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Objective:To observe the controlling effect of addition and subtraction therapy of Xuanbi tang on knee osteoarthritis of rheumatic fever arthralgia type (KOA) at attack stage and to investigate the influence to acute inflammation factors. Method:One hundred and twenty-eight patients were randomly divided into control group and observation group (1∶1) by random number table with SAS software. The patients in both groups got celecoxib capsules, 0.2 g/time, 1 time/day, glucosamine hydrochloride capsule, 1 grain/time, 2 times/day. Patients in control group addiiontally got Simiaowan, 6 g/time, 2 times/day. Patients in observation group got addition and subtraction therapy of Xuanbitang, 1 dose/day, with a treatment course of 2 weeks in both groups. Visual analogue scale of pain (VAS) was used to discuss pain degree of knee joint, and the VAS scores during activity and resting state were recorded every day, and the time to pain relief and time to pain disappearance were also recorded. Before and after treatment, the scores of osteoarthritis index visual scale of Western Ontario and McMaster University (WOMAC), scores of swelling degree and scores of rheumatism heat arthralgia syndrome were graded. The levels of high sensitive C-reactive protein (hs CRP), interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and serum matrix metalloproteinase-3 (MMP-3) were detected before and after treatment. In addition, safety was evaluated and discussed. Result:The comprehensive total effective rate in observation group was 95.00% (57/60), higher than 83.05% (49/59) in control group (P<0.05). At the third, seventh, tenth, fourteenth day after treatment, scores of knee joint pain degree in observation group were lower than those in control group (P<0.01). Time to pain relief and time to pain disappearance were shorter than those in control group (P<0.01). Scores of WOMAC, swelling degree and rheumatism heat arthralgia syndrome were all lower than those in control group (P<0.01). Levels of hs-CRP, IL-1β, IL-6, TNF-α and MMP-3 were lower than those in control group (P<0.01). In addition, there was no adverse reaction related to Xuanbitang. Conclusion:Addition and subtraction therapy of Xuanbitang can relieve pain, swelling and other symptoms, improve knee joint function, shorten the course of disease, and control the acute inflammatory reaction, with significant clinical efficacy and safety.
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Objective: To observe the effects of Gentianae Macrophyllae Radix (Qinjiao) in different combinations on the expression of MMP-3, TIMP-1, and ankle pathological changes in rheumatoid arthritis (RA) model rats, and to explore the relationship between medicinal properties-disease-efficacy and explore the mechanism of traditional Chinese medicine in the treatment of RA. Methods: Eighty SD rats were randomly divided into blank group, collage II model group, rheumatic fever model group, tripterygium group, single Qinjiao group, Qinjiao-Weilingxian (Clematidis Radix et Rhizoma) group, Qinjiao-Sangjisheng (Taxilli Herba) group, and Qinjiao-Fangji (Stephanlae Tetrandrae Radix) group. Rheumatic fever arthralgia model was induced by collage II and exposed in rheumatic fever environment. After modeling, each administration group was ig administrated with corresponding drug solution. The paw thickness was observed every 3 d, and swelling was calculated; The arthritis index was scored in the early, middle, and late stages. Rats were sacrificed on day 39. The expression of MMP-3 and TIMP-1 in the ankle joint of rats was detected by immunohistochemistry, and the pathological changes of ankle joint were observed by HE staining. Results: Compared with the blank group, the paw edema, AI, and expression of MMP-3 in collage II model group and rheumatic fever model group was significantly higher, the expression of TIMP-1 were significantly lower, the articular surface of two groups was rough and damaged, and the articular cartilage was severely damaged. A large number of granulation tissues proliferated, accompanied by a large number of inflammatory cell infiltration and neovascularization. After treatment, compared with rheumatic fever model group, the paw edema, AI, and expression of MMP-3 in all treatment groups were reduced to varying degrees, in which the Qin-Fang group were lower most significant; The serum levels of TNF-α and IL-1β in all treatment groups were significantly decreased in varying degrees, especially in the Qin-Fang group; The expression of TIMP-1 was significantly increased in varying degrees, especially in the Qin-Fang group. HE staining results showed that the area of articular cartilage destruction and the degree of destruction were reduced, the inflammatory cells and neovascularization decreased, the number of repair fibers increased, and the scar tissue increased. Conclusion: For the rheumatic fever arthralgia RA, the combined effect of mild and cold Chinese materia medica (CMM) is better than the combined effect of mild and warm CMM, the combined effect of mild CMMs. Experimental results are consistent with the principles of traditional Chinese medicine clinical treatment of "treating the hot diseases should use the cold medicine", the mechanism of the compatibility drug relieving rheumatic fever arthralgia RA may be related to its ability, which can reduce the expression of MMP-3, increase the expression of TIMP-1, reduce articular cartilage destruction, and reduce inflammatory cell infiltration and vascular proliferation.
RESUMEN
Objective: To study the effects of Gentianae Macrophyllae Radix in cold and heat compatibility in rheumatic fever arthralgia rheumatoid arthritis (RA) model rats by principal component analysis and cluster analysis. Methods: Eighty SD rats were randomly divided into blank group, collage II model group, rheumatic fever arthralgia model group, tripterygium group, single Qinjiao group, Qinjiao-Weilingxian (Clematidis Radix et Rhizoma) group, Qinjiao-Sangjisheng (Taxilli Herba) group, and Qinjiao-Fangji (Stephaniae Tetrandrae Radix) group; rheumatic fever arthralgia model were induced by collage II and being exposed in rheumatic fever environment, each administration group was gavaged with 15 mL/kg corresponding drug solution after modeling. The weight, paw thickness, arthritis index, pain threshold, cold pain tolerance time and pressure pain tolerance value were measured. The serum contents of RF, CRP, TNF-α, IL-1β, and PGE2 were detected by ELISA. Results: Principal component analysis selected two principal components, which carried 89.6% of the original information, the first principal component reflected all information in expect weight, the second principal component mainly reflected the weight. The total factor score F (the greater the F value, the more severe the disease) was obtained by the sum of the principal component factor score and its weight (variance contribution) product. The F value of rheumatic fever arthralgia model group was the highest and the score of the blank group was the lowest, the F value of Qin-Fang group was significantly lower than those of Qin-Wei group and Qin-Sang group. Cluster analysis divided eight groups into three categories according to the blank, model and administration, which was consistent with the theory; In the control group, Qin-Fang group was clustered into one group, and the other groups were clustered into one group. Conclusion: For the rheumatic fever arthralgia RA, the combined effect of mild and cold traditional Chinese medicine (TCM) is better than the combined effect of mild and warm TCM and the combined effect of mild TCMs. Experimental results are consistent with the principles of TCM clinical treatment of "treating the hot diseases should use the cold medicine"; Principal component analysis and cluster analysis are simple and reliable, and can be used to evaluate the animal model and drug efficacy.