OBJECTIVE To investigate the regulatory effects of tofacitinib combined with methotrexate （MTX） on gut microbiota and the clinical efficacy of this regimen in patients with rheumatoid arthritis （RA）. METHODS A retrospective analysis was conducted on the clinical data of 182 patients with RA admitted to Xingtai People’s Hospital from January 2022 to June 2025. The patients were divided into a control group （ n ＝88， treated with MTX monotherapy） and an observation group （ n ＝94， treated with tofacitinib combined w ith MTX） based on their treatment regimen. Gut microbiota abundance， inflammatory and immunological indicators [C-reactive protein （CRP）， erythrocyte sedimentation rate （ESR）， rheumatoid factor （RF）， and anti-cyclic citrullinated peptide antibody （anti-CCP） ] ， clinical efficacy indicators [American College of Rheumatology 20% response rate （ACR20）， Disease Activity Score in 28 Joints （DAS28）， and Health Assessment Questionnaire （HAQ） score ] ， and adverse reactions during treatment were compared between the two groups before and after 12 weeks of treatment. RESULTS After treatment， the abundance of Lactobacillus and Bifidobacterium were significantly increased in both groups compared with before treatment， whereas the abundances of Enterococcus and Enterobacter ， as well as the levels of CRP， ESR， RF， anti-CCP， DAS28 score， and HAQ score， were significantly decreased （ P ＜0.05）. The degree of improvement in the observation group was significantly greater than that in the control group （ P ＜0.05）. The ACR20 response rate in the observation group was significantly higher than that in the control group （81.91% vs. 56.82%， P ＜0.05）. There was no statistically significant difference in the incidence of adverse reactions between the two groups （ P ＞0.05）， and the main adverse reactions were gastrointestinal reactions and abnormal liver function. CONCLUSIONS Tofacitinib combined with MTX can effectively improve gut microbiota balance in patients with RA by increasing the abundance of probiotics and reducing the abundance of opportunistic pathogenic bacteria， thereby improving immune and inflammatory status. In addition， this combination regimen can enhance clinical efficacy， reduce disease activity， and improve functional status， with a favorable safety profile.

Objective:To explore effects of tofacitinib combined with traditional disease modifying antirheumatic drugs(DMARDs)on peripheral blood IL-22,IL-23 and Th22 cell subsets in patients with rheumatoid arthritis(RA).Methods:Retrospec-tive analysis of clinical data of 100 RA patients admitted to Xingtai People's Hospital from December 2022 to December 2024.Patients were divided into conventional group(n=33,treated with traditional DMARDs),single group(n=34,treated with tofacitinib)and combination group(n=33,treated with tofacitinib combined with traditional DMARDs)by random number table method.Serum IL-22 and IL-23 levels,Th22 cell subsets proportion,recovery of joint function,disease improvement and adverse reactions were compared in three group.Results:After 3 months of treatment,IL-22,IL-23 and Th22 cell subsets proportion in three groups were decreased compared to before treatment,and combination group was significantly lower than conventional group and single group(P<0.05);levels of anti-CCP and RF in three groups were decreased compared to before treatment,and combined group was significantly lower than conventional group and single group(P<0.05);joint swelling frequency,number of tender joints,morning stiffness time and VAS scores in three groups were decreased compared to before treatment,and combination group was significantly lower than conven-tional group and single group(P<0.05);DAS28 scores and HAQ scores of three groups were decreased compared to before treatment,and combined group was significantly lower than conventional group and single group(P<0.05);there was no statistically significant difference in incidence of adverse reactions among three groups during treatment period(Z=0.290,P=0.865).Conclusion:Clinical effect of tofacitinib combined with traditional DMARDs in treatment of RA is significant,which can effectively reduce serum IL-22,IL-23 and autoantibodies levels,regulate Th22 cell subsets proportion,alleviate inflammatory reactions,and improve joint function.

Objective:To explore effects of tofacitinib combined with traditional disease modifying antirheumatic drugs(DMARDs)on peripheral blood IL-22,IL-23 and Th22 cell subsets in patients with rheumatoid arthritis(RA).Methods:Retrospec-tive analysis of clinical data of 100 RA patients admitted to Xingtai People's Hospital from December 2022 to December 2024.Patients were divided into conventional group(n=33,treated with traditional DMARDs),single group(n=34,treated with tofacitinib)and combination group(n=33,treated with tofacitinib combined with traditional DMARDs)by random number table method.Serum IL-22 and IL-23 levels,Th22 cell subsets proportion,recovery of joint function,disease improvement and adverse reactions were compared in three group.Results:After 3 months of treatment,IL-22,IL-23 and Th22 cell subsets proportion in three groups were decreased compared to before treatment,and combination group was significantly lower than conventional group and single group(P<0.05);levels of anti-CCP and RF in three groups were decreased compared to before treatment,and combined group was significantly lower than conventional group and single group(P<0.05);joint swelling frequency,number of tender joints,morning stiffness time and VAS scores in three groups were decreased compared to before treatment,and combination group was significantly lower than conven-tional group and single group(P<0.05);DAS28 scores and HAQ scores of three groups were decreased compared to before treatment,and combined group was significantly lower than conventional group and single group(P<0.05);there was no statistically significant difference in incidence of adverse reactions among three groups during treatment period(Z=0.290,P=0.865).Conclusion:Clinical effect of tofacitinib combined with traditional DMARDs in treatment of RA is significant,which can effectively reduce serum IL-22,IL-23 and autoantibodies levels,regulate Th22 cell subsets proportion,alleviate inflammatory reactions,and improve joint function.