消痛贴膏辅助治疗活动期类风湿性关节炎寒湿痹阻证临床研究

Clinical Study on Xiaotong Plaster in Adjuvant Therapy for Rheumatoid Arthritis with Cold-Dampness Obstruction Syndrome in Active Stage

目的:观察消痛贴膏辅助治疗活动期类风湿性关节炎寒湿痹阻证的疗效。方法:将104例活动期类风湿性关节炎寒湿痹阻证患者随机分为对照组和观察组各52例。对照组服用美洛昔康片,外用双氯芬酸二乙胺乳胶剂。观察组服用美洛昔康片,外用消痛贴膏。2组均给予心理护理、生活饮食指导、活动指导、用药护理等护理措施。疗程均为2周。治疗前后评定主观疼痛、关节压痛、肿胀程度、关节活动及关节僵硬评分,评价28个关节的疾病活动度指数(DAS28)和健康评价问卷(HAQ)评分,观察治疗期间皮肤刺激反应的发生情况。统计达到美国风湿病学会20%缓解标准(ACR20)及ACR50的患者比例。结果:经2周的治疗,观察组达到ACR20的比例为57.69%,高于对照组的30.54%,差异有统计学意义(P<0.05);观察组达到ACR50的比例为38.46%,高于对照组的17.31%,差异有统计学意义(P<0.05)。2组主观疼痛、关节压痛、肿胀程度、关节活动和关节僵硬评分均较治疗前下降(P<0.01),观察组以上主要症状、体征评分均低于对照组(P<0.01)。2组HAQ评分及DAS28均较治疗前降低(P<0.01),观察组HAQ评分及DAS28均低于对照组(P<0.01)。2组皮肤刺激反应无统计学差异(P>0.05)。结论:在服用美洛昔康片的基础上加用消痛贴膏治疗活动期类风湿性关节炎寒湿痹阻证,可减轻患者的临床症状、体征,控制疾病活动情况,改善功能障碍。

Objective:To observe the curative effect of Xiaotong plaster combined with meloxicam tablets for rheumatoid arthritis with cold-dampness obstruction syndrome in active stage. Methods: A total of 104 cases of patients with rheumatoid arthritis with cold-dampness obstruction syndrome in active stage were randomly divided into the control group and the observation group,52 cases in each group. The control group was given the oral administration of meloxicam tablets and the external application of diclofenac diethylamine emulgel. The observation group was given the oral administration of meloxicam tablets and the external application of Xiaotong plaster. Both groups were given nursing measures,such as mental nursing,guidance of diet,lifestyle and activity,and medication nursing. Both groups were treated for two weeks. Before and after treatment, the scores of subjective pain, joint tenderness, swelling degree, joint motion, and joint stiffness were evaluated;Disease Activity Score in 28 Joints Index(DAS28) and the scores of Health Assessment Questionnaire(HAQ)were evaluated. The incidence of the skin irritative response during treatment was observed. The response rates of American College of Rheumatology 20%(ACR20) response rate and ACR50 response rate were evaluated. Results:After two-week treatment,ACR20 response rate was 57.69% in the observation group,higher than that of 30.54% in the control group,the difference being significant(P<0.05);ACR50 response rate was 38.46% in the observation group, higher than that of17.31% in the control group,the difference being significant(P<0.05). In the two groups,the scores of subjective pain,joint tenderness,swelling degree,joint motion,and joint stiffness were decreased when compared with those before treatment(P<0.01);the scores of the main symptoms and signs above in the observation group were lower than those in the control group(P<0.01). In the two groups,the scores of HAQ and DAS28 Index were decreased when compared with those before treatment(P<0.01);the score and the index in the observation group were lower than those in the control group(P<0.01).When compared the incidence of the skin irritative response between the two groups, there was no significance in the difference(P>0.05). Conclusion: Based on the oral administration of meloxicam tablets, the additional application of Xiaotong plaster can relieve clinical symptoms and signs, control the disease activity, and improve dysfunction in the treatment of rheumatoid arthritis with cold-dampness obstruction syndrome in active stage.