Analysis Of The Clinical Characteristics And The Distribution Of TCM Syndromes Of Senile Rheumatoid Arthritis

Objective:This study performed a statistical analysis of clinical programs in patients with rheumatoid arthritis(RA)of different ages,summarized the clinical characteristics of senile rheumatoid arthritis(SRA)patients,and explore the distribution of TCM syndromes in various clinical indicators of SRA patients,so as to improve the understanding of Chinese and western medicine of the SRA and to provide certain basis and reference for clinical differentiation of TCM.Method:A medical record collection form was prepared,The clinically relevant information of RA patients who were diagnosed and hospitalized in the outpatient clinic of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 2017 to November 2018 was collected.413 RA patients who met the inclusion criteria were divided according to age and age of onset.There were three groups,namely:senile rheumatoid arthritis(SRA)group:(1)elderly onset senile rheumatoid arthritis(EOSRA)group,(2)younger onset senile rheumatoid arthritis(YOSRA)group;and young and middle-aged rheumatoid arthritis(MRA)group.Through the comparative analysis of the three groups of patients in various clinical projects and the differences in clinical indicators between different syndrome types in the elderly patients,the clinical characteristics of SRA and the syndrome pattern of TCM were discussed.Result:1.Clinical features:(1)general information:The mean duration of disease in the EOSRA group,the YOSRA group and the MRA group was4.90±4.64,17.61±11.77,and 8.71±8.29 years,respectively.There were significant differences in the gender composition ratio between the three groups of patients,which were 1:1.95,1:4.39,1:4.69(P<0.01).(2)clinical manifestation:The proportion of the first joint between shoulder and knee joint in the EOSRA group was higher than in the other two groups(P<0.05).The proportion of the first joint between the proximal interphalangeal joint and the metacarpophalangeal joint in the YOSRA group and the MRA group was higher than that in the EOSRA group(P<0.05).The number of joint tenderness in the YOSRA group was higher than that in the MRA group(P<0.01),and the DAS28 score in the SRA group was higher than that in the MRA group(P<0.05).There were no significant differences in the morning stiffness time and joint swelling between the three groups.The proportion of patients with interstitial lung disease in the EOSRA group was higher than that in the MRA group(P<0.05).(3)laboratory indicators:The positive rate of CCP in EOSRA group was higher than that in MRA group(P<0.05).There was no significant difference in RF positive rate among the three groups.Patients in the SRA group had higher Ig A level than the MRA group(P<0.01 or P<0.05).The levels of TG and TC in the YOSRA group were higher than those in the MRA group(P<0.05).The TC level in the EOSRA group was higher than that in the MRA group(P<0.05),and the FT3 level was lower than that in the MRA group(P<0.05).There were no significant differences in RF and CCP titers,ESR,CRP,Ig G,Ig M,PLT,Hb,FT4 and TSH levels among the three groups.(4)hormone therapy and classification of joint function:The use of glucocorticoids in the three groups was statistically different(P<0.05).The proportion of hormones in the SRA group was significantly higher than that in the MRA group.There were significant differences in the classification of joint function between the three groups(P<0.01).The grades of joint function in the SRA group were mainly grade Ⅱ and grade Ⅲ.The grades of joint function in the MRA group were mainly grade Ⅰ and grade Ⅱ.2.Syndrome pattern:(1)distribution of syndrome type:There was a statistically significant difference in the overall syndrome distribution between the three groups(P<0.01).In the EOSRA group,the number of patients with liver and kidney deficiency was the highest;in the YOSRA group,the number of patients with sputum resistance syndrome was the highest;in the MRA group,the number of patients with the damp-heat block syndrome was the most.(2)distribution of syndrome type and general data and clinical manifestations:There was no significant difference in the distribution of gender and disease duration among patients in SRA group.There was no significant difference,such as distribution of morning stiffness,joint swelling,joint tenderness and DAS28 scores,in the SRA group.The distribution of syndrome types in patients with YOSRA was associated with interstitial lung disease(P<0.05).The distribution of syndromes in EOSRA patients was not associated with interstitial lung disease.(3)distribution of syndrome types and laboratory indicators:There were differences in the distribution of CRP,Ig G and Ig A in the EOSRA group(P<0.05).There was no significant difference in the distribution of ESR,RF,CCP and Ig M.There was significant difference in the distribution of ESR between the YOSRA patients(P<0.05).There was no significant difference in the distribution of CRP,RF,CCP,Ig G,Ig M and Ig A.There were significant differences in the distribution of TG and TC in the EOSRA group(P<0.05 or P<0.01).There was no significant difference in the distribution of PLT,Hb,FT3,FT4 and TSH.There was no significant difference in the distribution of each syndrome in the YOSRA group on PLT,Hb,TG,TC,FT3,FT4,TSH.(4)distribution of syndrome type and hormone therapy and classification of joint function:The distribution of each syndrome type in EOSRA group was related to the use of hormone therapy(P<0.05).The distribution of each syndrome type in patients with YOSRA was irrelevant to the use of hormone therapy.There was no significant difference about joint function grading in the distribution of TCM syndromesof the SRA group.Conclusion:1.Clinical features:Patients with SRA have higher levels of disease activity,higher Ig A levels,and more glucocorticoid therapy.The grades of joint function are mainly grade Ⅱ and Ⅲ.Among them,the proportion of males and females in the EOSRA group tends to be balanced.Most of the joints such as shoulders and knees are the first joints.The positive rate of CCP is higher,and it is easier to merge with interstitial lung disease.2.Syndrome pattern:The syndrome type of EOSRA group is more common in liver and kidney deficiency syndrome.The CRP level of damp-heat syndrome is the highest;the increase of blood lipid level is more common than that of deficiency syndrome.The TG level of liver-kidney deficiency syndrome is the highest,and the TC level of qi-blood deficiency syndrome is the highest.Most patients with glucocorticoid therapy have sputum resistance syndrome.The syndrome type of YOSRA group is more common in sputum resistance syndrome,and the ESR level of the damp-heat block is higher.