Abstract: To evaluate the value of drug combined with plasma exchange (PE) in the treatment of refractory rheumatoid arthritis (RA).〖WT5”HZ〗Methods〓〖WT5”BZ〗A total of 80 cases of refractory RA patients were randomly divided into PE treatment group and control group with 40 cases in each group.Disease activity score 28（DAS28）,VAS,rheumatoid factor (RF),erythrocyte sedimentation rate (ESR) ,Creactive protein(CRP),anticyclic citrullinated peptide(CCP) antibodies,lymphocytes and efficacy were compared before treatment and at 7d,28d,and 56d after treatment.〖WT5”HZ〗Results〓〖WT5”BZ〗Compared with the control group,DAS28,VAS，ESR in the PE treatment group were significantly decreased at 7d,28d and 56d after treatment,and RF,antiCCP antibody,CRP were significantly decreased at 7d,28d after treatment (P<0.05).〖JP2〗American college of rheumatology (ACR) 20,ACR50 and ACR70 were significantly〖JP〗 improved (P<0.05).The ratios of CD3+T cells in the PE group was significantly higher at 7d and 28d than those before 〖JP2〗treatment (P<0.05), the ratios of CD8+T lymphocytes were significantly lower than those before treatment(P<0.05), and the ratio of CD4+T cells was significantly higher than those before treatment and at the same period in the control group(P<0.05).The ratio of CD4+/CD8+ T lymphocytes〖JP〗 in the PE treatment group was significantly higher than those before and at 7d,  28d after the treatment(P<0.05),while the difference in the control group before and after treatment was not statistically significant(P>0.05).The adverse reaction of PE treatment was mild,and the condition was improved after symptomatic treatment.〖WT5”HZ〗Conclusion〓〖WT5”BZ〗Drug combined with PE therapy can quickly relieve the clinical symptoms of refractory RA patients with mild adverse reaction,and has an obvious therapeutic effect on refractory RA.

Key words: Arthritis rheumatoid, Plasma exchange, T lymphocyte subsets, Clinical observation