Clinical Observation Of Buyang Huanwu Decoction Combined With Total Knee Arthroplasty In The Treatment Of The Advanced Rheumatoid Arthritis

Objective:By observing the clinical effect of Buyang Huanwu Decoction combined with total knee arthroplasty in the treatment of the advanced rheumatoid arthritis,it provides a clinical reference and method for the perioperative treatment of the advanced rheumatoid arthritis.Methods:From October 2020 to October 2022,64 cases of advanced rheumatoid arthritis(RA)were selected in the second Department Traumatology of the First Affiliated Hospital of Anhui University of Chinese Medicine,and the cases were spilt into control group(32 cases)and experimental group(32 cases).All cases were subjected to total knee arthroplasty surgery(TKA).And after surgery,the control group cases routinely were treated with pain relief,swelling,infection prevention,thrombosis prevention,rehabilitation training,etc.On the second day after surgery,the experimental group cases added Chinese medicine Bu Yang Huan Wu Decotion for 1 month.The Hospital For Special Surgery Knee Score(HSS)、Visual Analogue Scale(VAS)were evaluated before surgery and 1 week 、 1 month after surgery.Besides,the levels of Erythrocyte Sedimentation rate(ESR),C-reactive protein(CRP),Rheumatoid Factor(RF)of the cases were measured before surgery,3 days 、1 week and 1 month after surgery.And the patient’s liver and kidney function and imaging review was measured before surgery and 3 days、1 month after surgery,and during the drug taking whether nausea and vomiting occurred were recorded,and all abnormalities were included in adverse events.All data statistically analysed can provide a result of clinical efficacy of this method.Results:1.All patients finally completed this study,and there were no adverse events,such as abnormal liver and kidney function,and loosening of postoperative prosthesis during the study.2 cases in the experimental group showed mild nausea and vomiting,and 1case developed mild diarrhea.And there was no significant difference in adverse events between the two groups(p>0.05)2.There were no prominent differences on the two groups’ data,such as gender、age and body mass index(BMI)before surgery(p>0.05),and the influence on the study could be ignored.At the same time,the differences in HSS score,VAS score,ESR,CRP and RF levels between the two groups were statistically significant(p>0.05)and were comparable.3.After treatment,HSS scores of two groups 1 week and 1 month after surgery were higher than those before surgery,presenting a trend of continuous increase,while VAS scores were lower than those before surgery,presenting a trend of continuous decline.Besides,the VAS score of the experimental group was significantly lower than control group at 1 week after surgery(p<0.05),but there was no significant difference at1 month after surgery.Ande there is a significant difference in HSS score of two groups at 1 month after surgery instead of 3 days and 1 week after surgery(p<0.05).4.On the 3rd day and 1 week after surgery,the levels of ESR and CRP of two groups were higher than before surgery and 1 month after surgery,showing a trend of increasing at first and then decreasing.Besides,ESR and CRP levels of two groups were similar at 3 days and 1 week after surgery,with no statistical significance(p>0.05).At the 1 month after surgery,the level of the control group was markedly lower,and the difference was markedly significant(p<0.05).5.The RF level scores on the 3rd day、1 week and 1 month after surgery were lower than those before surgery,showing a trend of continuous decline.The RF level of the experimental group was significantly lower than that of the control group at the time of1 week and 1 month after surgery rather than 3rd day and the difference was statistically significant(p<0.05).Conclusion:1.It is safe to involve Bu Yang Huan Wu Decoction after total knee arthroplasty due to the little adverse effects.2.Although TKA can improve the joint function status of patients with end-stage rheumatoid arthritis,the therapy of Bu Yang Huan Wu Decoction combined with total knee arthroplasty can greaterly relieve RA’s pain,regulate inflammatory response,improve knee joint function after surgery and can be used as an effective combination of integrative treatment.