Clinical research progress of acupuncture therapy in the treatment of ankylosing spondylitis

Ankylosing spondylitis is a chronic inflammatory disease characterized by ankylosis of the spine and sacroiliac joints.The continuous development of this disease can cause damage to multiple organs.At present,modern medical treatment programs generally focus on symptomatic treatment such as analgesia and anti-inflammatory,which can relieve pain and inflammation to a certain extent,but there are many problems such as adverse drug reactions,and cannot be completely cured.Modern medical treatment of ankylosing spondylitis focuses on relieving symptoms,controlling disease activity,slowing disease progression,and reducing disability rates.As an important part of traditional Chinese medicine,acupuncture therapy,compared with modern medicine,has obvious advantages in the treatment of ankylosing spondylitis,such as good curative effect,quick effect,safety and low price,and no toxic and side effects.By reviewing the literature,it is found that there are a large number of clinical studies on the treatment of ankylosing spondylitis by acupuncture and moxibustion in recent years,and it is concluded that acupuncture and moxibustion has unique advantages in reducing local pain,alleviating inflammatory symptoms,improving joint function,preventing spinal deformity,and improving quality of life.Therefore,this study summarizes and reviews the relevant literature on different acupuncture and moxibustion therapy for ankylosing spondylitis,in order to provide ideas and solutions for the effective treatment of this disease.

Treatment of ankylosing spondylitis by fire-needle therapy plus tuina manipulations

Objective：To observe the clinical effect of fire-needle therapy plus tuina manipulations for ankylosing spondylitis （AS）. 〈br〉 Methods：A total of 49 eligible cases were treated by fire-needle therapy plus tuina manipulations, once every other day. Ten days made one course. After the continuous treatment for six courses, the therapeutic effects were summarized and the changes in the clinical symptoms and signs were observed. 〈br〉 Results：During treatment, 7 cases dropped off. In 42 patients who had completed treatment for six courses, the results showed clinical recovery in 16 cases, remarkable effect in 13 cases, effect in 7 cases and failure in 6 cases. The measurements of the patients were all improved in different degrees than those before treatment. Moreover, no side effect was noticed during treatment. 〈br〉 Conclusion：The therapeutic effect is precise and free of adverse reaction in treatment of AS by fire-needle therapy plus tuina manipulations.

Clinical Observation on Acupuncture-moxibustion Therapy in Treating Ankylosing Spondylitis

Objective： To compare the clinical effects of different acupuncture methods in treating ankylosing spondylitis （AS）. Methods： Sixty patients in accordance with the diagnostic criteria for AS were randomly divided into an observation group （30 cases） and a control group （30 cases）. Patients in the observation group were given warm needling therapy, while that in the control group were treated by electroacupuncture. The effects of the two groups were compared after treatment. Results： The curative rate of the observation group was 40.0%, and the total effective rate was 96.7%; the curative rate of the control group was 10.0%, and the total effective rate was 76.7%. The difference was statistically significant （P〈0.05） Conclusion： As to acupuncture treatment for AS, warming needling moxibustion was significantly more effective than electroacuouncture.

