The Objective Study Of Rheumatoid Arthritis With Damp-heat Impeding And Cold-damp Impeding Pattern Of Syndrome In Traditional Chinese Medicine (TCM)

BackgroundRheumatoid arthritis (RA) is a chronic autoimmune disease characterized by jointswelling, synovial inflammation and cartilage destruction. So far, the pathogenesis andinflammation process of RA have not been elucidated. In Traditional Chinese Medicine(TCM), RA is a kind of arthromyodynia (BIZHENG in Mandarin) and its symptoms areanalogous to ‘LIJIEBING’,‘FENGSHI’,‘HEXIFENG’ in ancient Chinese books. Thediagnostic criteria of arthromyodynia could not meet the demand for clinical practice ofWestern Medicine, and easily lead to misdiagnosis. Now there is no standardized criteri forRA ZHENG. In China, TCM clinicians treat RA patients according to ZHENGidentification combined with their clinical experiences. Therefore, there are significantdifferences in therapeutic effect.Objective researches on TCM syndrome type of RA have been initially explored andacquired some preliminary results, but lack systemic and scientific investigation. Clinicalstudies demonstrate that the damp-heat and cold-damp impeding ZHENG are most commonin RA classification of TCM. According to preliminary statistics, damp-heat and cold-dampimpeding ZHENG were accounted for81.5%of all RA patients admitted to our department.So, it is important to study damp-heat and cold-damp impeding ZHENG of RA.Clinical data of RA patients with damp-heat and cold-damp impeding ZHENG werecollected. The disease activity, inflammatory and immunogical parameters between the twoRA ZHENG were measured by corresponding methods. We analyzed their correlations andvariabilities, and attempt to build a kind of new classification criteria of TCM syndromepattern in RA.ObjectiveThe objective regularity between damp-heat impeding and cold-damp impeding ZHENG of RA with TCM will be analyzed and explored.MethodsClinical data and serum of inpatients and outpatients with RA were collected. Thedisease activity scores (DAS) were calculated and laboratory data including C-reactiveprotein (CRP), erythrocyte sedimentation rate (ESR), albumin (ALB), globulin (GLB) andblood cell count in patients with RA were tested by conventional methods. Meanwhile,rheumatoid factor (RF) and anti-keratin antibody (AKA) were measured by immuneturbidimetry, indirect immunofluorescence, respectively. The anti-cyclic citrullinatedpeptides (anti-CCP), glucose-6-phosphate isomerase (GPI), tumour necrosis factor-alpha(TNF-α), interleukin-1β (IL-1β), matrix metalloproteinases-3(MMP-3) and tissueinhibitors of matrix metalloproteinases-1(TIMP-1) were determined by enzyme-linkedimmunosorbent assay (ELISA). The expression and mean fluorescence intensity (MFI) ofCD147and CD14on monocytes were tested by flow cytometry. All data were analyzed bySPSS13.0software. The ROC curve and unconditional multi-factorial Logistic regressionanalysis was performed for clinical parameters.Results1The levels of DAS28scores, ESR, CRP, white blood cell counts (WBC) and platelet(PLT) of RA patients with dampness-heat impeding pattern was significantly higher thancold-dampness impeding pattern (P <0.01). The levels of serum GLB of RA withdampness-heat impeding pattern was obviously higher than cold-dampness impedingpattern and control group (P <0.01), while the ALB level showed opposite tendency.2Compared to dampness-heat impeding pattern, the sequences below ROC curve wereranked as DAS28score> ESR> CRP> GLB> PLT> WBC. ALB was the only index ofdiagnostic value for cold-dampness impeding pattern and the area below the curve was0.636(P=0.000), when cold-dampness impeding pattern was selected as positive control.3The four indicators (RF, AKA, anti-CCP, GPI) showed no significant differencesbetween dampness-heat and cold-dampness bi-syndrome of RA (P>0.05), but there is apositive correlations between anti-CCP, GPI, RF and joint tender counts, swelling counts,morning stiffness times, DAS28(4) and CRP (P <0.01), as well as the coefficients ofcorrelation less than0.5.4The level of serum MMP-3and the expression intensity of CD147on monocyte with dampness-heat impeding pattern in RA were obviously higher than that of cold-dampnessimpeding pattern and control group (P <0.05). The concentration of serum TIMP-1washigher than that of control group (P <0.05), while there was no difference between the twopattern syndromes. The percentage of peripheral blood monouclear cells withdampness-heat impeding pattern in RA was obviously less than that of cold-dampnessimpeding pattern and control group (P <0.05).5Logistic regression analysis showed that the variables including ESR, WBC, CRP,joint heated, joint cold, thirst, sweating, aversion to wind and cold, and cold limbs wereused to distinguish damp-heat impeding from cold-damp impeding pattern of syndrome.The logistic formula about the two pattern of syndrome of TCM with RA wasIt wasprobably damp-heat impeding medical pattern if P value>0.5, otherwise to be cold-dampimpeding medical pattern. The accuracy rate was90.2%.Conclusion1These seven indicators such as DAS28score, CRP, WBC, ESR, PLT, GLB and ALBare helpful to identify the differences between damp-heat impeding and cold-dampimpeding pattern of RA syndrome.2Above indicators could provide diagnostic value for distinguishing damp-heatimpeding from cold-damp impeding pattern by ROC curve.3These diagnostic indicators, including anti-CCP, RF, GPI and AKA, could not beidentified between dampness-heat and cold-dampness pattern.4The higher concentration of serum MMP-3in dampness-heat impeding pattern withRA easily result in cartilage and bone destruction, the increase of CD147expression onCD14+monocytes and the decrease of CD14+monocytes percentage of peripheral bloodfrom RA patients might be the consequence of inflammation high disease activity andmonocytes migration in synovial membrane tissue.5The quantitive diagnosis formula based on Logistic regression analysis might beuseful for clinical diagnosis of the two traditional Chinese pattern of syndrome in RA.