Clinical Study Of Shangke Xiaoyan Plaster For Treatment Of Osteoarthritis And Mechanism Of Potential Substance Treating Osteoarthritis

Osteoarthritis is a common disease.Shangke xiaoyan plaster innovated by the department of traumatology and orthopedics,Jiangsu Traditional Chinese Medicine Hospital is a famous herbal plaster treating osteoarthritis.The objective of research is to explore the clinical effects of shangke xiaoyan plaster treating osteoarthritis and the mechanism of active compound derived from shangke xiaoyan plaster.This study was divided into three parts.In the first part,we reviewed the progress of diagnosis and treatment about osteo-arthritis in modern medicine.We also summarized the traditional Chinese medicine cognition about osteoarthritis,and we explored the advantages of traditional Chinese medicine(including shangke xiaoyan plaster)treating osteoarthritis.The second part:Objective:To investigate the efficacy of shangke xiaoyan plaster in the treatment of knee osteoarthritis(KOA).Methods:78 patients suffered from KOA were randomly divided into two groups:shangke xiaoyan plaster group(SKXYP,treatment group,n=40)and diclofenac diethylamine emulgel group(diclofenac emulgel,control group,n=3 8).SKXYP was applied to the SKXYP-treated group for 2 weeks,while diclofenac emulgel was applied to the diclofenac emulgel-treated group for 2 weeks.The pain score,stiffness score,physical function score,WOMAC total score,traditional Chinese medicine(TCM)syndrome integral and auxiliary serum index before and after the two weeks of treatment were compared.Results:The knee pain score,daily activity score,WOMAC total score and TCM syndrome integral in SKXYP were significantly reduced after the treatment(P<0.05),while the knee pain score in diclofenac emulgel was significantly reduced(P<0.05).The comparison between the two groups showed that ESR had significant difference(P<0.05).The other indexes were not statistically significant(P>0.05).SKXYP reduced total WOMAC scores by 52.50%,compared to 36.84%for diclofenac emulgel.SKXYP improved the integrals of TCM syndromes by 72.5%,compared to 50.00%for diclofenac emulgel(P<0.05).Conclusion:Shangke xiaoyan plaster is effective for the treatment of KOA,and its clinical efficacy is superior to diclofenac diethylamine emulgel.The third part is aimed to explore the effect and mechanism of potential substance treating osteoarthritis.We found that ar-tunnerone could not inhibit the inflammation in IL-1 ?-stimulated human original chondrocytes.We believe that it could not be a good potential prodrug for treating osteoarthritis,so we stopped further experiments.MMP-1,MMP-3,MMP-13,ADAMTS-4,and ADAMTS-5 were decreased by trans-cinnamaldehy(TCA)2-10 ?g/ml in a dose-dependent manner.NF-?B signaling pathway and p38-JNK signaling pathway were inhibited by TCA in vitro.Monosodium iodoacetate(MIA)-induced OA was established in rats to assess the chondrocyte protective effects of intraperitoneal injection of TCA(50 mg/kg).In vivo results demonstrated that TCA alleviated cartilage destruction and the OARSI scores.