Clinical Observation Of Guizhi Shaoyao Zhimu Decoction In The Treatment Of Rheumatoid Arthritis(Cold-heat Mixed Syndrome)and Its Effect On Patients’ Serum OPG，RANKL，RANK Expression

Objective: To apply Guizhi Shaoyao Zhimu Decoction to the treatment of patients with rheumatoid arthritis(cold-heat mixed syndrome),to observe its clinical efficacy and the effect on patients’ serum OPG,RANKL,RANK expression,to explore the clinical efficacy of Guizhi Shaoyao Zhimu Decoction treatment RA and its effect on bone damage in RA patients,with a view to providing a new solution for the Chinese traditional medicine intervention in RA patients,and providing a basis for prevention and treatment of bone damage in RA patients.Methods: The active RA patients who were randomly selected for the period from June 2018 to June 2019 in the rheumatology clinic of Henan Province Hospital of TCM were randomly selected,and 30 cases were divided into control groups and 30 trial groups according to the random figures.The control group was treated with methotrexate tablets and ceresib,and the experimental group was added Guizhi Shaoyao Zhimu Decoction on the basis of the control group.The course of treatment was 8 weeks,respectively,before and after the treatment of the control group and the treatment group,the number of joint swelling,joint pressure pain,morning stiffness time,VAS score,ESR,C-reactive protein,rheumatism factor,OPG,RANKL,RANK and other indicators,and calculated the patient’s DAS28(ESR)score,the application of spss19.0 for statistical analysis of the above data,compare the differences between the two groups of treatment.Results:A total of 60 patients were included in the trial,with 0 cases falling out,30 cases in the control group,and 30 cases in the treatment group.The general data of the two groups of patients,there was no statistical difference in the baseline data of the two groups of patients before treatment(P>0.05).1.Clinical efficacy The overall effective rate of the treatment group was 90%,and the effective rate of the control group was 66.7%,the difference was statistically significant(P=0.020 <0.05).Compared with the TCM symptom scores,the patients in both groups decreased after treatment,and the treatment group was better than the control,the difference was statistically significant(P=0.008<0.01).Comparison of disease activity between the two groups of patients,the treatment group was lower than the control group(P=0.009<0.01),the difference was statistically significant;the comparison of DAS28(ESR)scores,the DAS28(ESR)scores of the two groups decreased after treatment,the treatment group Compared with the control group(P=0.004<0.01),the difference was statistically significant.2.Symptoms and signs The VSA score,joint swelling,joint tenderness,morning stiffness,and VAS score of the two groups of patients were improved before and after treatment.Compared with the control group,the VSA score of the treatment group was lower(P=0.044<0.05)and the number of joint swelling was lower after treatment.(P= 0.026<0.05),fewer joint tenderness(P=0.014<0.05),short morning stiffness time(P=0.008 <0.01),the differences were statistically significant.3.Laboratory indicators The ESR,CRP,and RF of the two groups of patients were improved before and after treatment.Compared with the control group,the ESR(P=0.040 <0.05)and CRP(P=0.033<0.05)of the treatment group were decreased,and the differences were statistically significant;RF(P=0.304>0.05),the difference was not statistically significant.4.OPG,RANKL,RANK expression Before and after treatment,serum OPG expression was up-regulated,RANKL,and RANK expressions were down-regulated.Compared with the control group,OPG(P < 0.001)expression,RANKL(P=0.030<0.05),RANK(P=0.018<0.05)expression decreased,the difference was statistically significant.Conclusion: Guizhi Shaoyao Zhimu Decoction combined with MTX and Celecoxib capsules can make patients more benefit from clinical symptoms,inflammation indicators,disease activity,increase the expression of OPG,and reduce the expression of RANKL and RANK,compared with Western medicine alone for RA(cold-heat mixed syndrome).In summary,in the treatment of clinical RA,the addition of Guizhi Shaoyao Zhimu Decoction can improve the clinical efficacy,and may increase the expression of OPG,reduce the RANKL / RANK binding rate,and delay the bone destruction process in RA patient.