Longteng Decoction Intervention Study On Clinical And Immune Regulation Of Patients With Active Rheumatoid Arthritis

BackgroundRheumatoid arthritis is a refractory autoimmune disease.It is characterized by chronic,progressive,aggressive,inflammatory osteoarthritis and high disability.Modern medicine believes that its cause is related to CD4+T cell-mediated immune regulation abnormalities.Treatment is based on immunosuppression and anti-inflammatory.RA is a category of"arthralgia" in Chinese medicine.The main causes of pathogenesis include qi and blood internal injuries and exogenous evils.The understanding of it has been continuously improved with the trend of history.Professor Zhou Jingwei's theory of "Fu Xie Bi Zu" is another innovation.The "Longteng Tang" with the theory of "Tou Xie Tong Bi"has achieved good results in clinical practice.PurposeVerify that the "Tou Xie Tong Bi"under the guidance of the pathogenesis of "Fu Xie Bi Zu" has a better effect in RA treatment.Explore intra-articular pathological changes by using joint ultrasound techniques.Use different detection techniques to make up for the basic mechanism of treatment of RA.From the perspective of the positive and negative feedback of the inflammation-related factors in the cellular immune response network to regulate the dysfunction,to verify the effect mechanism.The results were interpreted from four levels:"clinical manifestations-ultrasound pathology-immune cells-inflammatory factors".MethodsThe prospective controlled study was used to divide the patients in the rheumatism of the Dongzhimen Hospital into 20 experimental groups(Longteng Tang combined with LEF)and positive drug control group(LEF alone)for 24 weeks.DAS28 scores were calculated at 0,4,12,and 24 weeks of treatment to assess disease activity,HAQ questionnaire scoring to assess subjective symptoms and joint function,and to monitor adverse events.Finally compare the disease relief.At the 0,12,and 24 weeks of patient treatment,the ultrasound examination of the joint based on US7 was performed in our hospital.The operation was performed by the same senior ultrasound physician.The 7 joint areas most susceptible to RA were observed,and the degree of synovial thickening of the joints was the main observation object.Dynamic comparison between the two groups.At the 0,12,and 24 weeks of treatment,the patient's peripheral blood was taken,EDTA was anticoagulated,and the relevant immune cells and factors were detected by flow cytometry CD3+labeled total T cells,CD3+CD4+labeled Th cells,CD3+CD8+labeled Ts cells,CD3-CD19+ labeled total B cells,CD3-CD16+CD56+ labeled NK cells,CD4+CD25+CD127-labeled Treg cells,CD3+CD4 + IFN-y labeled Thl cells,CD3+CD4+IL-4 labeled Th2 cells,and CD3+CD4+IL-17A labeled Th17 cells.Dynamic comparison between the two groups.The patient's peripheral blood was taken at the patient's treatment 0,12,and 24 weeks,and the serum was stored by centrifugation.AimPlex flow-through high-throughput multi-factor detection technology detects related inflammatory factors.These include IL-2,IL-4,IL-6,IL-10,IL-17A,TNFa,and IFNy.Dynamic comparison between the two groups.Results&ConclusionThe experimental group was better than the control group from the improvement of DAS28 and HAQ.Especially at the beginning of the treatment period of 4 weeks,the advantage is more prominent.This experiment proved the superiority of "Tou Xie Tong Bi" in the treatment of patients with active RA,with rapid relief and rapid compliance.Compared with the control group,the experimental group showed better improvement of the total thickness of the synovial thickening and the number of synovial thickening joints.Compared with the control group,the experimental group showed better down-regulation of IL-17A,IFN-?,and up-regulation of IL-4 ability,which means better down-regulation of Th1,Th17 and up-regulation of Th2.In terms of the target,the experimental group showed a multi-targeted regulation compared with the control group.The experimental group was T,B,NK,Treg,Th,IL-4,IL-17,and the control group was B,Treg,Ts.Compared with the control group,the experimental group showed better up-regulation of IL-4 and down-regulation of IL-10 and IFNy,which had certain advantages.The therapeutic targets of the experimental group were IL-17A,IFNy,and IL-6,and the therapeutic targets of the control group were concentrated in IL-17A.