To observe the clinical efficacy and safety of tocilizumab injection combined with iguratimod tablets in the treatment of elderly patients with rheumatoid arthritis (RA) complicated with interstitial pneumonia.

Elderly patients with RA complicated with interstitial pneumonia in our hospital were divided into control group and treatment group according to the treatment methods. The control group was given iguratimod tablets 25 mg bid, orally after breakfast and dinner, for a total of 12 weeks on the basis of the conventional treatment plan. The treatment group was given tocilizumab injection 8 mg·kg^-1 intravenously every 4 weeks on the basis of control group. When abnormal liver enzymes, decreased neutrophil count, or decreased platelet count occurred, the dose of tocilizumab injection was reduced to 4 mg·kg^-1, for a total of 12 weeks. The clinical efficacy, lung function and inflammatory response indicators of the two groups were compared, and the safety was evaluated.

A total of 84 cases were included in this study, with 39 cases in control group and 45 cases in treatment group. After treatment, the overall clinical response rates were 74.36% (29 cases /39 cases) in control group and 91.11% (41 cases /45 cases) in treatment group, respectively. The overall clinical response rate of treatment group was statistically significant higher than control group (P<0.05). After treatment, the levels of vital capacity (VC) in control group and treatment group were (2.25±0.34) and (2.38±0.30) L, respectively; the levels of forced expiratory volume in 1 second (FEV₁) were (2.71±0.39) and (2.85±0.36) L, respectively; the high-resolution CT (HRCT) scores were (1.59±0.68) and (1.49±0.59) points, respectively. There was no statistically significant difference in the above indicators between the two groups (all P>0.05). After treatment, the levels of interleukin-6 (IL-6) in control group and treatment group were (13.27±1.95) and (12.05±1.72) pg·mL^-1, respectively; the levels of rapid C-reactive protein (CRP) were (16.09±2.44) and (14.83±2.15) mg·L^-1, respectively; the levels of matrix metalloproteinase-3 (MMP-3) were (60.32±9.59) and (55.61±8.27) μg·mL^-1, respectively; the levels of tissue inhibitor of metalloproteinase-1 (TIMP-1) were (86.79±14.58) and (79.83±13.27) pg·mL^-1, respectively. All the aforementioned indicators in treatment group were statistically significant lower than control group (P<0.05, P<0.01). The main adverse drug reactions in control group were elevated aminotransferase, leukopenia and upper abdominal pain. The main adverse drug reactions in treatment group were elevated aminotransferase, leukopenia, decreased neutrophil count and upper abdominal pain. The total incidence of adverse drug reactions was 7.69% in control group and 11.11% in treatment group, with no statistically significant difference (P>0.05).

Tocilizumab injection combined with iguratimod tablets is effective in the treatment of elderly patients with RA complicated with interstitial pneumonia, and can effectively improve their clinical symptoms, serum marker levels, and lung function, reduce inflammatory responses, and has good safety.