Tehran University of Medical Sciences Iranian Journal of Allergy, Asthma and Immunology 1735-1502 0 0 2026 08 06 1 15 Li Zhang Department of Rheumatology, The Second Hospital of Lanzhou University, Lanzhou, Gansu, China Haili Shen The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China 2025 09 04 2026 04 24 Rheumatoid arthritis (RA) involves aberrant JAK-STAT signaling. Adalimumab suppresses inflammation but offers limited immune reconstitution. This retrospective study compared iguratimod+adalimumab versus adalimumab monotherapy in restoring immune function in RA patients. A total of 112 RA patients treated between March 2022 and March 2025 were included and divided into a control group (adalimumab) and a study group (iguratimod + adalimumab). Clinical data of patients were collected before and after 24 weeks of treatment, including laboratory indicators [tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP); T-lymphocyte subpopulations (CD4+, CD8+, CD4+ /CD8+ ratio)]; phosphorylated signal transducer and activator of transcription 3 (P-STAT3) levels; bone metabolism indicators osteocalcin N-terminal intermediate molecule (N-MID), total type I collagen amino-terminal prolongation peptide (T-P1NP), β-cross-linked C-telopeptide of type I collagen (β‑CTX); pain assessment; American College of Rheumatology 50% improvement criteria (ACR50) response rate; Fugl-Meyer Motor Function Assessment Scale (FMAS) score of upper and lower limbs; and incidence of adverse reactions. After treatment, serum TNF-α, IL-6, CRP levels, CD8+ T lymphocytes, β‑CTX, P-STAT3 levels, and pain assessment of patients in both groups were lower than those before treatment, and the study group was significantly lower; CD4+ T lymphocytes in the 2 groups, CD4+ /CD8+ ratio, N-MID, T-P1NP, limb function score upper and lower limb FMAS score, and ACR50 response rate after treatment were markedly higher in the study group. In conclusion, iguratimod combined with adalimumab synergistically inhibits the JAK-STAT pathway, significantly improving immune reconstitution and inflammation control in RA, with superior efficacy to adalimumab alone. https://ijaai.tums.ac.ir/index.php/ijaai/article/view/4574 https://ijaai.tums.ac.ir/index.php/ijaai/article/download/4574/2383