Research On The Efficacy Of Sinomenine In Treating Rheumatoid Arthritis With Cold-dampness Blocking Collaterals And The Mechanism Of Bone Destruction

Objective:To observe the efficacy of sinomenine(SIN)combined with Methotrexate(MTX)in the treatment of early rheumatoid arthritis(RA)with cold dampness bi resistance type(CDBR)and its effects on the expressions of matrix metalloproteinase-3(MMP-3)and activator of receptor activator of nuclear factor kappa B ligand(RANKL)/osteoprotegerin(OPG).Methods:Sixty-eight patients with early RA were selected and divided into the treatment group and the control group according to random digit table,with 34 case in each group.The patients in the control group were treated with MTX,and the patientes in the treatment group were treated with SIN combined with MTX,with a course of 12 weeks.The clinical effect was evaluated by American College of Rheumatology(ACR)20,50,70 criterion,efficacy for Chinese medicine(CM)syndromes and the levels of rheumatiod facter(RF),anti-cyclic peptide containing citrulline(anti-CCP)Erythrocyte Sdimentation Rate(ESR)an C-Reactive Proteind(CRP)and expressions of serum levels of MMP-3,OPG and RANKL were detected.Results:After treatment,the standard arriving rates of ACR20 50 70 in the treatment group were 76.7%,40.0% and 3.3% respectively,and the standard arriving rates in the control group were 34.5%,20.7% and 6.9% respectively.The standard arriving rate of ACR20 in the treatment group was higher than that in the control group(P<0.01).The effective rate of CM syndrome was 96.67% in the treatment group,higher than that in the control group(72.41%,P<0.05).After treatment the levels of RF,ESR and CRP in the treatment group were decreased(P<0.01),and there were no statistical differences on the levels of RF,ESR and CRP in control group between before and after treatment(P>0.05);between the two groups on the D-value of the levels of RF,ESR and CRP between before and after treatment(P<0.01),and the importent of above indexes in the treatment group was better than that in the control group;there were no statistical differences in the data of the level of anti-CCP.After treatment,the levels of MMP-3and RANKL in the treatment group were decreased(P<0.01,P<0.05),and the levels of OPG and the radio of OPG/RANKL between before and after treatment(P<0.01,P<0.05);the levels of MMP-3 in the control group was also decreased(P<0.05);there were statistical differences between the two groups on the D-value of the levels of OPG and RANKL and the radio of OPG/RANKL between before and after treatment(P<0.01,P<0.05),and the importent of above indexes in the treatment group was better than that in the control group.There were Hemoglobin reduction occurred in 1 case of the control group.Aggravation of joint symptoms and withdraw the test occurred in 4case of the treatment group and 4 cases of the control group.Conclusion:SIN combined with MTX can improve the clinical symptoms of patients with early RA,and regulate the level of MMP-3 and RANKL/OPG systems,which may be one of the mechanisms for its inhibiting bone erosion and promoting bone protection.