Study Of Observation On Curative Effect Of Duanteng Yimu Decoction On Rheumatoid Arthritis In Middle And Old Age Based On Bone Metabolism Level

Rheumatoid arthritis is an autoimmune inflammatory joint disease of unknown etiology,involving the small and medium joints of the whole body.Joint swelling and pain caused by joint synovial hyperplasia,eventually leading to bone destruction and joint dysfunction is its main clinical manifestation.A chronic disabling disease that seriously affects the quality of life of patients.Patients with rheumatoid arthritis have abnormal bone metabolism destruction.Rheumatoid arthritis belongs to the category of Bi syndrome in traditional Chinese medicine.Tendon injury and bone damage is an important pathological change of Bi syndrome.Duanteng Yimu Decoction is a clinical prescription for treating Rheumatoid arthritis,in which Kunming crabapple eliminates wind and dampness,dredges collaterals and relieves pain,which is a monarch medicine,and it can also antagonize the reproductive toxicity of monarch medicine to achieve the purpose of synergism and detoxification.The whole decoction plays the role of tonifying liver and kidney,dispelling wind and removing dampness,dispersing blood stasis and dredging collaterals.ObjectiveIn this study,we observed the improvement of bone metabolism and bone mineral density and the therapeutic effect of middle-aged and elderly RA patients during the 24-week course of treatment with Duan Teng Yi Mu Decoction,analyzed the laboratory indexes comprehensively,explored the mechanism of its improvement of bone metabolism and bone protection in RA patients,and regularly observed the blood system and blood system of patients.The drug safety information of liver and kidney function provides more theoretical basis for the clinical application of Duan Teng Yimu Decoction in the treatment of RA.Methods61 cases of rheumatoid arthritis in middle and old age were collected according to the inclusion criteria and exclusion criteria.The experimental group was treated with Duan Teng Yimu decoction,while the control group was treated with methotrexate tablets,10 mg each time,once per week.The control group and the experimental group were treated for 24 weeks.Serum ESR and CRP levels were measured at baseline,6th week,12th week and 24th week respectively.The serum levels of CTX-I and P I NP were measured at baseline and 24 weeks after admission.Bone mineral density(BMD)in L1-4 region was measured by Dual-energy X-ray absorptiometry,and T-Score(T value)and Z-Score(Z value)were calculated by formula.Cytokine IL-17,TNF-a,IL-6 and IL-1 levels as well as anti CCP levels.During the course of treatment,the safety indexes of the patients were closely observed and measured,including:the general vital signs of the subjects:blood pressure,heart rate,respiration,skin and mucosa and digestive tract reactions;the detection indexes included routine blood test and liver and kidney function test.The patients with RA were divided into kidney deficiency syndrome and non-kidney deficiency syndrome.The patients with kidney deficiency syndrome were grouped to compare the improvement of TCM syndrome,bone metabolism index and bone mineral density.ResultsThis study found that Duan Teng Yi Mu Decoction can reduce the level of CTX-I in RA patients,compared with MTX group,the difference was statistically significant.Duan Teng Yi Mu Decoction can increase the level of P I NP,compared with MTX group,the difference was not statistically significant.It is concluded that Duan Teng Yi Mu Decoction is superior to MTX in improving bone resorption index of RA,and is equivalent to MTX in improving bone destruction index of RA.The effect of Duan Teng Yi Mu Decoction on regulating bone metabolism CTX-I/P I NP ratio is better than MTX.The value of BMD,Z-score and T-score did not show any difference between the two groups after treatment,but the BMD of Duan Teng Yimu Decoction group was better than that of MTX control group.The results showed that Duan Teng Yi Mu Decoction may affect bone balance by reducing local arthritis and improving systemic bone metabolism,but it is better than MTX in improving systemic bone metabolism.Duanteng Yimu Decoction can improve the DAS28 score of RA patients,the curative effect is better than MTX.In improving the level of joint tenderness of RA patients,the curative effect of Duanteng Yimu Decoction is significantly better than MTX.In improving the level of joint swelling and pain of RA patients,the curative effect of Duanteng Yimu Decoction is quite with MTX.Duanteng Yimu Decoction can reduce the level of ESR