Humans ; Spondylarthritis/drug therapy* ; Spondylitis, Ankylosing/drug therapy* ; China

OBJECTIVE: To observe the efficacy of the combined treatment with acupuncture and governor vessel moxibustion on ankylosing spondylitis (AS) at early-middle stage and investigate the effect on bone marrow edema of sacroiliac joint. METHODS: Seventy patients of AS at early-middle stage were randomized into an observation group (35 cases) and a control group (35 cases, 1 case dropped off ). In the control group, the recombinant human tumor necrosis factor receptor-antibody of type Ⅱ fusion protein for injection was injected subcutaneously, 25 mg each time, once on every Monday and Friday, consecutively for 3 weeks. In the observation group, on the base of the intervention as the control group, acupuncture combined with governor vessel moxibustion were provided. Acupuncture was applied to Dazhui (GV 14), Changqiang (GV 1), Zhibian (BL 54), Baihui (GV 20), etc.; the thermal needling technique was adopted at Dazhui (GV 4) and Changqiang (GV 1) for promoting the circulation of the governor vessel, and the ginger-isolated moxibustion on the governor vessel was combined. Such intervention measure was provided once daily. One treatment session contained 7 treatments and 3 sessions were required. Before and after treatment, the scores of Spondyloarthritis Research Consortium of Canada (SPARCC), Bath ankylosing spondylitis disease activity index (BASDAI) and Bath ankylosing spondylitis functional index (BASFI) and Bath ankylosing spondylitis patient global score (BAS-G) were observed in the two groups separately. The efficacy and adverse effects were assessed in the two groups after treatment. RESULTS: The scores of SPARCC, BASDAI, BASFI and BAS-G were all reduced after treatment compared with those before treatment in the two groups (P<0.05), and those in the observation group were lower than the control group (P<0.05). The total effective rate was 97.1% (34/35) in the observation group, higher than 82.4% (28/34) in the control group (P<0.05). There were 4 cases of gastrointestinal reactions and 1 case of skin rashes in the control group; and 3 cases of local skin redness and pruritus after governor vessel moxibustion, no any drug adverse effect was found in the observation group. CONCLUSION Based on the western medicine treatment, the combined therapy of acupuncture and governor vessel moxibustion may relieve bone marrow edema of sacroiliac joint in patients with AS at early-middle stage, control the progression of disease and improve the daily life activity. This therapy is relatively safe and effective.
Acupuncture Points ; Acupuncture Therapy/methods* ; Bone Marrow ; Edema/therapy* ; Humans ; Moxibustion/methods* ; Sacroiliac Joint ; Spondylitis, Ankylosing/therapy*

To evaluate the efficacy and safety of Chinese patent medicines in the treatment of ankylosing spondylitis(AS) by frequency network Meta-analysis. Randomized controlled trials(RCTs)of Chinese patent medicines for AS were retrieved from CNKI, Wanfang, VIP, CBM, PubMed, EMbase and Cochrane Library databases from the time of database establishment to January 2021. The quality of the included RCTs was evaluated according to the Cochrane bias risk standard, and the data was analyzed by RevMan 5.3 and Stata/MP 15.1. A total of 12 kinds of Chinese patent medicines in 55 RCTs were included. According to Meta-analysis, in term of the effectiveness, the top three optimal medication regimens were Biqi Capsules, Yishen Juanbi Pills and Yaobitong Capsules combined with western medicine. The top three interventions to reduce the erythrocyte sedimentation rate(ESR)were Yishen Juanbi Pills, Xianling Gubao Capsules and Fufang Xuanju Capsules combined with western medicine. The top three interventions to reduce the C-reactive protein(CRP)were Biqi Capsules, Xianling Gubao Capsules and Fufang Xuanju Capsules combined with western medicine. In terms of the safety, top three optimal medication regimens were Total Glucosides of Paeony Capsules, Yishen Juanbi Pills, and Wangbi Tablets combined with western medicine. This network Meta-analysis suggests that Chinese patent medicines combined with conventional western medicine can effectively improve the joint pain symptoms of AS patients and reduce the acute inflammatory indicators, with high safety. However, the literature included in this study is generally of low methodological quality, and the conclusion needs to be verified by high-quality research.
Capsules ; China ; Drugs, Chinese Herbal/adverse effects* ; Humans ; Network Meta-Analysis ; Nonprescription Drugs/therapeutic use* ; Spondylitis, Ankylosing/drug therapy*

