Methotrexate combined with leflunomide in treatment of rheumatoid arthritis:inflammatory factors and prognosis assessment

He Gai-hong; Li Zhen; Qiang Bo

doi:10.3969/j.issn.1672-8157.2025.02.008

Abstract：Objective To explore the value of serum interleukin-23(IL-23)and interleukin-17(IL-17)for the prognosis eval-uation of methotrexate combined with leflunomide in the treatment of active rheumatoid arthritis(RA).Methods A total of 136 patients with active RA admitted to Yulin Hospital,the First Affiliated Hospital of Xi'an Jiaotong Universityfrom July 2021 to July 2023 were selected and treated with methotrexate combined with leflunomide.The levels of IL-23 and IL-17 were detected before treatment.After 6 months of follow-up,the prognosis status of patients with active RA after treatment was observed,and the above patients were classified into good prognosis group(n=91)and poor prognosis group(n=45).The levels of IL-23 and IL-17 detected before treatment and basic data were compared between groups.The influencing factors of poor prognosis in patients with active RA were analyzed.Receiver operating characteristic(ROC)curves of IL-23 and IL-17 in patients with different prognosis status were analyzed.Results The levels of IL-23 and IL-17 were(143.37±24.82)ng·L-1 and(23.09±4.06)ng·L-1 in the poor prognosis group,which were higher than(120.42±21.53)ng·L-1 and(17.61±3.88)ng·L-1 in the good prognosis group(t=5.556,7.632,both P<0.05).The disease activity score in 28 joints(DAS28)score,rate of concurrent other immune system diseases and positive rate of human leukocyte antigen-DR4(HLA-DR4)in the poor prognosis group were(4.61±0.85)points,26.67%and 73.33%,which were higher than those of(3.73±0.33)points,7.69%and 49.45%in the good prognosis group(t=3.103,χ2=9.020,7.022,all P<0.05).The Logistic regression analysis of the above influencing factors revealed that IL-23(odds ratio(OR)=1.133,95%confidence in-terval(95%CI)(1.025,1.252),IL-17(OR=1.124,95%CI(1.043,1.211)),positive HLA-DR4(OR=2.625,95%CI(1.173,5.874))and DAS28 score(OR=1.115,95%CI(1.027,1.211))were independent influencing factors of poor prognosis in active RA patients(P<0.05).ROC curve analysis demonstrated that the areas under the curves of IL-23 and IL-17 in predicting the poor prognosis of patients were 0.716 and 0.824,respectively.Conclusion Serum IL-23 and IL-17 are abnormally expressed in patients with active RA,and they are closely related to the poor prognosis of patients with active RA.Therefore,these two indexes have important val-ue for predicting the poor prognosis.