS44.
Results The study achieved a significant improvement in MRI-detected bone erosion. Bone erosion score of the patients in DFPP group was 11.29±9.55 (mean±SD) at month 12, compared with 14.37±9.55 at baseline (P<0.001) and 16.88±8.33 at month12 of the patients in no-DFPP group (P<0.001). The patients with a decreased erosion score were reached 84.21% at month 12 in the DFPP group. This study showed significantly greater subclinical remission and clinical remission rates in the DFPP group than in the no-DFPP group (P<0.001). Patients with synovitis scores were 0 reached 65.79% of the patients in DFPP group, compared with 0 in no-DFPP group at month 12. The patients with 0 score in synovitis and bone edema reached 55.26% in the DFPP group at month 12. Clinical remission in DAS44 achieved 71.05% at month 12 of the patients in DFPP group, compared with 5.88% of the patients in no-DFPP group. A sustained DAS44 remission for at least 6 months reached 57.89% of the patients in DFPP group at month 12, compared with 0% of the patients in no-DFPP group.
Conclusions The combination therapy of DFPP and DMARDs in long-standing RA patients achieved significant improvement in MRI bone erosion, repair of erosion. The DFPP combination therapy in RA patients had better responses in improving MRI bone erosion and reaching clinical remission and subclinical remission than DMARDs therapy.
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Disclosure of Interest None declared