BACKGROUND: Secukinumab demonstrated sustained efficacy in patients with ankylosing spondylitis (AS) through 5 years in pivotal Phase III studies. Here, we present efficacy and safety results (52-week) of secukinumab in patients with AS from the MEASURE 5 study. METHODS: MEASURE 5 was a 52-week, Phase III, China-centric study. Eligible patients were randomly assigned (2:1) to receive subcutaneous secukinumab 150 mg or placebo weekly for the first five doses and then once every 4 weeks (q4w). All placebo patients switched to secukinumab 150 mg q4w starting at Week 16. Primary endpoint was Assessments of SpondyloArthritis international Society (ASAS) 20 at Week 16. Randomization was stratified by region (China vs. non-China). RESULTS: Of 458 patients (secukinumab 150 mg, N = 305; placebo, N = 153) randomized, 327 (71.4%) were from China and 131 (28.6%) were not from China. Of these, 97.7% and 97.4% patients completed Week 16 and 91.1% and 95.3% (placebo-secukinumab) patients completed Week 52 of treatment. The primary endpoint was met; secukinumab significantly improved ASAS20 response at Week 16 vs. placebo (58.4% vs. 36.6%; P < 0.0001); corresponding rate in the Chinese population was 56.0% vs. 38.5% (P < 0.01). All secondary efficacy endpoints significantly improved with secukinumab 150 mg in the overall population at Week 16; responses were maintained with a trend toward increased efficacy from Week 16 to 52. No new or unexpected safety signals were reported up to Week 52. CONCLUSIONS: Secukinumab 150 mg demonstrated rapid and significant improvement in signs and symptoms of AS. Secukinumab was well tolerated and the safety profile was consistent with previous reports. Efficacy and safety results were comparable between the overall and Chinese populations. TRIAL REGISTRATION ClinicalTrials.gov, NCT02896127; https://clinicaltrials.gov/ct2/show/NCT02896127?term=NCT02896127&draw=2&rank=1.
Antibodies, Monoclonal/therapeutic use* ; Antibodies, Monoclonal, Humanized ; China ; Double-Blind Method ; Humans ; Spondylitis, Ankylosing/drug therapy* ; Treatment Outcome

To investigate the efficacy of Huangqin Qingre Chubi Capsules(HQC) in patients with ankylosing spondylitis(AS) and its effect on oxidative stress, and to explore its possible mechanism. Fifty-eight cases of AS patients were randomly divided into HQC group and salazosulfapyridine(SASP) group. Another 30 healthy people were employed as a control group. Superoxide dismutase(SOD), total antioxidant capacity(TAOC), malondialdehyde(MDA), lipid peroxidatio(LPO), interleukin-1β(IL-1β), IL-10, IL-4, and tumor necrosis factor-α(TNF-α) were detected by ELISA. The mRNA expression levels of AMP-activated protein kinase(AMPK-α), forkhead box O3a(FOXO3a), manganese superoxide dismutase(MnSOD), and peroxisome proliferator-activated receptor gamma(PPARγ) were detected by Real-time fluorescence quantitative polymerase chain reaction(RT-qPCR). The protein expression levels of AMPK-α, FOXO3a, p-FOXO3a, MnSOD, and PPARγ were detected by Western blot. A questionnaire was used to evaluate the disease activity score and observe the clinical efficacy of HQC in AS patients. The levels of MDA, LPO, TNF-α, and IL-1β were significantly increased in the peripheral blood of AS patients, and SOD, TAOC, IL-4, IL-10 levels were significantly decreased. After HQC treatment, scores of disease active indexes were all decreased, and its clinical efficacy was significantly higher than that in SASP group. After HQC treatment, TAOC, SOD, IL-4, IL-10 were increased and MDA, LPO, TNF-α, IL-1β were decreased; mRNA levels of AMPK-α, FOXO3a, MnSOD, PPARγ and protein levels of AMPK-α, FOXO3a, p-FOXO3a, MnSOD, PPARγ were increased(P<0.01 or P<0.05). HQC can effectively improve the clinical symptoms and oxidative stress of AS patients, and its mechanism may be related to activating PPARγ and up-regulating AMPK/FOXO3a signal pathway.
AMP-Activated Protein Kinases/metabolism* ; Capsules ; Drugs, Chinese Herbal/therapeutic use* ; Forkhead Box Protein O3/metabolism* ; Humans ; Oxidative Stress ; PPAR gamma/metabolism* ; Scutellaria baicalensis/chemistry* ; Signal Transduction ; Spondylitis, Ankylosing/drug therapy* ; Sulfasalazine/therapeutic use*

