OBJECTIVETo explore a treatment program for increasing therapeutic effect on rheumatoid arthritis at active stage.

METHODSOne hundred and forty-six cases were randomly divided into treatment group (n = 74) and medicine control group (n = 72). The treatment group were treated by electroacupuncture at Quchi (LI 11), Hegu (LI 4), Yanglingquan (GB 34), etc. , combined with meloxicam, sulfasalazine and MTX. The control group treated by simple the Western medicines. Their therapeutic effects were compared.

RESULTSThe effective rate was 79.73% in the treatment group and 51.39% in the control group with a significant difference between the two groups (P< 0. 05).

CONCLUSIONElectroacupuncture combined with medicine has a better therapeutic effect than the simple medicine on rheumatoid arthritis at active stage.

Using the complex network technology, the characteristics of the core acupoint prescriptions and the application of acupuncture-moxibustion techniques were analyzed in treatment of rheumatoid arthritis (RA) so as to provide the evidences for acupoint selection and therapeutic methods for RA treated with acupuncture and moxibustion. The articles of acupuncture and moxibustion for treatment of RA in recent 20 years were collated and imported, and the database of the acupoint prescriptions was developed. Using Cytoscape 3.9.2 software, the acupoints in the prescriptions were visualized for the common occurrence network analysis. The association rule analysis was performed with IBM SPSS Modeler 18.0 software and the complex network analysis was by Gephi 0.9.2 software. A total of 798 articles were screened, in which, 3 258 prescriptions were extracted with 253 acupoints involved. The analysis of acupoint selection was conducted in terms of syndrome/pattern differentiation, acupoint locations and main acupoints, and therapeutic methods. The results showed that the most common TCM syndromes of RA included painful bi syndrome, wandering bi syndrome, fixed bi syndrome and bi syndrome due to wind, damp and heat. Regarding the core combination of acupoints, painful bi syndrome: Guanyuan (CV 4) and Shenshu (BL 23); fixed bi syndrome: Yinlingquan (SP 9), Sanyinjiao (SP 6), Zusanli (ST 36), Pishu (BL 20) and Fenglong (ST 40); wandering bi syndrome: Fengchi (GB 20), Geshu (BL 17), Fengmen (BL 12), Xuehai (SP 10) and Waiguan (TE 5); bi syndrome due to wind, damp and heat: Dazhui (GV 14), Quchi (LI 11) and Hegu (LI 4). Regarding the acupoint locations, the acupoints located in the upper limbs, lower limbs and spinal region were generally selected. Quchi (LI 11) was one of the main acupoints in prescriptions with the highest use frequency. Zusanli (ST 36) and Shenshu (BL 23) presented the highest co-occurrence intensity, while Zusanli (ST 36) and Quchi (LI 11) indicated the highest correlation. The treatment of acupuncture-moxibustion for RA is generally complied with the principle as "the synthesis of main acupoints, supplementary acupoints in local affected area and those based on syndrome differentiation". Warm needling and the combination of acupuncture and herbal medication are the most common therapeutic methods for RA.
Humans ; Acupuncture Points ; Moxibustion ; Acupuncture Therapy ; Arthritis, Rheumatoid/therapy* ; Prescriptions

Abdomen ; Acupuncture Points ; Acupuncture Therapy ; Arthritis, Rheumatoid/therapy* ; Blood Sedimentation ; Humans ; Rheumatoid Factor ; Treatment Outcome

Rheumatoid arthritis (RA) is a chronic progressive disease, affecting an estimated 1% of the population worldwide. Although the optimal care of RA patients requires various modalities, pharmacotherapy remains the cornerstone of treatment for RA. Clinical studies in patients with RA have broadened understanding of its pathogenesis and have fundamentally changed the therapeutic approach to this disease in the last 10 years. It has become clear that early suppression of RA disease activity is important in preventing progressive joint destruction and functional decline. There has been a complete remodeling of the traditional "therapeutic pyramid" by rheumatologists, who now treat RA earlier and more aggressively than ever before, using combinations of classic disease-modifying antirheumatic drugs or new drugs. Although a cure remains elusive, remission is an approachable goal.
Antirheumatic Agents* ; Arthritis, Rheumatoid ; Drug Therapy ; Humans ; Joints

OBJECTIVETo summarize recent development of studies on acupuncture and moxibustion for prevention and treatment of rheumatoid arthritis, so as to provide a basis and thinking for clinical scientific studies.

METHODSMore than 60 papers about clinical and experimental studies were reviewed, choosing clinically commonly-used acupoints and introducing mainly different therapeutic methods.

RESULTSAcupuncture and moxibustion can prevent and cure rheumatoid arthritis with outstanding results.

CONCLUSIONAcupuncture and moxibustion have vast vistas for treatment of rheumatoid arthritis.

