A Comparative Drug Study of Dexamethasone, Leflunomide and Methotrexate on Rheumatoid Arthritis at JLN Hospital Ajmer

Background New studies focused on modern therapeutic methods which decrease the incidence of inflammation of joints and stimulate cartilage healing and repair the damage, including the use of Dexamethasone, Leflunomide and Methotrexate drug. This study has the purpose to present the use of PRP in management of knee Osteoarthrosis and its outcomes up to 6 month follow up RHEUMATOID ARTHRITIS Rheumatoid arthritis is a chronic multisystem disease of unknown cause. Although there are a variety of systemic manifestations, the characteristic Feature of Rheumatoid arthritis is persistent, progressive, inflammatory synovitis, usually involving peripheral joints in a symmetric distribution. The potential of the synovial inflammation to cause cartilage destruction and bone erosions and subsequent changes in joint integrity is the hallmark of the disease. Despite of its destructive potential, the course of rheumatoid arthritis can be quite variable. Some patients may experience only a mild oligoarticular illness of brief duration with minimal joint damage, whereas others will have a progressive polyarthritis with marked functional impairment (Lipsky, 2001). MATERIAL AND METHODS The present study was conducted in 108 patients of active rheumatoid arthritis at J. L. N. Medical College and Associated Group of Hospitals, Ajmer rajasthan. The subjects for study were taken from patients attending medical outdoors and admitted in various wards. The study design was open, Dexamethasone. controlled, randomized, prospective 24 weeks trial. The subjects selected for study were grouped as follows viz. GROUP I (Dexamethasone group, n=36) This group consisted of age, sex, BMI matched patients of active RA in age range 18 to 70 years who were treated with Dexamethasone with or without stable doses of NSAIDs. GROUP II. (Leflunomide group, n=36) This group consisted of age, sex, BMI matched patients of active RA m age range 18 to 70 years who were treated with loading dose of leflunomide l OOmg once a day for 3 days and then 20mg once a day for 12 weeks with or without stable doses of NSAIDs and low dose Dexamethasone. GROUP III. (Methotrexate group, n=36) This group consisted of age, sex, BMI matched patients of active RA age range 18 to 70 years who were treated with A Dose of 7.5 mg weekly. INCLUSION CRITERIA Patients of either sex, with age range 18 to 7Q years with active RA based on American College of Rheumatology Criteria (ACR) and ACR functional class I, II, III were included. The stable doses of NSAIDs and low dose Dexamethasone were allowed and treatment with other DMARDs was discontinued 4 weeks prior to enrolment. ACR criteria for the classification of RA 1. Morning stiffness stiffness in an around the joints lasting 1 hour before maximal improvement.2. Arthritis of three or more joint areas at least three joint areas, observed by a physician simultaneously, having soft tissue swelling or joint effusions, not just bony over growth. The 14 possible joint areas involved are right or left PIP, MCP, wrist, elbow, knee, ankle and MTP joints.3. Arthritis of hand joints arthritis of wrist, MCP, PIP joints.4. Symmetric arthritis simultaneous involvement of same joint areas on both sides of the body.5. Rheumatoid nodules Subcutaneous nodules over bony prominences, extensor surfaces or juxtaarticular lesions observed by a physician.6. Serum Rheumatoid factor Demonstration of abnormal amounts of serum rheumatoid factor by any method for which the result has been positive in less than 5 % of normal control subjects.7. Radiographic changes Typical changes of RA on posteroanterior hand and wrist radiographs which must include erosions or unequivocal bony decalcification localized in or most marked adjacent to the involved joints. Four of seven criteria are required to classify a patient as having rheumatoid arthritis. Patients with two or more clinical diagnosis are not excluded. Criteria 1-4 must be present for at least 6 week, criteria 2-5 must be observed by physician. Criteria for active rheumatoid arthritis (Arnet et al. , 1988).1. Tender and swollen joint count 6.2. Physician and patient global assessments of RA activity as fair, poor or very poor.3. C-reactive protein (CRP) greater than 20mg/L or ESR greater than 28 mm 1st hr. ACR Classification criteria of fun ctional status in RA (Hochberg et al.1992) Class 1 Completely able to perform usual activities of daily living (Self care, vocational and avocational). Class 2Able to perform usual self-care and vocational activities, but limited in avocational activities. Class 3-Able to perform usual self care activities, but limited m vocational and avocational activities. Class 4-Limited ability to perform usual self care, vocational and avocational activities. EXCLUSION CRITERIA Following patients were excluded from the stl!