伴与不伴外周关节炎的中轴型脊柱关节炎临床特征及治疗的比较研究

背景尽管中轴型脊柱关节炎(axial spondyloarthritis,axSpA)是一种以中轴脊柱受累为主的慢性炎症性疾病,部分患者仍可能出现外周关节炎。国内外关于伴发外周关节炎的axSpA患者的临床特征和治疗选择研究较少,误诊误治常见。目的比较伴与不伴外周关节炎的axSpA患者在临床特征和治疗选择上的差异,为临床医师提供诊治依据。方法本研究为回顾性研究,连续纳入2016年1月—2022年12月于解放军总医院第一医学中心首次就诊的axSpA患者,根据患者是否伴随外周关节炎分为伴外周关节炎组和不伴外周关节炎组。采用倾向性评分匹配均衡就诊时间,对伴外周关节炎组和不伴外周关节炎组进行1∶3匹配,匹配后456例axSpA患者(伴外周关节炎组和不伴外周关节炎组分别为114例和342例)纳入分析,比较两组间临床特征和治疗选择差异。结果456例axSpA患者中,男性357例,女性99例,中位年龄30.0(IQR:25.0~36.5)岁。相比不伴外周关节炎的axSpA患者,伴外周关节炎的axSpA患者发病年龄较晚[M(IQR):23.0(18.6~31.7)岁vs 21.5(17.0~27.0)岁,P=0.022],病程较短[M(IQR):5.7(1.7~10.5)年vs 7.7(3.5~11.4)年,P=0.024],体质量指数较低[M(IQR):22.3(19.6~25.3)kg/m^(2) vs 23.6(20.7~25.8)kg/m^(2),P=0.01],吸烟比例较低[10.5%(12/114)vs28.4%(97/342),P<0.001],伴随更多的附着点炎和指/趾炎(P均<0.05)。此外,伴外周关节炎的axSpA患者的红细胞沉降率和C反应蛋白(C-reactive protein,CRP)水平更高(P均<0.05)。治疗方面,伴外周关节炎的axSpA患者更少地使用中成药[44.7%(51/114)vs 59.9%(205/342),P=0.005],更多地使用传统抗风湿药(conventional synthetic disease-modifying antirheumatic drugs,csDMARDs)[79.8%(91/114)vs 59.9%(205/342),P<0.001]、生物类药物(biologic disease-modifying antirheumatic drugs,bDMARDs)[40.4%(46/114)vs 21.3%(73/342),P<0.001]和糖皮质激素[9.6%(11/114)vs 0.6%(2/342),P<0.001],更多地联合使用传统和生物类抗风湿药物[30.7%(35/114)vs 9.4%(32/342),P<0.001]或两种以上的csDMARDs用药[43.0%(49/114)vs9.9%(34/342),P<0.001]。多因素Logistic回归分析结果提示,患者发病年龄较小(OR=0.967,95%CI:0.942~0.992,P=0.011)、吸烟(OR=1.745,95%CI:1.030~2.955,P=0.038)、合并葡萄膜炎(OR=2.169,95%CI:1.025~4.592,P=0.043)/银屑病(OR=20.838,95%CI:2.340~185.560,P=0.006)、伴外周关节炎(OR=2.482,95%CI:1.423~4.332,P=0.001)或CRP升高(OR=1.011,95%CI:1.003~1.020,P=0.011)时,医师更倾向于开具有生物类抗风湿药物的处方。结论伴外周关节炎的axSpA患者尽管发病较晚、病程较短,但因为伴随更多的附着点炎、指/趾炎以及较高的炎症指标,往往需要接受多种药物治疗。

国医大师韦贵康“3+X”疗法治疗早期强直性脊柱炎经验浅析

本文通过跟师记录、诊治经验访谈从病-证-机-治-案几方面总结分析韦贵康教授辨治早期强直性脊柱炎的临证经验,发现韦贵康教授治疗早期强直性脊柱炎以虚、瘀、湿为辨证要点,提出了强直性脊柱炎“瘀血不去,肾气难扶,督脉难复”的治疗思想,针对早期强直性脊柱炎的病因构建了手法、中药、锻炼三位一体的“3+X”的综合疗法体系。

基于聚焦解决模式的护理干预对强直性脊柱炎患者情绪及治疗依从性的影响

目的:探讨强直性脊柱炎患者应用基于聚焦解决模式护理干预的效果及其对情绪及治疗依从性的影响。方法:选取2022年1—12月福建医科大学附属三明第一医院风湿内分泌科收治的58例强直性脊柱炎患者,按随机数字表法分为两组,给予对照组(n=29)患者常规护理,给予观察组(n=29)患者常规护理及基于聚焦解决模式的护理干预。观察比较两组心理状态、疼痛度、关节功能、自我效能及治疗依从性。结果:护理后,观察组抑郁自评量表(SDS)与焦虑自评量表(SAS)评分较对照组均显著更低(P<0.05);护理后,观察组Bath强直性脊柱炎功能指数量表(BASFI)与视觉模拟评分法(VAS)评估均显著低于对照组(P<0.05);观察组护理后一般自我效能感量表(GSES)评分及总依从率均显著高于对照组(P<0.05)。结论:强直性脊柱炎患者临床治疗中应用基于聚焦解决模式的护理,可明显改善患者不良情绪与疼痛感,并可提高其治疗依从性与自我效能,使患者能以积极心态主动配合治疗与护理,进而能有效提升其关节功能。

加味附子汤配合督灸治疗少阴证强直性脊柱炎临床观察

目的:观察加味附子汤配合督灸治疗少阴证强直性脊柱炎的临床疗效。方法:选取60例少阴证强直性脊柱炎患者,随机分为两组各30例。对照组予塞来昔布胶囊口服,治疗组在对照组基础上加用加味附子汤配合中医外治法督灸进行辨证治疗。连续治疗3个月,评估两组治疗前后血清血沉(ESR)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)等炎性指标水平及脊柱疼痛评分(VAS)、疼痛时间、晨僵时间等。结果:治疗组总有效率90.00%高于对照组的66.67%,两组比较差异有统计学意义(P﹤0.05);治疗后治疗组血清炎性指标、脊柱疼痛VAS评分、疼痛时间、晨僵时间均较对照组低(P﹤0.05)。结论:少阴证强直性脊柱炎患者采用加味附子汤配合督灸的疗法,能有效降低炎性指标水平,改善临床症状,有益于患者康复。

