Clinical Characterization Of Traditional Chinese Medicine Syndrome Types Of Rheumatoid Arthritis In Zhuji Area

Objective To analyze the clinical characteristics of Traditional Chinese Medicine(TCM)syndrome types in patients with rheumatoid arthritis in Zhuji area.Methods According to the inclusion and exclusion criteria of rheumatoid arthritis,300 patients with rheumatoid arthritis in Zhuji area were recruited.Questionnaire survey,clinical and demographical features including age,sex,occupation,disease duration,TCM-related pathological factors,TCM-related physique conditions,diagnosis of TCM syndrome types of rheumatoid arthritis,as well as the laboratory tests,including c-reactive protein and blood sedimentation,rheumatoid factor,anti CCP antibody,anti keratin antibodies were included in the current investigation.We analyzed the distribution of TCM syndrome types of rheumatoid arthritis and characterized the clinical features and pathological factors across TCM syndrome types.Symptoms,medical signs and syndromes,physical examination and other clinical data were acquired and collected by professional physicians,and laboratory data were analysed in standard protocol and retrieved.Variables with normal distribution were expressed as mean±standard deviation(x±s),and comparison between groups was analyzed by one-way analysis of variance.Variables with non-normal distribution were expressed as median and upper and lower quartiles,and comparison between groups was performed by Kruskal-Wallis H test.Categorical variables were expressed as ratio or percentage.Chi-square test was used for comparison between groups.Statistics were performed by using SPSS 22.0 software.Results 1.Demographic and clinical features:(1)233 were females and 67 were males.Male:Female=1:3.47.(2)The mean age of the patients was 51.4 years(standard deviation was 12.6),and the minimum age was 27 years old and the maximum age was 83 years old.(3)the average time window of disease duration was 9.49 years(standard deviation was 9.11),ranging from 0.5 to 40 years,and the proportion of patients with disease duration less than 5 years was the largest(n=155,51.7%).(4)Being in a humid environment for a long term,being exposed to cold and physical worn-out were the main causes of RA in this area.(5)Winter and spring were the seasons with high incidence of RA.(6)There were 106 patients with moderate/balanced TCM physique condition and 194 patients with unbalanced TCM physique condition,which was dominated with yang-deficiency.2.Differences of factors across the distribution of TCM syndrome types:(1)damp-heat obstruction syndrome(n=83,27.7%)and cold-dampness obstruction syndrome(n=78,26.0%)in 300 RA patients in Zhuji area.These two syndrome types were the most common,accounting for 53.7%.(2)There was no significant difference in the sex distribution of TCM syndrome types(P>0.05).(3)the TCM syndrome type distribution across different age groups had statistical significance(P<0.05);no patients aged younger than 40 years and older than 71 years were characterized with syndrome type of cold and sputum obstruction;patients aged between 31 and 70 were more frequently featured with syndrome types of cold and dampness obstruction and damp-heat obstruction;patients aged older than 71 were characterized with syndrome type of liver and kidney deficiency and qi and blood deficiency.(4)There was no significant difference in the distribution of TCM syndrome types regarding the duration of disease courses(P>0.05).However,the disease duration of RA was mainly concentrated in the less than 5-year group,accounting for 51.7%.Patients with disease duration less than 10 years are more commonly characterized with cold and dampness obstruction syndrome and dampness and heat obstruction syndrome.The proportion of liver and kidney deficiency syndrome increased significantly with the duration of RA disease,where it accounted for up to 50%in the group with 26-30 year disease duration.(5)There was no statistically significant difference in the distribution of TCM syndrome types in terms of the cause of onset and season(P>0.05).(6)The difference of TCM physique condition across TCM syndrome type distribution was statistically significant(P<0.05).The syndrome of cold and dampness obstruction accounted for up to 50%among the patients with yangdeficiency substance,and the syndrome of dampness and heat obstruction was the most common among the patients with damp-heat substance.Liver and kidney deficiency syndrome and damp-heat obstruction syndrome are more common in patients with yin deficiency.The syndrome of dampness-heat obstruction and the syndrome of qi and blood deficiency are more common in patients with qi deficiency.Patients with sputum and dampness have three syndromes:damp-heat obstruction syndrome,cold and dampness obstruction syndrome,sputum and stasis obstruction syndrome;The obstruction type was the mostly featured with qi stagnation and blood stasis.Patients with special physique condition were mainly characterized with deficiency syndrome type.(7)Damp-heat obstruction syndrome was more common with high ESR and CRP levels,and the differences of inflammatory markers of ESR and CRP across TCM syndrome types were statistically significant(P<0.05).(8)There were statistically significant differences of RF and anti-CCP antibody across TCM syndrome types(P<0.05).Qi-blood deficiency syndrome was often featured with high RF and anti-CCP antibody levels.However,there was no significant difference of anti-keratin antibody across the distribution of TCM syndrome types(P>0.05).Conclusion 1.Rheumatoid arthritis is more prevalent in females.2.The distribution of TCM syndromes of rheumatoid arthritis patients in Zhuji area from high to low was damp-heat obstruction syndrome,cold and dampness obstruction syndrome,liver and kidney deficiency syndrome,kidney deficiency and cold stagnation syndrome,coldness and heat mixed syndrome,qi and blood deficiency syndrome,sputum and blood stasis syndrome.3.Sex,duration of disease course,pathological factors,prone season and immune index anti-keratin antibodies showed no difference across the distribution of TCM syndrome types.4.There were significant differences in age,TCM physique condition,inflammatory markers ESR and CRP,and immune index RF,anti-CCP antibody levels across TCM syndrome types.5.Based on the investigation of the features and characteristic of TCM syndrome types of RA patients in Zhuji area,age,TCM physique condition,inflammatory markers ESR,CRP,and immune index RF,anti-CCP antibody shall be taken into consideration in the practice of differentiating TCM syndrome types.