Study On Relationship Between TCM Syndrome Type And Secondary Osteoporosis Of Rheumatoid Arthritis

Objective：Through observing the osteoporosis(OP) in rheumatoid arthritis(RA)patients of different TCM syndrome type,the relevance and pathogenesis was studied,andto provide evidence for syndrome differentiation and treatment. Methods：122RA patients’and30healthy subjects’ lumbar vertebrae and femur neck bone mineral density(BMD) wasmeasured by dual energy x-ray absorptiometry,and the bone biochemical index,such asserum calcium(Ca),serum phosphorus(P),N-terminal mid fragment of osteocalcin(OCN-Mid) and alkaline phosphatase(ALP).Measuring RA patients’ rheumatoidfactor(RF),anti-cyclic cit-rullinated peptide antibody(CCP),erythrocyte sedimentationrate(ESR),c-reactive protein(CRP) and joint function,X-ray stage,all results were analyzedand compared by SPSS19.0statistical software. Results：1. The incidence of osteoporosisor bone mass loss in RA patients was31.97%,29.51%,while the data in the healthy subjectswas3.33%,3.33%.The BMD of lumbar vertebrae and femur neck in RA patients wassignificantly lower than the healthy subjects(P<0.01);compareing with healthy subjects,theBMD of joint fuction gradingⅡⅢⅣand X-ray stagingⅡⅢⅣ in RA patients decreasedsignificantly(P<0.01),while there was no significant difference between the two groupswith joint fuction gradingⅠand X-ray stagingⅠ(P>0.05).There was negative correlationbetween the BMD of lumbar vertebrae or femur neck in RA patients and age,course,RF,ESR,CRP,DAS28, joint fuction grade,X-ray stage.2. The OCN-Mid level of RA patientswas higher than the healthy subjects(P<0.01),it shows positive correlation with ESR,CRPand DAS28,no correlation exists between OCN-Mid level and some general factors such asgender,age etc,or some immune biochemical index such as RF,Ca etc.3. The distribution ofsymptom type as follows:Damp-heat resistance, Damp-cold resistance, simultaneous occurrence of cold and heat syndrome,sputum with blood stasis type and deficiency of theliver and kidney type respectively accounts for31.15%,15.57%,13.93%,18.03%,21.31%.Sputum with blood stasis type and deficiency of the liver and kidney type,of which thecourse was longer than the other symptom types(P<0.05),also had a higher incidence ofosteoporosis or bone mass loss(P<0.01).The BMD of femur neck in the five syndrometypes was lower than the healthy subjects(P<0.01). The BMD of lumbar vertebrae inDamp-heat resistance, sputum with blood stasis type and deficiency of the liver and kidneytype was lower than the healthy subjects(P<0.01).No correlation was observed betweenTCM syndrome type and OCN-Mid,ALP,Ca,P,RF,CCP,ESR,CRP,DAS28(P>0.05),but hadsignificant correlation between syndrome type and joint fuction grade,X-ray stage,thespearman correlation coefficient was:0.338,0.314.Comparing with the other syndrometypes,the sputum with blood stasis type and deficiency of the liver and kidney type whichbeing seen more in advanced joint fuction and X-ray stage(P<0.01). Conclusion：1. Therewas significant correlation between RA and OP.2. Among the five syndrome types, thesputum with blood stasis type and deficiency of the liver and kidney type had more seriousincidence of bone loss and higher incidence of OP.3.In early stage,Damp-heat resistance,Damp-cold resistance, simultaneous occurrence of cold and heat syndrome is mainlyinduced by pathogenic toxin,the deficiency of the liver and kidney is not obvious,removing toxic materials ought to be the mainly therapeutic principle;in intermediate andadvanced stage, it is more seirous in deficiency of liver and kidney for the sputum withblood stasis type and deficiency of the liver and kidney type,the treatment is not onlyremoving toxic materials but nourishing liver and kidney should be more important.