裴氏消风除湿方治疗强直性脊柱炎临床观察

目的探究裴氏消风除湿方在强直性脊柱炎患者中的临床应用效果。方法选取2020年5月—2022年5月甘肃省人民医院中医二科门诊收治的强直性脊柱炎患者92例进行研究,按随机数字表法均分为两组,各46例。对照组采用塞来昔布治疗,观察组采用塞来昔布联合裴氏消风除湿方治疗。比较两组症状改善情况,T淋巴细胞亚群、炎性因子水平。结果干预前两组各项指标比较,差异无统计学意义(P>0.05),干预后,两组症状改善情况各评分及CD^(8+)、TNF-α、IL-2、IL-4水平均下降,且观察组各项指标低于对照组(P<0.05);干预后,两组CD^(3+)、CD^(4+)、CD^(4+)/CD^(8+)水平均上升,且观察组各项指标高于对照组,差异有统计学意义(P<0.05)。结论裴氏消风除湿方可减轻强直性脊柱炎患者炎症反应,改善机体免疫功能及临床症状。

运动针法配合药物及功能训练治疗强直性脊柱炎的疗效观察

目的观察运动针法配合静脉输注英夫利昔单抗及功能训练治疗强直性脊柱炎的临床疗效及其对患者腰椎活动度、疼痛及血清半乳糖凝集素-3(galectin-3)水平的影响。方法将94例强直性脊柱炎患者随机分为治疗组和对照组,每组47例。对照组采用静脉输注英夫利昔单抗和功能训练治疗,治疗组在对照组基础上采用运动针法治疗。观察两组治疗前后腰椎活动度、Bath强直性脊柱炎病情活动指数(Bath ankylosing spondylitis disease activity index,BASDAI)、视觉模拟评分法(VAS)评分、Bath强直性脊柱炎功能指数(Bath ankylosing spondylitis functional index,BASFI)及血清galectin-3、C反应蛋白(C-reactive protein,CRP)和红细胞沉降率(erythrocyte sedimentation rate,ESR)水平的变化情况,比较两组临床疗效和安全性。结果两组治疗后腰椎活动度及血清galectin-3水平均较同组治疗前显著上升,BASDAI评分、VAS评分和BASFI评分及CRP和ESR水平均显著下降,差异均具有统计学意义(P<0.05)。治疗组治疗后腰椎活动度及血清galectin-3水平明显高于对照组,BASDAI评分、VAS评分和BASFI评分及CRP和ESR水平均明显低于对照组,差异均具有统计学意义(P<0.05)。治疗组治疗后总有效率及治疗期间不良反应发生率分别为89.4%和10.6%,对照组分别为68.1%和31.9%,两组差异均具有统计学意义(P<0.05)。结论运动针法配合静脉输注英夫利昔单抗及功能训练治疗强直性脊柱炎疗效确切,能有效缓解疼痛,提高血清galectin-3水平,降低CRP和ESR水平,且安全性较高。

艾灸疗法联合康复训练对强直性脊柱炎的临床疗效分析

目的进行艾灸疗法联合康复训练治疗强直性脊柱炎(AS)的临床疗效分析。方法选择2021年4月至2023年4月医院收治的72例入院的AS患者作为研究对象,随机分为治疗组、对照组,各为36例。治疗组运用艾灸疗法联合康复训练治疗,对照组使用康复训练治疗,两组分别治疗12周。艾灸疗法每周治疗2次;康复训练每日2 h。治疗12周后比较两组的临床疗效,治疗6、12周比较两组的实验指标(ESR、IL-6、CRP、TNF-α)、各项评分(VAS评分、BASFI评分及BASDAI评分)及Schorber试验、胸廓活动度、枕墙距、指地距。结果治疗12周后,治疗组总有效率为86.11%,高于对照组的63.89%(P<0.05);治疗6、12周后,两组ESR、IL-6、CRP、TNF-α数值,较治疗前均降低(P<0.05),治疗组低于对照组(P<0.05);两组VAS评分、BASFI评分及BASDAI评分,较治疗前均降低(P<0.05),治疗组低于对照组(P<0.05);两组Schorber试验、胸廓活动度数,较治疗前均提高(P<0.05),治疗组改善优于对照组(P<0.05);枕墙距、指地距数值,较治疗前均降低(P<0.05),治疗组改善优于对照组(P<0.05)。结论艾灸疗法联合康复训练治疗AS,在减轻患者临床症状、改善不良体征和实验室指标、控制疾病发展方面疗效确切,值得临床推广。

