Efficacy of plasma exchange combined with low dose of methotrexate in treatment of severe older age rheumatoid arthritis

Objective To assess the efficacy of plasma exchange combined with low dose of methotrexate(MTX)in treatment of severe rheumatoid arthritis in older age patients.Methods Sixty-four older age patients with severe rheumatoid arthritis were enrolled.Thirty-four patients(experimental group)were treated with plasma exchange combined with low dose MTX and sulfasalazine(SSZ).Another 30 patients(control group)were treated with low dose MTX and SSZ.Patients were assessed at week 1,12,24.Results At week 1,patients having 20% improvement(ACR20)were 32.4% in experimental group and 6.7% in control group(P=0.011);at week 12,patients having ACR20 were 70.6% in experimental group and 43.3% in control group(P=0.028),patients having 50% improvement(ACR50)were 47.0% in experimental group and 23.3% in control group(P=0.030);patients having 70% improvement(ACR70)were 26.5% in experimental group and 6.7% in control group(P=0.041);at week 24,patients having ACR20 were 85.3% in experimental group and 60.0% in control group(P=0.022),patients having ACR50 were 58.8% in experimental group and 33.3% in control group(P=0.041),patients having ACR70 were 35.3% in experimental group and 13.3% in control group(P=0.043).The occurrence of adverse events were six cases in experimental group and four cases in control group,no serious adverse events occurred.Conclusion Treatment with plasma exchange combined with low dose MTX is more effective than immunosuppressive alone in the older age patients of severe rheumatoid arthritis.