The Observation On Clinical Effects Of The Herb Fumigation And Steaming Therapy In The Treatment Of Rheumatoid Arthritis And The Relationship To The Heat Shock Protein 70

Objective:To evaluate the effect of the herb fumigation and steaming therapy in the treatment of rheumatoid arthritis(RA), and help to explain the clinical efficacy for RA, we observe the therapeutic effect and its adverse reactions of herbal fumigation and steaming for RA in clinic and for the adjuvant arthritis rat(AA), then test the inflammatory cytokines in blood and HSP70 expression changes in articular synovial of the rat. It will help to clarify the mechanism of the herb fumigation and steaming therapy for RA, provide the theoretical basis, innovate the theory, and play a role in TCM clinic better.Methods:Collect 36 patients with RA, hospitalized in the department of Traditional Chinese Medicine of General Hospital of Guangzhou Military Area Command of Chinese PLA from February,2009 to February,2010. The subjects were randomizedly divided into two groups, one treated with the conventional therapy, the other added-on the herb fumigation and steaming therapy. Afrer one course(20 days), we compare the changes of the patients' joint symptoms, signs, clinical symptoms, inflammatory index (erythrocyte sedimentation rate, C-reactive protein), Health Values Questionnaire (HAQ) and the safety risk(such as blood routine,liver and renal functions test,and electrocardiogram, et al) before and after treatment and between two groups.Establish the AA model in rats, then randomizedly divide into the normal group, the model group, the distilled water group, the low concentration of herb fumigation and steaming therapy group, the high concentration of herb fumigation and steaming therapy group and the western medicine group. The rats of the normal group and the model group had no treatment, the distilled water group, the low concentration of herb fumigation and steaming therapy group, the high concentration of herb fumigation and steaming therapy group treated with distilled water, low concentration of herb fumigation and steaming and high concentration of herb fumigation and steaming separately, the western medicine group treated with Votalin spray. Measure the rats' weight and the two swelling posterior limbs once two days. After one course(10 days), compare the chages of the rats' weight and the swelling posterior limbs, and observe the changes of the pathological joints, the expression of HSP70 in synovial tissue and cytokines IL-4, IL-10, IFN-γ, TNF-αin serum.Results:The herb fumigation and steaming therapy group (short for fumigation group) in the total efficiency and the improvement of the percentage of ACR70 was significantly higher than those of the none herb fumigation and steaming therapy group (short for non-fumigation group) (P＜0.01). Fumigation group serum C-reactive protein decreased significantly compared with non-fumigation group (P＜0.05). However, the changes of the joint symptoms, signs, symptoms of TCM, HAQ, ESR had no significant differences (P＞0.05). And the blood routine, liver and kidney function (ALT, AST, and Cr, BUN), urine routine and ECG also had no significant differences (P＞0.05).Animal experiments showed that fumigation could significantly improve the swelling paw and joint in AA rat, increase the weight of rats, and improve the physical conditions.It also significantly improves the ankle joints pathological changes, such as inflammatory cell infiltration, fibroblast prolifeRAtion and synovial cell hyperplasia. The herb fumigation and steaming therapy could induce HSP70 expression in synovial membrane, reduce pro-inflammatory cytokines TNF-α, IFN-γ, and increas anti-inflammatory cytokines IL-4, IL-10, so that reduce the IFN-γ+TNF-α/IL-4+IL-10 ratio. The high concentrations of herb fumigation and steaming therapy group was better than the the low concentration in increasing the rats'body weight, easing the feet swollen, inducing the HSP70 expression, and reducing the inflammatory cytokines levels and rising the anti-inflammatory cytokines levels (P＜0.05).It implied that the effect of the herb fumigation and steaming therapy is depend on the concentration of the herb. Conclusion:The herb fumigation and steaming therapy in the treatment of RA is effective and without significant additional safety risk. The anti-inflammatory mechanism is reached probably by inducing the expression of HSP70, increasing the levels of the anti-inflammatory cytokines IL-4, IL-10, reducing the levels of the inflammatory cytokines IFN-γ, TNF-α. And the heat in the steam may also be an important factor in anti-inflammatory. The effect of the herb fumigation and steaming therapy is related with the drug concentration.