Study On The Distribution And Influencing Factors Of TCM Syndrome Types In Rheumatoid Arthriti

Objective:The purpose of this study was to explore the incidence of frailty in RA patients by collecting clinical data of rheumatoid arthritis patients who visited the outpatient or ward of the Department of Rheumatology,Guang’an men Hospital,Chinese Academy of Chinese Medical Sciences,and analyze the relationship between the level of frailty and the general condition of patients,TCM symptoms,disease activity,laboratory indicators and joint ultrasound,so as to provide ideas for clinical identification and treatment of patients with RA.Method:According to the inclusion criteria,RA patients who visited the Department of Rheumatology of Guang,an men Hospital of China Academy of Chinese Medical Sciences from October 2020 to February 2023 were screened.Evaluation of the patient’s level of frailty using the FRAIL scale;Refer to the "Guidelines for Integrated Diagnosis and Treatment of Rheumatoid Arthritis Symptoms(2017)" to conduct TCM differentiation for patients;The general information,symptoms and signs,laboratory indicators,joint ultrasound and other clinical data of patients were collected,and statistical analysis was performed using SPSS Statistics 26.0 software and R software.Result:1 General Information and Frailty Level(1)Frailty level:A total of 613 RA patients were included in this study.According to the FRAIL questionnaire evaluation results,there were 58 patients in the frail group,409 in the pre-frail group,and 146 in the non-frail group,with occurrence rates of 9.46%,66.72%,and 23.82%,respectively.(2)Age:The age of the included patients ranged from 19 to 91 years old,with a median age of 60(51,67)years old.The older the patient,the higher the level of frailty(P<0.05),and there were statistically significant differences between the three groups when comparing pairwise.(3)Gender:501 female patients and 112 male patients were included in the study,with no statistically significant differences in gender ratio between the three groups(P>0.05).(4)Body Mass Index(BMI):56.56%of the included patients had normal weight,25.36%were overweight,11.08%had low body weight,and 6.9%were obese.The median BMI of the three groups of patients showed no statistical difference.(5)Disease history and personal history:The included patients had a disease course ranging from 1 month to 51 years,with a median course of 8(2,15)years,and there were no statistically significant differences in the disease course between the three groups(P>0.05).There were also no statistically significant differences between the three groups regarding smoking history and alcohol consumption history(P>0.05).(6)Comorbidities:The included patients had respiratory system diseases>hypertension>cardiovascular diseases>diabetes>digestive system diseases>thyroid diseases>cerebrovascular diseases>urinary system diseases>malignant tumors.Among respiratory system diseases,secondary interstitial lung disease>bronchiectasis>chronic obstructive pulmonary disease>chronic bronchitis were most common.Among cardiovascular system diseases,arrhythmia>coronary heart disease>hypertension heart disease were most common.Among digestive system diseases,erosive gastritis>gastric ulcer>atrophic gastritis>gastrointestinal bleeding were most common.Among urinary system diseases,chronic renal insufficiency>nephrotic syndrome>chronic glomerulonephritis were most common.The incidence rates of secondary lung interstitial fibrosis,hypertension heart disease,and coronary heart disease differed significantly between the three groups(P<0.0001);the higher the level of frailty,the higher the incidence rate of these diseases.The incidence rates of bronchiectasis and chronic bronchitis were higher in the frail and pre-frail groups than in the non-frail group(P<0.05),and the incidence rate of chronic obstructive pulmonary disease was higher in the pre-frail group than in the non-frail group(P<0.05).2 Frailty and Traditional Chinese Medicine Syndrome Types2.1 Distribution of TCM Syndrome Types in RA PatientsThe distribution of TCM syndrome types in the included patients was as follows:Damp-heat obstructing collaterals pattern>Qi and Yin deficiency pattern>Phlegm and stasis obstructing collaterals pattern>Liver and kidney deficiency pattern>Qi and blood deficiency pattern>Rheumatism obstructing collaterals pattern>Cold and dampness obstructing collaterals pattern>Stasis obstructing collaterals pattern.2.2 Distribution Patterns of TCM Pattern Types in Different Levels of FrailtyThe percentage of each syndrome type in the debility group was as follows:Damp-heat obstructing collaterals pattern>Qi and Yin deficiency pattern=Liver and kidney deficiency pattern.The percentage of each syndrome type in the pre-debility group was as follows:Damp-heat obstructing collaterals pattern>Qi and Yin deficiency pattern>Phlegm and stasis obstructing collaterals pattern.The percentage of each syndrome type in the non-debility group was as follows:Damp-heat obstructing collaterals pattern>Qi and Yin deficiency pattern>Phlegm and stasis obstructing collaterals pattern.The percentage of Damp-heat obstructing collaterals pattern in the debility group was lower than that in the pre-debility group(P<0.0001),and the percentage of Liver and kidney deficiency pattern was higher than that in the pre-debility group and the non-debility group(P<0.0001).There was no statistically significant difference in the distribution of other pattern types among the three groups(P>0.05).When dividing the eight pattern types into deficiency pattern and excess pattern,it was found that the higher the level of debility,the greater the percentage of deficiency pattern(P<0.01).3 The Relationship Between RA Frailty and Symptoms and Signs of RAThe number of tender joint count(TJC)in the debility group and pre-debility group was higher than that in the non-debility group(P<0.001,P<0.001).The pain visual analogue scale(VAS)score in the debility group and pre-debility group was higher than that in the nondebility group(P<0.05,P<0.05).There