| OBJECTIVE:To clarify the efficacy?safety and advantages of Bu Shen Qu Han Zhi Wang Decoction combined with methotrexate in treating rheumatoid arthritis with kidney deficiency and cold syndrome.Observing the effect of Bu Shen Qu Han Zhi Wang Decoction on improvement of joint swelling in CIA rats,and the expression of tumor necrosis factor-a and matrix metalloproteinase-13 in articular cartilage and bone tissues.Exploring the mechanism of Bu Shen Qu Han Zhi Wang Decoction in inhibiting inflammation and reducing bone destruction,which provides an objective basis for the clinical use of Bu Shen Qu Han Zhi Wang Decoction.METHOD:1.Clinical study:A total of 51 rheumatoid arthritis patients from the Department of Chinese Medicine Rheumatology at the China-Japan Friendship Hospital between May 2016 and October 2017 were collected.According to 2:1 randomly divided into treatment group 34 cases and control group 17 cases.The treatment group was treated with Bu Shen Qu Han Zhi Wang Decoction combined with methotrexate,and the control group was treated with methotrexate.The course of treatment in the two groups was 12 weeks.The basic information including erythrocyte sedimentation rate(ESR)?C-reactive protein(CRP)?tender joint count(TJC)?swollen joint count(SJC)?disease activity of 28 joints(DAS28)?pain visual analogue score(VAS)?health quality of life questionnaire(HAQ)and TCM syndrome score of the two groups were recorded,analyzing the differences of before and after treatment in both groups and the response to ACR20 and ACR50.2.Experimental study:A total of 24 Sprague-Dawley rats were purchased.After adaptive feeding for 1 week,they were divided into blank group?model group?treatment group and control group according to the random number table.Except blank group,the remaining 3 groups were established a collagen-induced arthritis model.7 days after modeling,the rats were given treatment.The blank group and model group were given 10 ml/kg of distilled water,the control group was given MTX 10 ml/kg,and the treatment group was given 10 ml/kg of Bu Shen Qu Han Zhi Wang Decoction,once a day for 4 weeks.The weight and thickness of swelling knee joint were recorded weekly.After 4weeks of treatment,selecting the left hind ankle joint to testing the expression of TNF-? and MMP-13 in the joint tissue by western blot.RESULT:1.Clinical study:?There was no difference in age,duration of disease,ESR,CRP,anti-CCP antibody positive rate,RF positive rate and DAS28 between the two groups(P>0.05).?After treatment,the ESR,CRP,DAS28,TJC,SJC,VAS,HAQ and TCM syndrome score were significantly improved in both groups,and the DAS28,VAS scores and TCM syndrome score in the treatment group were lower than those in the control group(P<0.05).?After 12 weeks of treatment,the response rate of ACR20(85.3%)in the treatment group was significantly higher than that in the control group(58.8%)(P<0.05).There was no significant difference in the ACR50 between the two groups(P>0.05).?The total effective rate in the treatment group is 82.4%,which was significantly higher than that in the control group(70.6%),in contrast the adverse reaction rate in the treatment group(2.9%)was lower than that in the control group(11.8%)(P<0.05).2.Experimental study:?There was no significant difference in weight between the four groups during different periods(P>0.05).?Compared with the blank group,the thickness of swelling joint in the model group?the control group and the treatment group was significantly increased on the 21st day to the 35th day(P<0.05).The thickness of swelling join in the treatment group was significantly decreased from the 42nd day to the 49th day and it is lower than in the control group on the 21st day(P<0.05).?The expression of TNF-a and MMP-13 in the joints of the model group was higher than that of the blank group.After treatment,the expression of TNF-? and MMP-13 in the treatment group was lower than that in the model group,and the expression of MMP-13 in the treatment group was lower than the control group.group,there was no difference of the expression of TNF-a compared with the control group.Conclusion:1.The efficacy of Bu Shen Qu Han Zhi Wang Decoction combined with methotrexate in the treatment of rheumatoid arthritis is clear,and it can significantly improve the number of tender joints,swollen joints and VAS scores,reduce the DAS28 score,improve the response rate of ACR20 and the efficiency of treatment.2.Bu Shen Qu Han Zhi Wang Decoction can relieve the degree of joint swelling in CIA rats and down-regulate the expression of TNF-a in joint tissues.Compared with the model group and the control group,the expression of MMP-13 in thetreatment group was significantly reduced,indicating that Bu Shen Qu Han Zhi Wang Decoction can reduce inflammation,relieve bone and cartilage degradation in the joints,playing a role in bone protection. |
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