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ObjectiveTo study the clinical efficacy of the Qingre Lishi Huazhuo method on patients with chronic gouty arthritis of dampness-heat obstruction syndrome and the effect on nucleotide-binding oligomerization domain-like receptor 3（NLRP3）/interleukin-1β （IL-1β） signaling pathway to preliminarily explore its mechanism. MethodSixty patients with chronic gouty arthritis of dampness-heat obstruction syndrome were enrolled and divided into a treatment group （30 cases） and a control group （30 cases） according to the random number table method. Thirty people were assigned to the healthy group. Patients in the control group were treated with oral Febuxostat， while those in the treatment group were treated with modified Simiaosan combined with Febuxostat. Treatment lasted four weeks. The general clinical data， traditional Chinese medicine （TCM） syndrome scores， serum uric acid （UA）， serum creatinine （SCr）， blood urea nitrogen （BUN）， fasting blood glucose （FPG）， low-density lipoprotein （LDL）， triglyceride （TG）， total cholesterol （TC）， erythrocyte sedimentation rate （ESR）， and C-reactive protein （CRP） of patients were recorded. Enzyme-linked immunosorbent assay （ELISA） was employed to measure the levels of IL-1β，TNF-α， and IL-6，and the levels of NLRP3，cysteinyl aspartate-specific protease-1 （Caspase-1）， and apoptosis-associated speck-like protein containing a CARD （ASC） were detected by Western blot. ResultBefore treatment， the levels of body mass index （BMI）， systolic blood pressure （SBP），diastolic blood pressure （DBP），UA，SCr，BUN，FPG，LDL，TG，and TC in both groups significantly increased （P<0.05，P<0.01），and the levels of HDL significantly decreased as compared with those in the healthy group（P<0.05）. Additionally， the levels of IL-1β， TNF-α， and IL-6 in both groups significantly increased before treatment （P<0.01）. Compared with the results before treatment， patients in the two groups had significant reductions in tube pain， joint tenderness， joint swelling，joint fever， activity disorders， body fatigue， sliminess， bitter mouth， yellow and red urine， and tongue manifestation scores （P<0.05，P<0.01）. Compared with patients in the control group after treatment， those in the treatment group had a significant decrease in joint fever， body fatigue， sliminess， bitter mouth，sticky stool，yellow and red urine， tongue manifestation score， and pulse score （P<0.05）. The total effective rate in the treatment group was 80.0% （24/30）， higher than 56.7% （17/30）in the control group（χ2=11.916，P<0.05）. Compared with the results before treatment， BMI， SBP， DBP， UA， SCr， BUN， FPG， LDL， TG， TC， ESR，CRP， IL-1β， TNF-α， IL-6 levels， and VAS score in both groups significantly decreased （P<0.05，P<0.01）. Compared with patients in the control group after treatment， those in the treatment group had decreased DBP，ESR， IL-1β levels， and VAS score （P<0.05）. Western blot results showed that before treatment， the protein expression of NLRP3， Caspase-1， and ASC in peripheral blood mononuclear cells （PBMCs） of patients in both groups were higher than those in the healthy group （P<0.01）. Compared with the results before treatment， the protein expression of NLRP3， Caspase-1， and ASC in PBMCs in patients of both groups after treatment decreased （P<0.05，P<0.01）. Compared with the control group after treatment， the treatment group showed decreased expression levels of NLRP3 and Caspase-1（P<0.05）. ConclusionThe Qingre Lishi Huazhuo method can effectively improve the clinical symptoms and reduce inflammation of chronic gouty arthritis of dampness-heat obstruction syndrome with good safety. The mechanism may be related to the inhibition of the NLRP3/IL-1β signaling pathway.
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Objective To study the effect of Febuxostat on NALP3 inflammasome in chronic gouty arthri-tis. Methods A total of 89 patients with chronic gouty arthritis and 50 healthy cases were enrolled in this study and 89 patients were divided into Benzbromarone group,Allopurinol group,Febuxostat group and placebo group. The expression of NALP3 inflammasome mRNA and the protein were detected by RT-PCR and Western blot. Re-sults The levels of Uric Acid,NALP3,ASC and caspase-1 mRNA in chronic gouty arthritis patients were higher than those in healthy cases before treatment(#P = 0.000);the level of NALP3 in benzbromarone and allopurinol group had no change after treatment(*P<0.05).The levels of NALP3 mRNA and caspase-1 mRNA in Febuxostat group were lower but the level of ASC mRNA was higher than those in other groups after treatment(*P < 0.05). Conclusions NALP3 inflammatory may be associated with chronic gouty arthritis. Febuxostat can effectively re-duce the level of Uric Acid,and affect the function of NALP3 inflammasome.
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Deposition of monosodium urate crystal in joints and periarticular soft tissue is regarded as one of the characteristics of chronic gouty arthritis. In spine, however, only nineteen cases of tophaceous deposits have been reported to date suggesting the rarity of clinical symptoms secondary to involvement of spine. Authors report a case of spinal stenosis due to hypertrophy of ligament flavum with monosodium urate deposits. The patient was 65 years of age with chronic gouty arthritis who underwent a decompressive laminectomy at L4-5. At surgery, hypertrophied ligament flavum that was covered with chalky amorphous materials was noted without any evidence of radiologic features. Microscopically, a portion of ligament flavum had been focally destoryed by amorphous material deposits that were surrounded by a thin layer of mononuclear and giant cells along with occasional sprinkling of chronic inflammatory cells and negative birefringence on polarizing microscopy.