Network Pharmacological And Clinical Research On Treatment Of Rheumatoid Arthritis With YunpiJieduTongluoQushi Decoction

ObjectiveTo study the mechanism of Yunpi Jiedu Tongluo Qushi Decoction in the treatment of rheumatoid arthritis(RA)through network pharmacology.To observe the efficacy and safety of Yunpi Jiedu Tongluo Qushi Decoction by non-randomized controlled clinical trials in order to provide patients with a safe and effective combination of Chinese and Western treatment.MethodsNetwork pharmacology part:collected RA targets in the gene database of Pub Med database.Collected ingredients and targets of Yunpi Jiedu Tongluo Qushi prescription through TCMSP database to analyze key components by constructing component-target network.Finally,the shared target of Yunpi Jiedu Tongluo Qushi Recipe and RA were obtained to analyze the KEGG signaling pathway of the shared targets through Cytoscapesoftware,and constructed RA-related componentstarget-pathway network.Clinical research part : they were divided into exposure group and non-exposure group by non-randomized control trials and observed for 12 weeks.Conventional western medicine treatment in the non-exposed group was based on Methotrexate.The treatment of the exposed group was combined with conventional western medicine with Yunpi Jiedu Tongluo Qushi Decoction.The main efficacy index was DAS28 score.Finally,the efficacy and safety of Yunpi Jiedu Tongluo Qushi Decoction were evaluated through the disease activity,symptoms and signs,C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)and the incidence of adverse events.ResultsNetwork pharmacology part:Quercetin,kaempferol,luteolin,wogonin andβ-sitosterol of Yunpi Jiedu Tongluo Qushi Decoction may play a therapeutic role through IL-17 signaling pathway,TNF signaling pathway,JAk-STAT signaling pathway,and MAPK signaling Pathway,Toll-like receptor signaling pathway,T cell receptor signaling pathway,osteoclast differentiation,Th1 and Th2 cell differentiation,B cell receptor signaling pathway and VEGF signaling pathway of the targets such as TNF,IL6,VEGFA,EGFR,CASP3,JUN,AKT1,TP53 and MAPK8.Clinical research part:using a non-randomized controlled prospective research method,a total of 40 RA patients were enrolled.After 12 weeks of treatment,the patient’s disease activity,symptoms and signs,laboratory inflammation levels,and disease activity improved;during the treatment,the incidence of gastrointestinal reactions and liver function abnormalities in the exposed group was slightly lower than that of the non-exposed group.One case of allergic reaction occurred in exposed group.However,the difference in efficacy and incidence of adverse events between the two groups was not statistically significant.ConclusionThe mechanism of Yunpi Jiedu Tongluo Qushi Decoction in treating RA may be achieved through multiple components,multiple targets,and multiple pathways.Yunpi Jiedu Tongluo Qushi Decoction combined with conventional Western medicine treatment has slightly better efficacy and safety than the conventional Western medicine treatment group,but the difference is not statistically significant.Therefore,a larger sample size clinical study is needed.