OBJECTIVE: To observe the clinical efficacy of moxibustion on rheumatoid arthritis (RA) and its effect on related negative emotions, and to explore the possible mechanism. METHODS: A total of 70 patients with RA were randomized into an observation group (35 cases, 1 case dropped off) and a control group (35 cases, 2 cases dropped off). Conventional western medication therapy was adopted in the control group. On the basis of the treatment in the control group, moxibustion at Zusanli (ST 36), Shenshu (BL 23) and ashi points was adopted in the observation group, once every other day, 3 times a week, and totally 5-week treatment was required in the two groups. Before and after treatment, the scores of visual analogue scale (VAS), morning stiffness, 28-joint disease activity score (DAS28), self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were observed and levels of serum 5-hydroxytryptamine (5-HT), glucocorticoid receptor (GR) and interleukin (IL)-1β were detected by ELISA method in the two groups respectively. RESULTS: Compared before treatment, the scores of VAS and DAS28 were decreased after treatment in both groups (P<0.01, P<0.05), and the scores of morning stiffness, SAS, SDS and the serum levels of 5-HT, GR, IL-1β were decreased after treatment in the observation group (P<0.01). After treatment, the scores of VAS, morning stiffness, DAS28, SAS, SDS and the serum levels of GR, IL-1β in the observation group were lower than those in the control group (P<0.05, P<0.01). The clinical symptoms of RA (scores of VAS, morning stiffness and DAS28) were positively correlated with negative emotions (scores of SAS and SDS, r=0.439, P<0.01), the VAS score was positively correlated with serum levels of 5-HT (r=0.189, P<0.05) and IL-1β (r=0.189, P<0.05). CONCLUSION Moxibustion can improve the clinical symptoms and negative emotions in patients with RA by regulating the inflammatory reactions.
Humans ; Moxibustion/methods* ; Serotonin ; Arthritis, Rheumatoid/therapy* ; Acupuncture Points ; Emotions

OBJECTIVE: To study the proportion of cervical spine instability in treatment-naive rheumatoid arthritis (RA) patients, to investigate the associated neck symptoms, and to analyze the clinical characteristics in treatment-naive RA patients and treated RA patients. METHODS: RA patients who underwent cervical spine X-ray imaging from the Department of Rheumatology and Immunology of Peking University Third Hospital and Peking University Shenzhen Hospital from August 2015 to October 2019 and had clinical records of medication administration were included. Clinical and laboratory data including cervical symptoms and X-ray imaging data of cervical spine were collected. The constituent ratio of cervical spine instability in treatment-naive RA patients was statistically analyzed. The clinical data and laboratory data were analyzed by t-test, u-test and chi square to explore the clinical characteristics of the treatment-naive RA patients with cervical instability. RESULTS: Of the 408 RA patients, 105 patients were treatment-naive. Of the 105 treatment-naive patients, 82.9% (87/105) were female, with an average age of (52±14) years, the median duration of the disease was 24 months, the shortest history was 2 weeks, and the longest history was 30 years. 28.6% (30/105) of the treatment-naive RA patients showed cervical spine instability. The prevalence of cervical instability was 13.6% in the treatment-naive RA patients with disease duration less than 24 months. Among them, there were no significant differences in neck symptoms between cervical spine instability group and none cervical spine instability group. The patients with cervical spine instability had a longer duration of disease [60 (18, 180) months vs.16 (8, 51) months], a higher proportion of peripheral joint deformity (63.3%vs.21.3%), and a lower hemoglobin [(106.90±21.61) g/L vs. (115.77±14.69) g/L]. There was no significant difference in the occurrence of cervical instability in the treatment-naive RA patients compared with treated RA patients. Among the RA patients with cervical instability, there was no statistically significant difference in the composition of each type between the patients with treatment-naive RA and patients with treated RA, except for a shorter duration of disease [120.0 (72.0, 240.0) months vs. 60.0 (27.0, 167.5) months]. CONCLUSION 28.6% of treatment-naive RA patients showed cervical spine instability. Cervical instability was also common in RA patients with a duration less than 24 months. There was no significant correlation between cervical instability and neck symptoms. Patients with cervical spine instability had a long-term disease, a higher proportion of peripheral joint deformity and a lower hemoglobin. Controlling the condition of RA early may help to control the progression of cervical involvement in patients with RA.
Adult ; Aged ; Arthritis, Rheumatoid/drug therapy* ; Female ; Humans ; Middle Aged

