Treatment Of Active Rheumatoid Arthritis By Huayu Tongbi Decoction

Rheumatoid arthritis(RA) belongs to the Bi-syndrome of the scope of Chinese medicine, The understanding of its pathogenesis is always linking to pathogenic factors and vital qi, and both of them can cause blood stasis, block meridian and joints, then lead to Bi-syndrome. Not only incunabula but also many specialist in modern times has discussed the important pathogenesis of blood stasis. In order to elucidate the pathogenesis of blood stasis in RA, our team had done many research, relating to literature research, clinical research, pharmacological research and mechanism research. Now, an overview is as follows.In literature research, by systematic review of incunabula and documentation we found that various etiology can cause blood stasis. Then the point "blood stasis is one of the basic pathogenesis of RA" is proposed. By analysis case reports we found that blood-activating herbs were widely used in treatment Bi-syndrome. In clinical research, we had carried out a number of clinical studies on the treatment of RA by blood-activating medicine (e. g. Dansheng, Huayu Tongbi Recipe), and had proved its efficacy and safety. In pharmacological research, it is proved that Dashen and other blood-activating drugs can not only inhibit the expression of blood stasis related molecular markers, e. g. VEGF, TxA2, but also the expression of a varirty of Pro inflammatory factors, such as IL-6 and TNF-a. In mechanism research, our team first addressed that the TxA2/COX-2 pathway is one of the important molecular basis of blood stasis syndrome of RA.Based on the above research conclusion, our team addressed the academic idea that blood stasis occurs in each phase of RA, and suggested that activating blood and resolving stasis should be used in RA. On the Inaugural Conference of the Specialty Committee on Immunology of Traditional Chinese Medicine of the World Federation of Chinese Medicine Societies cum the First Annual Meeting in October 2014 our team first time addressed Chinese herb DMARDS and Huayu Tongbi Recipe. Early a retrospective study had indicated that Huayu Tongbi Recipe combined MTX was one of effective treatment methods for treating RA, the efficacy was equivalent to that of LEF combined MTX, but with more stable therapeutic effects and lesser adverse reactions. But whether the combined treatment of traditional Chinese medicine(TCM) and western medicine(WM) has a high effect and safety still need more evidence. So the aim of this issue is to prove the advantages of combined treatment of TCM and WM through different aspects, including retrospective study, questionnaire and prospective study.Objective1. Through retrospective study of patients with RA, to evaluate the effect of integrated Chinese and Western medicine.2. To investigate the TCM constitution of patients with RA, and to analysis the constitution.3. To observe the therapeutic effect of methotrexate(MTX) combined with Huayu Tongbi Decocion in the treatment of active RA.Method1. Retrospective study:review the patients who visited the Outpatient Department of rheumatism and diagnosed with RA in January 2010 to November 2015, and divided into the pure western medicine group and western medicine regimen combination therapy group according to the treatment. Collected data before and 4-,12-weeks in the number of swollen joints, pain, inflammation index, and compared efficacy and advantages of the different groups.2. Physique investigation:formulated the scale according to the Constitution of TCM> (People’s Medical Publishing House,2005), then took the investigation method of questionnaire to have a idea of the physical distribution in RA.3. Prospective clinical study:According to the principle of open clinical trial, patients with RA were randomly divided into treatment group and control group. Treatment group was given MTX 10-15mg qw combined LEF 10mg bid, while control group was given MTX 10-15mg qw combined Huayu Tongbi Decoction. Both group courses are for 12 weeks, respectively, before treatment and after taking 4-,12-week follow-up, clinical assessment and records. To evaluate the clinical efficacy of MTX combined Huayu Tongbi Decoction.Results1. Retrospective study:This part of the study included a total of 80 patients with RA, including pure western medicine group (n= 24), western medicine regimen combination therapy group (n=56). The research results show that:pure western medicine scheme and the combination of Chinese traditional and Western medicine scheme can effectively improve the symptoms of patients with joint, signs, reduce inflammatory markers, and compared with those before the treatment, joints swelling, pain, ESR and CRP values were decreased significantly, the difference has statistical significance (P<0.05). During the treatment, the pure western medicine group appeared 2 patients with abnormal liver function. Western medicine regimen combination therapy group appeared 1 patient with allergic,1 cases of infection.2. Physique investigation:126 questionnaires were sent out, and the response questionnaires were 111. Analyzing the available questionnaires, the results showed that:the main TCM constitution of RA is Yang deficiency(42.3%) and blood stasis(27%), while there were 49%(23/47) with blood stasis in Yang deficiency.3. Prospective clinical study:Both therapies were effective for treating active RA with joint pain. In 4-,12-weeks, the joint pain, joint swelling, ESR, CRP, and DAS28, HAQ, VAS score were obviously improved, but there was no significant difference between 2 groups. Treatment group had no obvious adverse reaction, while the control group had 1 patient with abnormal liver function.Conclusion1. Retrospective study:western medicine regimen combination therapy can be effective in treating rheumatoid arthritis, and compared with the pure western medicine program was safer2. Physique investigation:Blood stasis is through with the disease development and blood stasis physique is one of the main physical performance in RA.3. Prospective clinical study:The MTX combined Huayu Tongbi Decoction can be effective in the treatment of active RA, and was equivalent to MTX combined LEF, with no serious adverse reactions occurred.The above research results showed, western medicine regimen combination therapy could achieve same effect with pure western medicine therapy, meanwhile reduced the occurrence of adverse reactions. This provided foundation for further optimization scheme. Physique investigation results suggested the importance of blood stasis in the development of RA. Clinical research provided this point, and the efficacy and safety of the optimization regimen.