Clinical Research Of Lijie Capsule In Treating Refractory Rheumatoid Arthritis

Objective: To observe the clinical efficacy of Lijie capsule in the treatment of refractory rheumatoid arthritis(RRA)and its effect on the expression of P-glycoprotein(P-gp)in peripheral blood lymphocytes of patients with RRA.Methods: Fifty patients with RRA were treated at the Department of Rheumatology,Guangxi University of Traditional Chinese Medicine from April 1,2019 to December 31,2019,who were randomly divided into treatment group and control group,25 cases in each group.The control group was treated with methotrexate,leflunomide and meloxicam,the treatment group was treated with Lijie capsule on the basis of the above western medicines for 12 weeks.The joint tenderness,joint swelling,CRP,ESR,RF,rest pain,HAQ,EGA,PGA,DAS28,ACR20 standard and TCM syndrome scores were observed before and after treatment.And the expression of P-glycoprotein(P-gp)in peripheral blood lymphocytes of the two groups was detected before and after treatment.Results: 1.The improvement rate of ACR20 standard in the treatment group was 84.00%,and the control group was 56.00%.The scores of DAS28 was improved in both groups(P<0.05),and the treatment group was superior to the control group(P<0.05).The scores of TCM symptoms in the two groups were decreased(P<0.05),and the decrease degree of the treatment group was higher than that of the control group.The overall response rate of TCM syndrome in the treatment group was 88.00%,and the control group was 60.00%.The total effective rate in the treatment group was 80.00%,and the control group was 52.00%.The difference between the two groups was statistically significant(P<0.05).2.The laboratory indexes of the two groups before and after treatment were compared: CRP,ESR and RF of the two groups were reduced,the difference between the two groups was statistically significant(P<0.05),indicating that the treatment group was superior to the control group.3.Both groups reduced the number of joint tenderness,joint swelling,rest pain,HAQ,EGA,PGA,and the difference between the treatment group and the control group was statistically significant(P<0.05),indicating that the treatment group was superior to the control group.4.By detecting the expression of P-gp in peripheral blood lymphocytes,the expression of P-gp in the treatment group was decreased(P<0.05),while that in the control group was increased(P>0.05).After treatment,there was significant difference between the two groups(P < 0.05).Conclusions: 1.Lijie capsule can improve the symptoms,physical signs,inflammatory indexes,disease activity(DAS28 score),ACR20 compliance rate,TCM syndrome score and TCM syndrome efficacy of RRA patients.2.Lijie capsule can effectively reduce the expression of P-glycoprotein(P-gp)in peripheral blood lymphocytes of patients with RRA.One of the mechanisms is to down regulate the expression of P-gp in peripheral blood lymphocytes of patients with RRA.