Based On OPG/RANKL/RANK System To Explore The Effect Of Heat Clearing And Detoxification Method On Bone Metabolism Of Patients With Active Rheumatoid Arthritis And Its Clinical Efficacy

Objective:Observe the effects of heat-clearing and detoxifying prescriptions on the disease activity and inflammatory indexes of patients with active RA(rheumatoid arthritis),and observe the serum bone metabolism markers nd receptor of Activator of Nuclear Factor-κ B(Receptor of Activator of Nuclear Factor-κB)before and after treatment.RANK/Receptor of Activator of Nuclear Factor-κB Ligand(RANKL)/Osteoprotegerin(OPG)changes,to explore the effects of heat-clearing and detoxifying prescriptions on bone metabolism in RA patients,and Based on the OPG/RANKL/RANK system to explore its possible mechanism of action,it provides new ideas for the treatment of RA with abnormal bone metabolism in Chinese medicine.Methods: Sixty cases of RA patients who met the inclusion criteria in the Department of Rheumatology and Immunology of Shandong Provincial Hospital of Traditional Chinese Medicine from December 2019 to October 2020 were selected as the research objects,and were randomly divided into a control group(30 cases,Iramod tablets + calcium carbonate D3))And the treatment group(30 cases,heat-clearing and detoxifying prescriptions + Ilamod tablets + calcium carbonate D3),and before and after 3 months of treatment,the clinical data and laboratory indicators of the patients were collected,and the patients’ erythrocyte sedimentation rate(ESR)before and after treatment were monitored.C-reactive protein(CRP),rheumatoid factor(RF),anti-cyclic citrulline antibody(anti-CCP antibody),serum osteocalcin(bone glaprotein BGP),Nterminal propeptide of typeⅠcollagen PINP),β-collagen special series(Cterminal telopeptide β-CTX)and liver and kidney function indexes,using dual-energy X-ray method to detect the bone mineral density of the patient’s femoral neck,lumbar spine and forearm,and collect the patient’s serum before and after treatment,and apply enzyme-linked immunosorbent Method to determine the serum RANKL and OPG levels of patients.Results:(1)A total of 29 cases were in the control group,0 cases were clinically controlled,7 cases were markedly effective,19 cases were effective,and3 cases were ineffective.The total effective rate of the control group was89.7%,and there were 30 cases in the treatment group,0 cases were clinically controlled,10 cases were markedly effective,and effective.There were 17 cases and 3 cases were ineffective.The total effective rate of the treatment group was 90.0%.There was no significant difference between the two groups in total effective rate.(2)After treatment,RSR,CCP,RF,and CRP of the two groups of RA patients were significantly reduced compared to before treatment(P<0.05).The treatment group was better than the control group in reducing ESR and CRP(P<0.05),and CCP was reduced There is no significant difference between the two in terms of RF and RF.(3)The DAS28-ESR scores of the two groups of RA patients after treatment were significantly lower than before treatment,and the disease activity of the treatment group was lower than that of the control group(P<0.05),and the treatment group was better than the treatment in reducing disease activity group.(4)The symptoms of morning stiffness,joint swelling,unfavorable joint flexion and extension,joint fever,joint pain and joint tenderness of the two groups of patients improved significantly after treatment(P<0.05),and the treatment group improved symptoms and TCM syndrome scores Better than the control group.(5)Serum β-CTX and RANKL concentrations of the two groups of patients decreased significantly after treatment(P<0.05),and the levels of PINP and BGP were significantly higher than before(P<0.05).The treatment group was superior in reducing β-CTX and RANKL.In the control group(P<0.05),the OPG/RANKL ratio of the two groups increased significantly after treatment,and the treatment group was better than the control group in increasing the OPG/RANKL ratio(P<0.05).(6)The changes in bone mineral density of the left hip joint,lumbar spine and forearm between the two groups before and after treatment were not statistically significant(P>0.05).Conclusion: The heat-clearing and detoxifying prescriptions can significantly reduce the inflammatory indexes of RA patients,reduce the disease activity,control the disease,reduce the patients’ joint symptoms,reduce the patients’ TCM syndrome scores,and have a definite therapeutic effect.The heat-clearing and detoxifying prescriptions can significantly reduce serum β-CTX levels in RA patients,increase PINP,BGP,reduce RANKL levels,increase OPG/RANKL ratio,reduce osteoclast activity,reduce bone resorption,and improve bone metabolism in RA patients.