and CRP of RA patients,and the curative effect is similar to MTX.The level of serum anti-CCP in both groups decreased before and after treatment,but there was no significant difference between the two groups.So it could not be explained that Duantong Yimu Decoction could improve the level of anti-CCP.The levels of IL-17,TNF-a,IL-6 and IL-1 in the two groups decreased significantly after treatment,and the levels of inflammatory cytokines improved significantly after treatment.The improvement of TNF-a and IL-6 was better than that with MTX group,and the difference was statistically significant,-which suggesting that Duantong Yimu Decoction was better than MTX in reducing some inflammatory factors.Comparing the improvement of TCM syndrome,bone metabolism index and bone mineral density between the two groups of RA patients with kidney deficiency syndrome,it was found that Duan Teng Yimu Decoction was better than MTX in the improvement of TCM syndrome of middle-aged and elderly RA patients with kidney deficiency syndrome during the course of 24 weeks.Duan Teng Yimu Decoction has a significant improvement effect on bone metabolism index CTX-I level,P I NP level and CTX-I/P I NP ratio of RA patients with kidney deficiency syndrome during the course of 24 weeks.The effect is better than MTX,the difference is statistically significant.Duan Teng Yi Mu Decoction can significantly improve the BMD level of RA patients with kidney deficiency syndrome,its effect is better than MTX,the difference is statistically significant,analysis of the reasons in addition to Kunming Begonia anti-rheumatic,improve the disease,maybe Duan Teng Yi Mu Decoction and Leonurus can fit the kidney deficiency pathogenesis of elderly RA patients,can improve bone balance.It is also suggested that the application of Kunming Begonia as the main drug in the treatment of RA should be combined with syndrome differentiation to improve the curative effect.The study of drug safety analysis,two groups of patients did not appear serious adverse reactions in the blood system,there is a case of control group patients with slightly elevated transaminase,two groups of patients with renal function tests showed no significant abnormalities.Some patients had adverse reactions such as epigastric discomfort and pruritus.There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).ConclusionDuanTeng Yimu Decoction can effectively improve the activity of RA patients,improve the symptoms of joint tenderness and swelling,reduce the level of inflammation,improve the bone balance of RA patients,improve the level of bone mineral density,and then prevent RA osteoporosis,reduce the incidence of osteoporotic fracture.Among them,the improvement of bone metabolism index and bone mineral density in RA patients with kidney deficiency syndrome is more significant,which may be related to the main pathogenesis of traditional Chinese medicine in middle-aged and elderly patients with rheumatoid arthritis.The innovation of this topic are:1.To choose the middle-aged and elderly patients with kidney deficiency syndrome as the research object,and study the effect of DuanTeng Yimu Decoction on bone metabolism of RA patients with kidney deficiency and non-kidney deficiency,explore the significance of DuanTeng Yimu Decoction and the advantages of syndrome differentiation.The results showed that DuanTeng Yimu Decoction was more effective in improving bone balance of patients with kidney deficiency type,suggesting that the combination of Kunming Begonia and Leonurus heterophyllus was more suitable for the pathogenesis of middle and old-aged patients with kidney deficiency type,and suggesting that the special prescription combined with syndrome differentiation treatment had more advantages.2.To observe the effect of DuanTeng YiMu Decoction on bone metabolism in RA patients,the ratio of CTX-I,P-I NP and CTX-I/P-I NP were combined with bone mineral density.The results showed that DuanTeng Yimu Decoction was superior to MTX in improving bone metabolism,suggesting that DuanTeng Yimu Decoction could not only improve bone balance by controlling local joint inflammation and bone destruction,but also affect bone balance by improving bone metabolism of the whole body.3.To observe the curative effect of Duan Teng Yi Mu Decoction in treating RA in middle and old-aged patients with multiple inflammatory factors IL-17,TNF-α,IL-6 and DAS28.Results The improvement degree of DAS28,TNF-a and IL-6 in Duan Teng Yi Mu Decoction group was better than that in MTX group,indicating that Duan Teng Yi Mu Decoction had a definite therapeutic effect on RA.