三九穴位贴敷减少类风湿关节炎复发临床疗效观察

Clinical observation on the therapeutic effect of Sanjiu acupoint application to reduce the recurrence of rheumatoid arthritis

目的观察三九穴位贴敷疗法减少类风湿关节炎(rheumatoid arthritis,RA)复发临床疗效。方法纳入2021年12月至2022年6月在重庆市中医院风湿科接受三九贴治疗的缓解期28个关节疾病活动度评分(DSA28)<2.6分RA患者105例,随机数字表分为对照组53例,治疗组52例,对照组口服甲氨蝶呤(通化茂详制药有限公司,H22022674)7.5 mg,1次/周,叶酸(天津力生制药有限公司,H12020215)5 mg,1次/周,来氟米特(爱若华,H20000550)10 mg,1次/d;治疗组在对照组口服治疗的基础上采用三九穴位贴敷外用,随访3个月。观察两组患者疾病复发率及DSA28,视觉模拟评分(VAS)、健康评估问卷(HAQ)评分、28个肿胀关节数(28SJC)、28个压痛关节数(28TJC)、血沉(ESR)、C反应蛋白(CRP)及不良反应情况。结果对照组、治疗组患者复发率分别为24.5%、9.6%,干预后两组患者DSA28评分,ESR、CRP指标,关节肿胀、疼痛数目,疼痛及自理能力评分均显著增加;与对照组干预后相比,三九穴位贴敷治疗组上述指标升高不明显。两组患者治疗期间均未出现不良反应。结论三九穴位贴敷疗法干预后可能通过降低ESR、CRP水平,减轻患者关节肿胀、疼痛症状,改善患者VSA、HAQ评分,降低DAS28增高幅度,从而减少RA复发。

Objective To observe the clinical efficacy of Sanjiu acupoint application to reduce the recurrence of rheumatoid arthritis(RA).Methods 105 RA patients who received Sanjiu acupoint application at the Rheumatology Department of Chongqing Traditional Chinese Medicine Hospital from December 2021 to June 2022 and had a joint disease activity score(DSA28)<2.6 were randomLy divided into a control group of 53 cases and a treatment group of 52 cases.The control group received 7.5 mg of methotrexate(Tonghua Maoxiang Pharmaceutical Co.,Ltd.,H22022674)orally once a week,and folic acid(Tianjin Lisheng Pharmaceutical Co.,Ltd.,H12020215)5 mg once a week,Leflunomide(Irowa,H20000550)10 mg,once a day;On the basis of oral treatment in the control group,the treatment group was treated with external application of Sanjiu acupoints,followed up for 3 months.The disease recurrence rate and DSA28,visual analogue scale(VAS),health assessment questionnaire(HAQ)score,28 swollen joints(28SJC),28 tenderness joints(28TJC),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),and adverse reactions of two groups of patients were observed.Results The recurrence rates of patients in the control group and the treatment group were 24.5%and 9.6%respectively.After intervention,the DSA28 scores,ESR and CRP indicators,joint swelling and pain numbers,pain and self-care ability scores of both groups of patients significantly increased;Compared with the control group after intervention,the increase in the above indicators was not significant in the Sanjiu acupoint application treatment group.Both groups of patients did not experience any adverse reactions during the treatment period.Conclusion After the intervention of Sanjiu acupoint application therapy,it may reduce the levels of ESR and CRP,alleviate joint swelling and pain symptoms,improve VSA and HAQ scores,reduce the increase in DAS28,and thus reduce the recurrence of RA.