Treatment Of Erigerontis With Leflunomide On Ra And Relationship Between Curative Effect And IL-1β,TNF-α,ET-1,NO

Objective: RA(Rheumatoid arthritis ) is a chronic auto-immunity disease, the chief manifestations indlude chronic,progressive,multiple arthritis. The initial stage manifest synovitis, anaphase manifest cartilage and bone destruction. It's active stage is a peak of inflammtion. So, control the active stage is a key to treatment. Chinese troditional medicine confine RA as " Bi Syndrome "and indiate "blood stasis"is the key to pathogenesis. The article investigates relationalship between active RA and "blood stasis syndrome"; observes Herba Erigerontis(HEr)'s enhancing-effection to Leflunomide (LEF) and investigates it's function mechanism.Method: 60 patients with active RA were randomly divide into controled group and treatment group.The controled group received LEF(20mg.d-1.po).The treatment group received LEF and HEr(40ml. d-1.VD), 2 weeks is a period of treatment , All the patients were followed up 3 month. At pre-treatment,the 4 th week and the 12 th week observe blood stasis score,morning stiffness time,number of pain joint count,number of swelling joint count,patients evaluation,doctors evaluation,ESR,CRP,RF etc;At pre-treatment and the 12 th week measure the plasma level of Endothelin-1(ET-1),the serum level of Nitric Oxide(NO),Interleukin-1β(IL-1β) and Tumor Necrosis Factor-α(TNF-α). Analize the correlation of blood stasis score,ET-1,NO,IL-1β,TNF-αwith ESR,CRP.Results: (1) Overall response rate:At the 4th week, LEF group's overall response rate is 66.7%(20/30)and 90%(27/30)for HEr+LEF group; At the 12th week, LEF group's overall res-ponse rate is 86.7%(26/30)and 96.7%(29/30)for HEr+LEF group; HEr+LEF group had more great improvement than LEF group, (P<0.05).(2) Improvement of clinical symptoms at the 4th week: Clinical symptoms of the LEF group were improved at post-treatment (P<0.01),other than the blood stasis score had no significance (P>.05);clinical symptoms of the HEr+LEF group were all improved significantly (P<0.01).(3) Improvement of clinical symptoms at the 12th week: the two groups were all improved (P<0.01);there was a significance between the two groups.(4) Improvement of joints function: The LEF group were improved only at the 12 th week; the HEr+LEF group were improved at the 4 th and the 12 th week; there was a significance between the two groups.(5) ET-1,NO,IL-1β,TNF-α: Differences between pre- and post treatment were significant(P<0.01) in the two groups; the HEr+LEF group had a great decrease than the LEF group on blood stasis and inflammtion (P<0.01).(6) Correlations: ESR had correlations with blood stasis score,ET-1,NO,IL-1β,TNF-α(P<0.05); CRP had correlations with blood stasis score,ET-1,NO,IL-1β,TNF-α(P<0.05);blood stasis score at pre- and post treatment had correlations with ESR,CRP,ET-1,NO,IL-1β,TNF-α(P<0.05).(7) Adverse effect: the HEr+LEF group had little adverse effect than the LEF group.Conclusion: (1) Blood stasis syndrom has a close relation- ship with RA and it is the key to RA's pathogenesis.(2) HEr with LEF treatment has a satisfied effect,It indiates that HEr has a enhancing effection on LEF;the follow up observation are still needed.(3) Function mechanism of enhancing effection: modify- ing blood stasis symptoms and reduce the plasma level of ET-1 that can decrease new vessels and pannus.(4) To reduce the serum level of IL-1β,TNF-αthat can inhibit inflammtion.(5) To reduce the serum level of NO that can decrease cartilage destruction.(6) By enhancing LEF's biology utilization and decreasing it's adverse effect that can enhance the tolerance of patients.