| OBJECTIVE:This study used a comparative study to investigate the characteristics of elderly-onset rheumatoid arthritis(EORA)and the differences in TCM syndromes,and to analyze the correlation between TCM syndromes and clinical indicators.To improve the understanding of EORA and to provide a theoretical basis for clinical diagnosis and treatment.Thereby improving the level of diagnosis and treatment and improving the prognosis of the disease.METHODS:Patients with active rheumatoid arthritis were enrolled in the rheumatology clinic/inpatient department of Jiangsu Provincial Hospital of Traditional Chinese Medicine from 2018 to 2019,including 60 elderly-onset rheumatoid arthritis(EORA)and 62 younger-onset rheumatoid arthritis(YORA).This experiment collected the patient's clinical data,progressed the activity score and depression and anxiety assessment,conducted TCM syndrome differentiation,and analyzed the correlation between TCM syndrome and some clinical data.It mainly includes:Part ?:Collecting clinical data for patients who meet the inclusion and exclusion criteria.The clinical data includes basic information,serum indicators,joint ultrasound score,joint symptoms,treatment methods,activity scores,TCM syndrome scores,depression and anxiety self-rating scale.The activity scores were selected by SDAI,CDAI,DAS28-ESR,and DAS28-CRP.Part?:Refer to "Practical Chinese Medicine Rheumatology" and "Guidelines for Clinical Research of New Drugs in Traditional Chinese Medicine" and combining the years of clinical experience of Professor Ji Wei,the disease is divided into three main syndromes:cold damp stagnation,heat damp stagnation and cold-heat complex with four kinds of accompanying symptoms.They are Deficiency of Qi and Blood,Deficiency of Liver and Kidney Yin,Deficiency of Spleen and Kidney Yang,Phlegm and Blood Stasis.Then we made a syndrome judgment on the patient,and summarized the distribution pattern of EORA syndrome,and analyzed the correlation between the EORA card and some clinical data.Part ?:Data analysis was performed using SPSS 20.0 statistical software.RESULTS:Part ?:1.General situation:The average age of the elderly group was 69.65±6.13 years old,and the average age of the young and middle-aged group was 49.35±5.20 years old.The incidence rate of the male group was significantly higher than that of the young and middle-aged group(P<0.01).The course of disease was significantly shorter than the young and middle-aged group.(P<0.001).2.Joint symptoms:the acute onset rate of the elderly increased(P<0.05),tenderness joint count increased(P<0.01),morning stiffness,swollen joint count,joint deformity did not differ.3.Serological indicators:WBC,RBC,Hb decreased(P<0.05),serum creatinine increased(P<0.05),and there was no difference in PLT,ALT,AST and urea.In terms of inflammation index,the ESR of the elderly group was significantly increased(P<0.001);the CRP results showed that the elderly group was higher than the young and middle-aged group,but the difference was not significant(P=0.05).Cortisol levels(8:00)were lower than normal in the two groups,and younger and younger patients were more significantly(P<0.001).In terms of specificity index,the RF and anti-CCP positive rates in the elderly group were lower(P<0.05),but there was no difference between the AKA and total ANA positive rates.4.Joint ultrasound:Ultrasound scoring results of the two groups showed that the hand and joint ultrasound scores of the young and middle-aged groups were higher than those of the elderly group(P<0.05),and the wrists,elbows,shoulders,knees,and ankles did not show positive results.5.Activity scores:The DAS28-ESR in the elderly group was significantly higher than that in the younger and younger(P<0.01),and the other three scores were higher than those in the younger and younger(P<0.05).In addition,in terms of activity level distribution,the four groups of scores were mainly in the disease activity,but the number of DAS28-CRP was significantly lower than that of SDI(P<0.05).There was no difference between the TCM syndrome score.6.Treatment:The hormone use rate in the elderly group was increased(P<0.05),and the use rate of Tripterygium wilfordii preparation was significantly increased(P<0.001).The use rate of LEF was higher in the young and middle-aged group(P<0.05),and the use rate of biological agents was significantly higher(P<0.01).There were no differences between the two groups in the use of MTX,HCQ,ilamod,NSAIDs,and Chinese medicine.7.Depression and anxiety assessment:There was no difference between the depression self-rating scale,and the anxiety self-rating scale.Part ?:1.Main TCM syndrome type:The old group is followed by cold and hot syndrome(50%),dampness and heat stasis syndrome(30%),and cold dampness syndrome(20%);the young and middle-aged group is damp-heat and stasis syndrome.(46.77%),cold and heat miscellaneous syndrome(40.32%),cold and dampness resistance syndrome(12.8%).2.Accompanying symptom type:The elderly group had more than two cards(56.67%,P<0.05),and the young and middle-aged group had more than one card(66.13%,P<0.01).The frequency of senile group syndrome is stagnation,liver and kidney yin deficiency,spleen and kidney yang deficiency,qi and blood deficiency;the young and middle-aged group is liver and kidney yin deficiency,phlegm obstruction,qi and blood deficiency,spleen and kidney Yang deficiency.Among them,the spleen and kidney yang deficiency in the elderly group was higher than that in the young and middle-aged group(P<0.05),and the sputum resistance was significantly higher than that in the young and middle-aged group(P<0.01).3.The main syndrome of EORA and some clinical indicators:the female patients with cold and hot syndrome were higher(P<0.05).but there was no difference between the main syndrome and the course of disease,serum indicators,joint symptoms and various scores.CONCLUSIONS:The current understanding of EORA is not sufficient.The study found that:I,the gender difference of EORA is reduced,the medical history time is shortened,and the acute onset rate is increased.The results show that the general conditions of patients with EORA are worse,accompanied by high levels of inflammatory markers,low RF levels,low anti-CCP antibody positive rates,and high disease activity.Ultrasound scores of the joints and cortisol levels were better,but it may be due to the duration of the disease and the possibility of merging with geriatric diseases.The EORA treatment program also has its own characteristics.The hormone and tripterygium preparations have higher utilization rates because of the low price,fast onset speed and the difference in drug toxicity of patients.II,cold-heat complex and heat damp stagnation are the main types of RA main syndrome,EORA has more syndromes of cold-heat complex,and YORA mainly relies on heat damp stagnation syndrome.This further illustrates the complexity of the EORA.The results of the accompanying symptoms show that syndrome of deficiency in the elderly is more obvious.As a pathological product and a causative factor,phlegm-stasis plays an important role in the disease activities,especially in the elderly.There is a certain correlation between TCM syndrome types and clinical indicators,but this study is mainly based on negative results,and related research needs further improvement and deepening. |
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