| Objective:To observe the effect of the herb fumigation and steaming therapy on treating rheumatoid arthritis(RA) patients and adjuvant arthritis(AA) rats. Testing HSP70 expression in rat synovial and HSP70mRNA expression in human synovial to make an objective evaluation and clarify the mechanism of the herb fumigation and steaming therapy for RA.Methods:1. Clinical study:60 patients with RA who hospitalized in the department of Traditional Chinese Medicine of General Hospital of Guangzhou Military Area Command of Chinese PLA were collected from February,2009 to March,2011. The subjects were randomizedly divided into the herb fumigation and steaming therapy group (short for fumigation group) and the none herb fumigation and steaming therapy group(short for non-fumigation group). Patients in non-fumigation group were treated with the conventional therapy(Compound danshen injection 20ml ivdrip 1/day; Meloxicam7.5mg oral 1/day; Methotrexate10mg oral 1/w; TCM treatment). Patients in the other group were added the herb fumigation and steaming therapy on the basic of the conventional therapy. After one course(20 days) of treatment, we compared the changes of the patients' joint symptoms, signs, clinical symptoms, inflammatory index (erythrocyte sedimentation rate, C-reactive protein) and health values questionnaire (HAQ). Besides, safety index (blood routine, liver and renal functions and electrocardiogram) was also tested before and after treatment in both two groups.2. Experimental study:42 Wister SPF male rats were chosen to establish AA model in rats. Then randomizedly divide them into normal group, model group, distilled water group, low-concentration herb fumigation and steaming therapy group, high-concentration herb fumigation and steaming therapy group and western medicine group. Each group contained seven rats. Rats in the normal group and the model group received no treatment. Rats in the distilled water group, low- concentration herb fumigation and steaming therapy group, high-concentration herb fumigation and steaming therapy group were treated with distilled water, low-concentration herb fumigation and steaming and high-concentrationherb fumigation and steaming separately. Rats in the western medicine group were treated with Votalin spray. Weight of the rats and the two swelling posterior limbs were mesuared every other day. After one course(10 days) of treatment, weight and the swelling posterior limbs in different groups were compared and the expression of HSP70 in synovial tissue in different groups was also observed.3. Clinical research study:15 cases of the synovial tissue samples, getting from electronic needle mirror and arthroscopic surgery in the department of Traditional Chinese Medicine and Orthopaedic of General Hospital of Guangzhou Military Area Command of Chinese PLA were collected from March 1,2010 to October 1,2010. The involved patients included 10 patients with RA and 5 patients with non-traumatic arthritis.10 patients with RA were divided into two groups, one was the non-fumigation group, treated with the conventional therapy(Compound danshen injection20ml ivdrip 1/day; Meloxicam7.5mg oral 1/day; Methotrexate10mg oral 1/w; TCM treatment.), the other was fumigation group which was added-on the herb fumigation and steaming therapy on the basic of the conventional therapy.5 patients with non-traumatic arthritis had no treatment. After 10 days'treatment, the expression of HSP70mRNA in each group was tested with qRT-PCR. After 20 days' treatment, the patients'joint symptoms, signs, clinical symptoms, inflammatory index (erythrocyte sedimentation rate, C-reactive protein), health values questionnaire (HAQ) before and after treatment in each group were compared between fumigation group and non-fumigation group.Results:1.Clinical Research:After 20 days'treatment, the VAS pain scores, joint swelling, joint tenderness, the frequency of joint pain, morning stiffness duration, joint local temperature, joint flexion, TCM symptoms, HAQ, ESR and CRP in both two groups were significantly improved than before(P<0.01).The total efficiency and the improvement of the percentage of ACR70 in Fumigation group were significantly higher than the non-fumigation group(P<0.01). The patient's joint tenderness, the frequency of joint pain, morning stiffness duration and joint local temperature in Fumigation group were significantly improved than non-fumigation group (P<0.05). There were no significant differences in joint swelling and improvement of joint flexion (P>0.05). VAS scores in pain, symptoms of TCM, HAQ, ESR and CRP in the two groups were significant different (P<0.05). After one course of treatment, the blood routine, liver and kidney function (ALT, AST, and Cr, BUN), urine routine and ECG were retested and there were no no significant difference (P>0.05).2. Experimental study:The herb fumigation and steaming therapy could significantly improve the swelling paw and joint in AA rat, increase the weight of rats, and improve their physical conditions. The herb fumigation and steaming therapy could induce HSP70 expression in synovial membrane. The high-concentrations of fumigation group was better than the the low concentration and distilled water group in increasing the rats'body weight, easing the feet swollen, inducing the HSP70 expression (P<0.05). It implied that the effect of the herb fumigation and steaming therapy may depend on the concentration of the herb.3. Clinical research study:The expression of HSP70mRNA in synovium of RA patients was significantly higher than normal, the difference was significant (P<0.01), which implied that the expression of HSP70mRNA in synovium in patients with RA was higher. After treated with herb fumigation and steaming therapy, the expression of HSP70mRNA also increased as the change of clinical ACR20,50,70,VAS pain scores, symptoms in joint, HAQ and serum inflammation index.Conclusion:The herb fumigation and steaming therapy is effective in anti-inflammatory, relieving swelling and analgesic. The clinical efficacy and safety of the herb fumigation and steaming therapy was significant. The mechanism of anti-inflammatory is reached probably by inducing the expression of HSP70. The increased expression of HSP70 in RA patients and AA rat was important in the pathogenesis, which could be intervened and adjusted by the herb fumigation and steaming therapy. The heat of the steam may play a role in anti-inflammatory and relieving swelling. The effect of the herb fumigation and steaming therapy is related with the drug concentration.
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