Relationship Between TCM Syndrome Differentiation Of Rheumatoid Arthritis And Interstitial Lung Disease

Objective:To investigate the relationship between TCM different syndromes and incidence of interstitial lung disease(ILD) in rheumatoid arthritis (RA), in order to early discover the interstitial lung disease of RA.Methods:Based on the TCM symptoms diagnostic code of RA,76 RA patients were sorted to 4 types of groups:the Stagnancy of cold-dampness type, the Stagnancy of heat-dampness type, the cold-heat complicated syndrome type, and the deficiency of both the liver and kidney with stagnancy of sputum-blood type. According to HRCT of baenosome, patients are divided into 2 groups:non-ILD and RA-ILD. And the prevalence, characteristics and correlation examination in different syndromes and groups are compared accordingly.Results:Age, morning stiffness, joint function grading, the content of ESR and RF in RA-ILD were highly significantly higher than the non-ILD (P<0.01). Joint X-ray grading, the content of CRP and IgA were significantly higher than the non-ILD (P<0.05).The levels of HA and PcⅢwere highly significantly higher than the non-ILD (P<0.01).Ⅳ·C were significantly higher than the non-ILD (P<0.05). The levels of VC, MVV and DLCO in lung function tests were also had highly significant difference between non-ILD and RA-ILD (P<0.05). Take the HRCT as gold standard, saitivity of Pectoral X-ray is 60%, specificity is 93.55%.Inception rate of the patients who have deficiency of both the liver and kidney with stagnancy of sputum-blood was significantly higher than other syndromes(P<0.01), and appearance of HRCT is the most serious.Conclusions:(1)The symptoms of RA-ILD are not typical nor obvious. Cough, stethocatharsis and chest distress after daily activities are the main symptoms. Physical signs, such as Velcro and achropachy are often not appeared in early stage. (2)The levels of HA, PcⅢandⅣ·C were highly significantly higher than the non-ILD indicates that HA, PcⅢandⅣ·C may have effect of pathopoiesis effect. The index of fibrous degeneration may be used to evaluate pathogenetic condition and to estimate prognosis. Lung function tests indicate that RA-ILD patients mostly have restrictive ventilatory disorder. Diffusion function usually decreases in earlier period. To diagnose interstitial lung disease, HRCT is better than X-ray, especially in earlier diagnosis. (3) Possible high risk group of RA-ILD are those patients whose age, morning stiffness, joint function grading, joint X-ray grading, the content of ESR, CRP, RF, and IgA are higher; TCM syndrome as deficiency of both the liver and kidney with stagnancy of sputum-blood is also the high risk group.