was no statistically significant difference in the swollen joint count(SJC)among the three groups(P>0.05).4 The Relationship Between RA Frailty and Disease ActivityThe incidence of frailty in RA patients with different disease activity levels was different(P<0.001),and there was a weak correlation between disease activity and frailty level(P<0.001).The higher the level of debility,the higher the disease activity.5 The relationship between RA Frailty and laboratory indicators.5.1 Relationship between RA attenuation and inflammation and immune indicatorsThere were differences in the positivity rates of ESR,CRP,IgM,C3,and anti-keratin antibody(AKA)among patients with different degrees of attenuation(P values were all<0.05).Patients in the frailty group and the pre-frailty group had higher levels of CRP than those in the non-frailty group(P<0.001,P<0.001).Patients in the frailty group and the prefrailty group had higher levels of ESR than those in the non-frailty group(P<0.001,P<0.001).The C3 level in the frailty group was lower than that in the pre-frailty group(P=0.015).The positivity rates of AKA in the frailty group and the pre-frailty group were higher than that in the non-frailty group(P<0.016,P<0.016).The IgM level in the frailty group was lower than that in the non-frailty group(P=0.011).There was no statistically significant difference in the levels of complement C4,IgG,IgA,anti-cyclic citrullinated peptide antibodies,and anti-nuclear factor antibodies among the three groups(P>0.05).The abnormality rate of IL-10 in the frailty group was higher than that in the pre-frailty group(P=0.038),and the abnormality rate of TNF-α in the frailty group was higher than that in the prefrailty group and the non-frailty group(P<0.016).There was no statistically significant difference in the levels of IL-6,IL-8,IL-1β,and IL-2 among the different frailty groups.5.2 Relationship between RA Frailty and Blood Routine,Biochemical Indexes,and Iron MetabolismThere were differences in HGB,TP,and Alb among the three groups of RA patients(P values were all<0.05).The HGB level of frailty group was lower than that of non-frailty group(P<0.001).The TP level of frailty group was higher than that of non-frailty group(P=0.003<0.001);the TP level of pre-frailty group was also higher than that of non-frailty group(P=0.015).The Alb level of frailty group was lower than that of non-frailty group(P=0.002);the Alb level of pre-frailty group was also lower than that of non-frailty group(P<0.001).There were differences in total iron binding capacity,occurrence rate of low values of transferrin,and occurrence rate of low values of serum iron among the three groups of RA patients(P values were all<0.05).There were statistically significant differences in pairwise comparisons of total iron binding capacity among the three groups,and the greater the degree of deterioration,the poorer the total iron binding capacity.6 The Relationship between RA Frailty and Szkudlarek Grading of Joint UltrasoundThere is a significant statistical difference in bone erosion grading among patients with different levels of deterioration(P=0.002).The proportion of patients with bone erosion grading of 0 in the deterioration group is significantly lower than that in the early deterioration group(P<0.001)and the non-deterioration group(P<0.001),whereas the proportion of patients with bone erosion grading of 3 in the deterioration group is significantly higher than that in the early deterioration group(P<0.016)and the nondeterioration group(P<0.016).The Cramer’s V correlation coefficient shows a weak correlation between the two(P=0.002).There is a difference in the distribution of synovial blood flow grading among patients with different levels of deterioration(P=0.039).The proportion of patients with synovial blood flow grading of 0 in the deterioration group is significantly higher than that in the early deterioration group(P<0.016),while the proportion of patients with synovial blood flow grading of 1 in the deterioration group is significantly lower than that in the non-deterioration group(P<0.016)and the early deterioration group(P<0.016).The Cramer’s V correlation coefficient shows a weak correlation between the two(P=0.039).There is no significant difference in synovial hyperplasia grading and joint effusion grading among patients with different levels of deterioration(P>0.05 for both).7 Logistic regression analysis of RA patients with frailtyMulti-factor logistics regression analysis showed that age,ESR,female gender,respiratory system disease,diabetes,hypertension,and cardiovascular disease were independent risk factors for frailty in RA patients in this study.This means that advanced age,female gender,respiratory system disease,diabetes,hypertension,and cardiovascular disease are independent risk factors for frailty in RA patients;high albumin level is an independent protective factor for frailty in RA patients.Conclusion1 The incidence of frailty in our hospital is 9.46%,while the pre-frailty incidence is 66.72%.2 Differences exist among RA frailty patients with varying levels of disease activity,as measured by age,gender,certain inflammatory markers and hematological indicators,disease activity,and Szkudlarek grading on joint ultrasound.3 Among frail patients,the most common traditional Chinese medicine pattern is damp-heat impediment(31.0%),followed by Qi-yin deficiency pattern(17.2%)and liver-kidney insufficiency pattern(17.2%).Among pre-frail patients,damp-heat impediment pattern is the most common(45.2%),followed by Qi-yin deficiency pattern(20.3%)and phlegm-blood impediment pattern(7.3%).4 The higher the degree of frailty in RA patients,the greater the proportion of virtual syndrome types(such as Qi-blood deficiency syndrome,Qi-yin deficiency syndrome,and liver-kidney insufficiency syndrome)identified.5 Advanced age,female gender,respiratory diseases,diabetes,hypertension,and cardiovascular diseases are independent risk factors for frailty in RA patients;while high level of albumin is an independent protective factor for frailty in RA.