OBJECTIVE: To analyze the indications and dominant diseases of the spreading moxibustion therapy. METHODS: By retrieving 7 databases of both Chinese and English version, such as CNKI, WANFANG, VIP and PubMed, the eligible articles of randomized controlled trials (RCTs) treated with spreading moxibustion therapy were collected. The number of annual publications, the number of each disease system, the indications and dominant diseases involved in the related articles were analyzed statistically, as well as the number of cases and the corresponding clinical effective rates. RESULTS: A total of 182 articles were included, including 40 indications for the spreading moxibustion and covering 9 major disease systems. Specially, the indications in the motor system were maximal in number, accounting for 17.50% (7/40) of the total number of indications. The number of indications in the digestive system was on the second top, accounting for 15.00% (6/40). The dominant diseases were mainly distributed in motor system, respiratory system, nervous system and gynecological system. There were 3 dominant diseases in motor system, i.e. ankylosing spondylitis, back pain and rheumatoid arthritis; 1 dominant disease, i.e. chronic obstructive pulmonary disease in the respiratory system, 1 dominant disease, i.e. primary dysmenorrheal in the gynecological system and 1 dominant disease, i.e. post-stroke paralysis in the nervous system. CONCLUSION At present, the indications of the spreading moxibustion therapy are widely distributed and the dominant diseases are concentrated, representatively by ankylosing spondylitis. But, the indications and the dominant diseases of spreading moxibustion are changeable dynamically and the disease spectrum of spreading moxibustion needs to be further explored.
Acupuncture Therapy ; Dysmenorrhea ; Female ; Humans ; Moxibustion ; Randomized Controlled Trials as Topic ; Spondylitis, Ankylosing ; therapy

Arthritis of hip joints deteriorates the quality of life in ankylosing spondylitis (AS) patients. Secondary to the articular inflammatory process, the shortened hip-girdle muscles contribute to the decreased joint mobility which may lead to the functional impairment. As the limitation of range of motion (ROM) usually progress slowly, clinicians regard it as a chronic condition and prescribe long-term therapy. However, by short-term intensive multimodal treatment, a 20-year-old man diagnosed as AS with severely limited hip joint ROM who relied on crutches doubled the joint angle and could walk independently only within 2 weeks. The combination included intra-articular steroid injection, electrical twitch obtaining intramuscular stimulation, extracorporeal shock wave therapy, heat, manual therapy, and stretching exercises. The management focused on the relaxation of hip-girdle muscles as well as the direct control of intra-articular inflammation. Hereby, we emphasize the effectiveness of intensive multimodal treatment in improving the function even within a short period.
Arthritis ; Combined Modality Therapy ; Crutches ; Exercise ; Hip Joint ; Hip ; Hot Temperature ; Humans ; Inflammation ; Joints ; Muscle Relaxation ; Muscles ; Musculoskeletal Manipulations ; Quality of Life ; Range of Motion, Articular ; Relaxation ; Shock ; Spondylitis, Ankylosing ; Young Adult

OBJECTIVE: To compare the clinical efficacy between herb-separated moxibustion and conventional moxibustion on ankylosing spondylitis (AS) based on oral administration of sulfasalazine enteric-coated tablets. METHODS: A total of 64 patients with AS of cold-dampness obstruction type were randomly divided into an herb-separated moxibustion group and a conventional moxibustion group, 32 cases in each one. Based on oral administration of sulfasalazine enteric-coated tablets, the patients in the conventional moxibustion group were treated with moxibustion at the area with Dazhui (GV 14) to Changqiang (GV 1) as center and about 10 cm in width; the moxibustion was given for 1 hour. In the herb-separated moxibustion group, the gauze was soaked in the medicinal liquor and ginger juice, and placed on the same moxibustion area as the conventional moxibustion group, followed by moxibustion for 1 hour. The treatment in the two groups was given once a week, three treatments constituted a course and totally three courses were given. The symptom quantification score, occipital-wall distance, Schober test, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels were observed before and after treatment in the two groups, and the clinical efficacy was evaluated. RESULTS: Compared before treatment, the symptom quantification score, occipital-wall distance, CRP and ESR levels were lower but the Schober test was higher after treatment in the two groups (all <0.05). The symptom quantification score, Schober test, CRP and ESR levels in the herb-separated moxibustion group were superior to those in the conventional moxibustion group (all <0.05), but no significant difference was observed on occipital-wall distance (>0.05). The total effective rate was 90.0% (27/30) in the herb-separated moxibustion group, which was higher than 73.3% (22/30) in the conventional moxibustion group (<0.05). CONCLUSION The herb-separated moxibustion combined with sulfasalazine enteric-coated tablets has significant efficacy for AS with cold-dampness obstruction type, which could obviously relieve pain symptoms, improve occipital-wall distance, Schober test and other physical signs, and improve the quality of life.
Acupuncture Points ; Humans ; Moxibustion ; Quality of Life ; Spondylitis, Ankylosing ; therapy ; Sulfasalazine ; Tablets, Enteric-Coated ; Treatment Outcome

