Abstract: 【Abstract】Objective To explore the efficacy of double filtration plasmapheresis (DFPP) combined with methotrexate (MTX) in the treatment of rheumatoid arthritis (RA). Methods A total of 120 RA cases treated during April 2016 to May 2017 were randomly divided into control group (n=60) and observation group (n=60). Patients in control group were treated with MTX and Leflunomide. The levels of inflammatory factors, Dickkopf-1 (DKK1) and nuclear factor κ-B receptor activation factor ligand (RANKL), and joint symptoms were monitored before and after treatment in the two groups. Results After the treatment, DKK1 (t=4.112, P=0.000) increased; RANKL (t=2.208, P=0.000), IL-6 (t=3.926, P=0.000), TNF-α (t=10.320, P=0.000), RF(t= 35.509,  P=0.000), CRP (t=7.233, P=0.000), ESR (t=42.563, P=0.000), number of painful joints (t=9.603, P=0.000) and swollen joints (t=6.056, P=0.000) decreased in the two groups. The degrees of the changes were greater in observation group than in control group (P<0.05). The total number of the adverse reactions was significantly lower in observation group than in control group (c2=3.159, P=0.047). There were no significant differences in WBC, platelet and albumin between the two groups before and after treatment (P＞0.05). Conclusion DFPP combined with MTX treatment increased serum DKK1, reduced RANKL and inflammatory
factors, and improved clinical symptoms.

Key words: Double filtration plasmapheresis, Rheumatoid arthritis, Dickkopf-1, NF κ-B receptor activation factor ligand