EVALUATION OF THE EFECTS OF ELECTRONIC ACUPUNCTURE COMBINED WITH “TAM TY THANG” REMEDY IN THE TREATMENT OF RHEUMATOID ARTHRITIS BY WIND-COLD-DAMP

Objectives: To assess the effect of electronic acupuncture combined with “Tam ty thang” remedy in the treatment of rheumatoid arthritis by wind-cold-damp. Materials and methods: prospective study, comparing before and after treatment, including 43 patients who were diagnosed with rheumatoid arthritis by wind-cold-damp according to traditional medicine. Results: good level occupied 69,8%, and fair good level occupied 30,2%.The improved motor function accounted for 95.3%, to relieve pain up to 95,3%, reducing inflammation of VSS in 1 hour at the moment No 31,65, N28 17,88. The improvement in the level of activity of the hand reached 48,8% for good level. Conclusions: The method of electronic acupuncture combined with “Tam ty thang” remedy have a good effect in the treatment of rheumatoid arthritis by wind-cold-damp and it didn’t cause significantly side effects in clinic. Key words: rheumatoid arthritis, electronic acupuncture, “Tam ty thang” remedy

CLINICAL CHARACTERISTICS AND DETERMINE THE CONCENTRATIONS OF AUTOBODIES AND CYTOKINES IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background: Rheumatoid arthritis is an autoimmune disease with complex pathophysiological mechanisms, in which cytokines plays an important role. Currently, based on the understanding of the cytokines, the treatment of rheumatoid arthritis with biological agents had changed the course of the disease. Objectives: Study the clinical characteristics and determine the concentrations of autoantibodies (RF, Anti CCP) and cytokines (IL-1α,IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, VEGF, IFN-γ, TNF-α, MCP1, EGF) in patients with rheumatoid arthritis, simultaneously, evaluate the correlation between the cytokines concentrations and levels of autoantibodies in patients with rheumatoid arthritis treated at Cho Ray Hospital.Subjects and Methods: Descriptive cross-sectional study conducted in 76 patients with rheumatoid arthritis treated at Cho Ray Hospital form June 2013 to April 2014.Results: - Clinical and laboratory characteristics: The most common clinical manifestations are arthritis (98.7%), symmetry joint damage (96.1%), morning stiffness over 1 hour (90.8%). Subcutaneous nodule is accounted for 3.9%. The most common joints involved in rheumatoid arthritis are wrist (93.4%), MCP and knee (90.8%), PIP (76.3%) and ankle (67.1%), the least common is the hip (14.5%). The percentage of autoantibodies and cytokines: rheumatoid arthritis patients with positive results of anti – CCP is accounted for 86%. rheumatoid arthritis patients with increased IL-1α concentrations is accounted for 40,8%; increased IL-1β concentration in 48.7%; increased IL-2 concentration in 32,9%; increased IL-4 concentration in 86%; increased IL-6 concentration in 100%; increased IL-8 concentration in 39,5%; increased IL-10 concentration in 81,6%; increased VEGF concentration in 51,3%; increased IFN-γ concentration in 67,1%; increased TNF-α concentration in 61,8%; increased MCP1 concentration in 30,3%; increased EGF concentration in 39,43%. The average concentrations of cytolines in rheumatoid arthritis patients is as followings: IL-1α (57.36 ± 196.43), IL-1β (123.77± 532.51), Il-2 (279.93 ± 945.04), IL-4(279.93 ± 945.04), IL-6(91.35 ± 170.52), IL-8(270.84 ± 445.45), IL-10(134.58 ± 496.14), VEGF(638.87 ± 540.18), IFN-γ(136.43 ± 338.68), TNF-α(106.27 ± 265.57), MCP1(292.34 ± 265.52), EGF(152.62 ± 123.64).RF is correlated with IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-10, IFN-γ, and TNF-α. Anti – CCP is correlated with IL-1α, IL-6. Key words: Rheumatoid arthritis, cytokines

Painful Rheumatoid Arthritis

Rheumatoid arthritis is a crippling disease that is often associated with severe pain, suffering, and diminished function, thereby detracting from an optimal quality of life. Over the past decade a greater appreciation of the pathophysiology of rheumatoid arthritis has been gained. In the past “decade of pain research,” biologic agents which may modify rheumatoid arthritis have emerged as potent therapeutic antirheumatic drugs. Biologic agents include 5 tumor necrosis factor alpha inhibitors (etanercept, infliximab, adalimumab, golimumab, certolizumab pegol), interleukin-1 blockers (anakinra), monocloncal antibodies against B cells (rituximab), T cell costimulation blocker (abatacept), and interleukin-6 inhibitors (tocilizumab). Currently, utilizing therapy aimed at targeting various abnormalities of rheumatoid arthritis may be possible. It appears that the combined use of etanercept and methotrexate may improve the imbalance of Th1/Th2 and Th17/regulatory T cells (Treg) (and related cytokines) often seen in rheumatoid arthritis. Furthermore, this improvement in Tcell ratios/cytokines is also associated with improvement in clinical indicators of rheumatoid arthritis severity. Although rheumatologists are generally the specialists “called on” to manage complex patients with rheumatoid arthritis, pain specialists may be asked to join interdisciplinary teams managing patients with advanced refractory rheumatoid arthritis with severe pain since one of the most common and debilitating symptoms of rheumatoid arthritis is pain. Thus, pain specialists should have some appreciation of the current thoughts regarding rheumatoid arthritis pathophysiology and treatment. This narrative review of rheumatoid arthritis is intended to familiarize the interventional pain specialist with current concepts surrounding rheumatoid arthritis. Key words: Rheumatoid Arthritis, Pain, DMARDs, biological agengs, TNF inhibitors

Biological Agents in the Treatment of Rheumatoid Arthritis

Rheumatoid arthritis (RA) is the commonest joint disease with considerable morbidity and mortality. Conventional disease modifying antirheumatic drugs like methotrexate form the cornerstone of therapy. These drugs have several limitations in terms of slow onset of action, adverse effects and modest remission rates. Several cytokines are involved in the pathogenesis of RA. Biological agents that specifically inhibit the effects of tumour necrosis factor-alpha (TNF-a) or interleukin-1 (IL-1) represent a major advancement in the treatment of RA. By targeting mediators that are directly involved in the pathogenesis of RA, these agents slow the radiological progression of bone and cartilage damage in joints, prevent or delay the onset of disability. These are highly specific and better tolerated. The use of these biological agents needs careful monitoring for side effects, including the development of infection. Additional anti-cytokine agents for the treatment of RA are under further development. Key words: Rheumatoid arthritis; biological agents; inflammatory cytokine. DOI: 10.3329/jbsp.v29i1.7168J Bangladesh Coll Phys Surg 2011; 29:27-31