OBJECTIVE: To explore the effects and mechanisms of the long-snake moxibustion on ankylosing spondylitis (AS) based on Th17/Treg/Th1 immune imbalance. METHODS: A total of 60 AS patients were randomized into an observation group and a control group, 30 cases in each one. In the observation group, the long-snake moxibustion therapy was used on the acupoints of the governor vessel from Dazhui (GV 14) to Yaoshu (GV 2) as well as the bilateral Jiaji (EX-B 2) alternatively. The moxibustion was given once a day, for 7 days continuously as one course. There were 3 days at the interval between the courses and 4 courses were required. In the control group, the routine western medication was provided, the salazosulfapyridine combined with non-steroidal anti-inflammatory drugs were used, for 7 days continuous as one course. A total of 4 courses of medication were required. The enzyme linked immunosorbent assay (ELISA) was adopted to determine the levels of interleukin-6 (IL-6), interleukin-17 (IL-17), interleukin-23 (IL-23) and tumor necrosis factor-α (TNF-α). The real-time quantification polymerase chain reaction (RT-PCR) was used to determine the mRNA expressions of the specific transcription factors, FoxP3 and T-bet of the helper 17 cells (Th17), regulatory T cells (Treg) and T helper 1 cells (Th1). The flow cytometry was applied to determine the rates of Treg, Th1 and Th17, as well as the changes of the inflammatory reaction index, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). The therapeutic effects were compared between the two groups. RESULTS: After treatment, the total effective rate was 93.3% (28/30) in the observation group, which was better than 86.7% (26/30) in the control group (<0.05). After treatment, the levels of CRP, ESR, IL-6, IL-17, IL-23 and TNF-α, as well as the rate of Th17 were reduced significantly as compared with those before treatment in the observation group (all <0.05). The mRNA expressions of FoxP3 and T-bet and the rates of Treg and Th1 were increased as compared with those before treatment (all <0.05). The change degree in the observation group was significant as compared with the control group (all <0.05). In the control group, the levels of CRP, ESR, IL-6, IL-17, IL-23 and TNF-α, as well as the rate of Th17 were reduced, and the mRNA expressions of FoxP3 and T-bet and the rates of Treg and Th1 were increased after treatment. But the changes were not significant as compared with those before treatment (all >0.05). CONCLUSION The long-snake moxibustion effectively relieves the clinical symptoms in AS patients and regulates the Th17/Treg/Th1 immune imbalance. Its effect target is probably related to the modulation of the AS immune derangement and the inflammatory responses induced by immune derangement so as to achieve the dual-positive regulatory effect.
Animals ; Humans ; Lymphocyte Count ; Moxibustion ; Snakes ; Spondylitis, Ankylosing ; therapy ; T-Lymphocytes, Regulatory ; Th1 Cells ; Th17 Cells

OBJECTIVETo observe the clinical effect of Chinese medical (CM) syndrome differentiation based Chinese herbs and recombinant human tumor necrosis factor receptor II-antibody fusion protein (etanercept) for treating ankylosing spondylitis (AS) patients.

METHODSTotally 35 AS patients were treated with syndrome differentiation based Chinese herbs and etanercept. Reinforcing Shen and strengthening Du channel, activating meridians to stop pain was principle used in syndrome differentiation based treatment. Etanercept was subcutaneously injected, 25 mg each time; twice per week for the first three months and once a week for the latter three months. The clinical efficacy was evaluated after 3 and 6 months of treatment. Meanwhile, ASAS20 and ASAS50 standards arriving rates were also observed. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), visual analog score (VAS) for spine pain, VAS for night pain, patient global assessment (PGA), VAS for physician global assessment, CM syndrome score, finger-ground distance, thoracic activity, tragus-wall distance, lumbar scoliosis, cervical rotation, Schober improved test, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were observed before treatment, 3 and 6 months after treatment.

RESULTSCompared with before treatment, BASDAI, BASFI, VAS for spine pain, night pain, physician global assessment, PGA, CM syndrome score, finger-ground distance, thoracic activity, tragus-wall distance, lumbar scoliosis, Schober improved test, ESR, and CRP all decreased after 3 and 6 months of treatment, with statistical difference (P < 0.05). Cervical rotation also decreased after 6 months of treatment, with statistical difference (P < 0.05). Compared with 3 months of treatment, total effective rate of CM syndrome, ASAS20 and ASAS50 standards arriving rates increased after 6 months of treatment, with statistical difference (P < 0.05). There were statistical differences in all indices mentioned above between after 3 months of treatment and after 6 months of treatment (P < 0.05).

CONCLUSIONSyndrome differentiation based Chinese herbs combined etanercept could alleviate inflammatory reaction favorably, control the progression of active AS, and improve joint functions.

Disease Progression ; Drugs, Chinese Herbal ; therapeutic use ; Etanercept ; therapeutic use ; Humans ; Pain ; prevention & control ; Pain Management ; Spondylitis, Ankylosing ; drug therapy ; Treatment Outcome