Wantong Jingu Tablet (WJT), a mixture of traditional Chinese medicine, was reported to relieve the symptoms of rheumatoid arthritis (RA), but its pharmacological mechanism was not completely understood. The aim of this study was to investigate the therapeutic mechanisms of WJT for RA in vivo. The effects of WJT on joint pathology, as well as the levels of Bax, Bcl-2, caspase-3, cleaved-caspase-3, ERK1/2, pERK1/2, TNF-α, IL-1β, and IL-6 were measured using collagen-induced arthritis (CIA) rats. The intestinal flora composition and the metabolites alteration were analyzed by 16S rDNA sequencing and metabolomics method, respectively. We found that WJT ameliorated the severity of the CIA rats which might be mediated by inducing apoptosis, inactivating the MEK/ERK signals and reducing the production of pro-inflammatory cytokines. WJT, in part, relieved the gut microbiota dysbiosis, especially bacterial phylum Bacteroidetes, Tenericutes and Deferribacteres, as well as bacterial genus Vibrio, Macrococcus and Vagococcus. 3'-N-debenzoyl-2'-deoxytaxol, tubulysin B, and magnoline were significantly associated with the specific genera. We identified serotonin, glutathione disulfide, N-acetylneuraminic acid, naphthalene and thromboxane B2 as targeted molecules via metabolomics. Our findings contributed to the understanding of RA pathogenesis, and WJT played essential roles in gut microbiota health and metabolite modulation in the CIA rats.
Animals ; Arthritis, Experimental/drug therapy* ; Arthritis, Rheumatoid/drug therapy* ; Dysbiosis ; Metabolomics ; Rats ; Tablets

Introduction. Studies have shown that tocilizumab (TCZ) is effective in the treatment of rheumatoid arthritis. This study examined the efficacy and safety of TCZ in Filipino patients with moderate to severe rheumatoid arthritis (RA). Methods. This was an open-label, one-arm clinical trial approved by the Philippine Council Health Research Development-National Ethics Committee (PCHRD-NEC), among moderate-severe active RA Filipino patients in 4 RA clinics. The study consisted of a 28-day screening-baseline period; a 24-week treatment period, with once every-4-weeks TCZ 8mg/kg intravenous infusion (IV) and an efficacy-safety evaluation. Patients already receiving methotrexate (MTX) at study entry went on with MTX plus TCZ per medical discretion. Descriptive statistics computed for physician's and patient's global assessment of disease activity, patient's global assessment of pain, ACR20, ACR50 and ACR70. Analysis of variance (ANOVA) determined significant changes over time for DAS-28 ESR, FACIT and HAQ-DI fatigue scores. Twenty-nine of thirty patients were included in efficacy and safety analysis. Results. After 24 weeks of TCZ: 86%, 66%, and 48% of 29 Filipino RA patients achieved ACR20, ACR50, ACR70, respectively, with 34% achieving remission according to DAS28-ESR. Median times to first achieving ACR20, ACR50 and ACR70 were 4, 12, and 24 weeks, respectively. There were also significant rapid reductions in physician's and patient's global assessment of disease activity, patient's global assessment of pain, HAQ-DI and FACIT scores noted over time. Tolerability profile was similar to published literature on TCZ. Conclusions. TCZ has been shown to be effective in the treatment of Filipino patients with moderate to severe rheumatoid arthritis. TCZ can be given in an out-patient RA clinic setting.
Human ; Male ; Female ; TOCILIZUMAB ; ARTHRITIS, RHEUMATOID ; MUSCULOSKELETAL DISEASES ; JOINT DISEASES ; ARTHRITIS ; THERAPEUTICS ; THERAPY ; TREATMENT OUTCOME ;

OBJECTIVE: To observe the effect of moxibustion at "Zusanli" (ST 36) and "Shenshu" (BL 23) on inflammatory factors and intestinal flora in the rats with adjuvant arthritis. METHODS: A total of 36 Wistar rats were randomized into a normal group, a model group and a moxibustion group, 12 rats in each one. In the model group and the moxibustion group, the adjuvant arthritis model was established by a compound method, including the environmental factors, i.e. wind, cold and damp, and Freund's complete adjuvant. In the moxibustion group, moxibustion intervention was exerted at "Zusanli" (ST 36) and "Shenshu" (BL 23), for 20 min at each acupoint, once daily, consecutively for 21 days. The paw swelling degree and arthritis index (AI) score were observed before and after intervention in the rats of each group. Using real-time fluorescence quantitative PCR method (real-time PCR) and Western blot method, the mRNA and protein expressions of inflammatory factors of colon tissue, i.e. interleukin (IL) 1β, tumor necrosis factor-α (TNF-α), IL-6, were detected after intervention in the rats of each group. The intestinal flora was detected with 16SrRNA sequencing technology after intervention in the rats of each group. RESULTS: Compared with the normal group, the paw swelling degree and AI score were increased in the rats of the model group ( CONCLUSION Moxibustion at "Zusanli" (ST 36) and "Shenshu" (BL 23) relieves the joint symptoms of adjuvant arthritis rats and inhibits the expressions of inflammatory factors, which is probably related to the regulation of the structure of intestinal flora.
Animals ; Arthritis, Experimental/therapy* ; Arthritis, Rheumatoid ; Gastrointestinal Microbiome ; Moxibustion ; Rats ; Rats, Wistar