Clinical Observation By Doppler Ultrasound On Duantengyimu Decoction Combined With Leflunomide In Treating Rheumatoid Arthritis

Objective1.Approach the therapeutic effect of Duanteng Yimu Decoction combined with leflunomide on rheumatoid arthritis.2.To evaluate the validity of Doppler ultrasonographic of diagnostic and the therapeutic effect evaluation in patients with rheumatoid arthritis.MethodsAccording to inclusion criteria,we collected 60 cases from rheumatology department of The First Affiliated hospital of Guangzhou University of Chinese Medicine.This 60 cases were equally randomized into treatment group and control group.The treatment group was treated with Duanteng Yimu decoction(tripterygium hypoglaucum hutch 45g,leonurus japonicus houtt 30g,dipsacus asper wall 15g,one dose per day)and leflunomide tables(20mg per day),the control group was treated with methotrexate tablets(10mg per week)and leflunomide tablets(20mg per day)for 12 weeks.Before and after treatment,observe and record the clinical symptoms,DAS-28,HAQ(Health Assessment Questionnaire)and ESR,CRP of each patient.All patients underwent Doppler ultrasonography assessment of 22 joints,including double wrist joint,bilateral MCP(metacarpophalangeal joint),bilateral PIP(proximal interphalangeal joint),to observe and record the thickness of pathological synovial hyperplasiathen、blood flow signal,bone erosion of each joint and calculate the total integral by semi-quantity method.Using the ACR20(American College of Rheumatology criteria for 20%)and DAS28 as effective evaluation criteria.Monitor adverse reactions during therapy process,asses the clinical efficacy and safety of two groups.ResultsBefore treatment,there were no significant differences in general clinical data of two groups including gender,age,course of disease,RA disease activity,joint function grading,all the datas above were comparable(P>0.05).Before treatment,the number of joints had US synovitis was more than clin ical synovitis(P<0.05).The score of pathological synovial hyperplasiathen and blood flow signal have a correlation with DAS28,ESR and CRP(r>0.04,P<0.05).After 12 weeks treatment,All the clinical indicators were significant improvement(P<0.05),there was no significant difference between the two groups(P<0.05).After 12 weeks treatment,the laboratory indicators(ESR,CRP)in both group had significant improvement,statistically significant difference.(P<0.05),and ESR of the treatment group were improved significantly than the control group(P<0.05).After 12 weeks treatment,ACR20 in the treatment group and the control group was 86.66%and 80.00%,there was no significant difference between two groups(P>0.05),compared to original level,the DAS28 had statistical significance in both groups,and there was no significant difference between total effective rate of DAS28 in the treatment group(83.33%)and control group(76.66%)(P>0.05).After 12 weeks treatment,the ultrasound indexes(pathological synovial hyperplasiathen,blood flow signal)in both group had significant improvement,statistically significant difference.(P<0.05),there was no statistically significant difference of bone erosion(P>0.05);blood flow signal score and pathological synovial hyperplasiathen score of the treatment group were improved significantly than the control group(P<0.05).Conclusions1.Duanteng Yimu decoction combined with leflunomide can effectively improve the joint function,relieve clinical symptoms,reduce inflammation index such as CRP and ESR,reduce the ultrasound indexes of RA patients.The efficacy was almost equal with MTX+LEF.Duanteng Yimu decoction is more effective in the aspect of improve ESR and the ultrasound indexes.2.DUS can detected subclinical synovitis in rheumatoid arthritis.The score of pathological synovial hyperplasiathen and blood flow signal has a significant correlation with the laboratory indicators and DAS28.DUS is a valid method to assess the effect of treatment in patients with rheumatoid arthritis.Combined ultrasonograpic examination with clinical and libratory examination results have important implications for Rheumatologist to evaluate the disease activity and to choose therapeutic option in patients with rheumatoid arthritis.