Study On The Correlation Between Coagulation / Fibrinolysis Index And TCM Syndromes And Disease Activity Of Rheumatoid Arthritis Based On DAS28 And CDAI

[Objective](1) Through detection of common oagulation/fibrinolysis indicators of rheumatoid arthritis(RA) patients, observe the differences of RA hypercoagulation between different TCM syndrome types,and analysis relevance between abnormal coagulation/fibrinolysis in RA and traditional TCM pathogen like"heat, dampness, blood stasis, kidney deficiency".(2)Evaluate the correlation between coagulation/fibrinolysis indicators of RA patients and disease activity,and compare the correlation with ESR and CPR,which is used as the most commonly accepted inflammation indicator of active RA, explore new monitoring indicators of active RA.(3) Compare the difference of RA activities evaluated by the two common evaluation methods,DAS28 and CDAI,and analyze the possible reasons.[Methods] Screened RA patients and healthy subjects in Dongzhimen hospital, Xiyuan hospital. All the patients and healthy subjects wih informed consent were instructed toprovide general information and send the morning fasting venous blood specimens to the clinical laboratory in Xiyuan hospital to detecting the common coagulation/fibrinolysis indicators(DD, Fbg, PT, APTT) and platelet parameters(PLT, MPV). Additionally, the RA patients were also guided to detect ESR, CRP, RF, and fill out the clinical data form, TCM syndrome types questionnaire, and was classified by TCM syndrome types. Finally we analyzed the statistics about all the collected datew.[Results]1. Bssic information:209 cases with RA were collected into the study,ages 26 to 69 years old, mean age 54.23±10.83 years.There were 51 cases of men whose mean age was 58.69±9.62 years old and 158 cases of women whose mean age was 52.80±10.83 years old.There were 60 cases with joint deformities in total, accounting for 28.7% of all cases, including 14 male patients and 46 female patients.There was no statistical difference between percentage of deformity in male and female. There were 122 patients who taking DMARDs drugs regularly in the past year, accounting for 58.4% of the total, and percentage of deformity in patients with DMARDs drugs regularly(22.1%) was less than the patients who were not regular medication (38.1%).Methotrexate was the most commonly used DMARDs, closely followed by leflunomide.There were only a small number of patients who took Sulfasalazine, Hydroxychloroquine or other DMARDs.However,there were more elderly patients choosing tripterygium Tripterygium Glucosides as long-term oral drugs.2. Distribution of TCM syndrome types:damp-heat stagnation was the most commonly TCM syndrome type in all seven types.The follows from high to low was:damp-cold stagnation, yin deficiency and blood stasis, damp-heat and blood stasis, static blood blocking collaterals, liver-kidney-yin deficiency, yang deficiency cold of kidney. The frequency of all the syndrome factors from high to low in turn was:dampness, blood stasis, heat, Yin deficiency, cold, Yang deficiency.Besides, proportion of male patients in yang deficiency cold of kidney group was much higher than other types,and proportion of famale patients in yin deficiency and blood stasis group and liver-kidney-yin deficiency group were also much higher than other types.However, the distribution of TCM syndrometypes in different disease activity was no tstatistically significant.3. Correlations between coagulation/fibrinolysis indicators, platelet parameters and TCM syndrome types:Patients in sthenic syndromes like damp-heat and blood stasis, damp-heat stagnation, static blood blocking collaterals group had more higher levels of DD、Fbg、PLT than patients in asthenia syndromes like liver-kidney-yin deficiency and yang deficiency cold of kidney.There were no statistical differences in leves of PT,APTT,MPV between RA patients andhealthy subjects,also among all the TCM syndrome types.4.Correlations between disease activity and coagulation/fibrinolysis indicators and TCM syndrome types:Assessed by the DAS28, all the 209 RA patients were in active stage patients,including 120 cases of high activity,75 cases of medium activity and 14 cases of low activity.In all the TCM syndrome types, patients in damp-heat and blood stasis group had the highest disease activity.Disease activities in patients of yang deficiency cold of kidney group and liver-kidney-yin deficiency group were more lower than anyother types.There were significant positive correlations between DD, Fbg, PLT and DAS28,CRP,ESR.There were 161 RA cases who have a higher level of DD than normal, accounting for 77% of the total,and we found that DD had a higher sensitivity in diagnosis of active RA than ESR(74.2%)、CRP(75.6%), from which we can consider initially that DD could be a new monitoring indicator of active RA.5. Comparison of the RA active difference evaluated by DAS28 and CDAI:There were 51 RA cases who had different disease activities assessed by two methods.With a further analysis by multivariate linear regression,we considered that the difference exsisted might because doctors and patients often had different focus when they evaluated disease activity.RA patients were more focused on duration of morning stiffness and pain in joints,while doctors were more focused on swollen of joints,and sometimes they may pay attention to ESR or CRP.[Conclusions]1. Sthenic syndromes like damp-heat and blood stasis group, damp-heat stagnation group, static blood blocking collaterals are more common in active RA than asthenia syndromes like liver-kidney-yin deficiency and yang deficiency cold of kidney.Dampness, heat, blood stasis are three most important pathogenic factors to active RA.So we should Emphasize "eliminating pathogens" in clinical treatment.2. Coagulation/fibrinolysis indicators like DD, Fbg, PLT are higher in RA patients of sthenic syndromes like damp-heat and blood stasis, damp-heat stagnation, static blood blocking collaterals than patients of asthenia syndromes like liver-kidney-yin deficiency and yang deficiency cold of kidney,which indicates that sthenic pathogens like dampness, heat or blood stasis play critical roles in abnormality of Coagulation/fibrinolysis system and microcirculation. Besides, activation of Coagulation system is not exactly the same as the conception of "blood stasis" in TCM.3.Coagulation/fibrinolysis indicators like DD, Fbg have significant positive correlations with RA disease activity.Especially, DD has a high sensitivity in diagnosis of activity RA,which indicates DD could be a new monitoring indicator of active RA. Associated detection of DD,ESR,CRP may help improve the sensitivity of active RA diagnosis.4. Subjective factors of doctors and patients result to evaluation difference of DAS28 and CDAI,however,to our health workers and patients,CDAI is also a credible and more convenient evaluation method of RA disease activity.