强直性脊柱炎验案两则

强直性脊柱炎是以中轴关节的慢性炎症为主的风湿免疫性疾病,此病由于起病缓慢隐匿,而且大多数男性病情较重,疾病后期多发生脊柱强直和关节的畸形,对患者的生活质量与生存状态造成明显影响,西医用非甾体抗炎药和肿瘤坏死因子(TNF)拮抗剂治疗,可暂时性缓解疼痛、解决疾病急性期的炎症状态,但停药后易复发,治疗效果经长期观察并不显著。强直性脊柱炎归属于中医学“脊痹”范畴,通过中医药辅助治疗此病,从整体观念出发,因人而异,辨证论治,对证定方,标本兼治,配合中医外治法,效果明显,可使患者的生活质量与生存状态得到明显的改善。

针刺治疗强直性脊柱炎机制的研究新进展

目的研究总结近10年来,针刺疗法在治疗强直性脊柱炎(AS)方面的作用机制。方法运用计算机搜集2017年至2023年期间,收录在中国知网、维普、万方关于针刺疗法治疗AS的临床研究,并进行归纳与整理。结果通过资料发现,针刺疗法治疗AS的作用机制主要体现在调和人体阴阳、调节致炎因子水平、改善病灶局部微循环障碍、维持骨稳态和脊柱、关节活动度等方面。结论随着针刺技术不断更迭,其作用机制的研究也持续深入,更多深层次理论和更为有效临床经验值得研究探讨。

督脉至阳穴埋针治疗强直性脊柱炎临床观察

目的观察督脉至阳穴埋针治疗强直性脊柱炎(AS)的临床效果。方法将永春县中医院、德化县中医院就诊的60例AS患者随机分为两组,观察组30例给予督脉至阳穴或至阳穴附近阿是穴埋针治疗,对照组30例给予华佗夹脊穴普通针刺治疗。治疗1个月后,观察治疗前后主要症状、体征及相关指标的情况。结果通过治疗,两组患者各临床症状、体征及相关指标均有显著改善(P<0.05),观察组在晨僵时间、疼痛NRS评分、关节活动度改善方面较对照组更加明显(P<0.05)。结论督脉至阳穴或至阳穴附近阿是穴埋针治疗能有效改善AS患者晨僵,减缓疼痛,增加胸廓活动度,提高患者生活质量,降低血沉(ESR)、C反应蛋白(CRP)等炎症指标水平,效果确切、持久,患者依从性好。

裴氏乌药甘草二三汤联合龙骨灸治疗强直性脊柱炎临床观察

目的观察裴氏乌药甘草二三汤联合龙骨灸治疗强直性脊柱炎(AS)的临床效果。方法选择肾虚督寒型AS患者100例,按随机数字表法分为对照组和观察组,各50例。对照组选用西药规范治疗,观察组在对照组基础上加用裴氏乌药甘草二三汤联合龙骨灸治疗。治疗4周后,比较两组患者的总有效率、中医证候积分、疾病活动度、炎症指标及患者满意度等。结果观察组总有效率为96.00%(48/50),高于对照组的78.00%(39/50)(P<0.05)。治疗后,观察组中医证候积分、疾病活动度评估指标和炎症指标均明显低于对照组,满意度高于对照组(P<0.05)。结论裴氏乌药甘草二三汤联合龙骨灸治疗AS效果明确,且能够显著提高患者的总满意度。

强直性脊柱炎中医治疗及运动疗法

强直性脊柱炎是一种以侵犯人体脊柱中轴及骶髂关节为主要病变的一种慢性炎症性免疫疾病。现有治疗以减轻症状、延缓病情进展和改善病人生存质量为主,口服中药、中医理疗及运动疗法对强直性脊柱炎疗效显著且不良反应较小,该文将对目前强直性脊柱炎的中医治疗及运动疗法等作一综述。

Therapeutic Observation on Heat-sensitive Moxibustion plus Acupoint Injection for Ankylosing Spondylitis

Objective： To observe the clinical efficacy of heat-sensitive moxibustion plus acupoint injection in treating ankylosing spondylitis （AS）. Methods： Totally 116 subjects with AS were randomized into a treatment group and a control group, 58 each. The treatment group was intervened by heat-sensitive moxibustion plus acupoint injection, and the control was by oral medication. Therapeutic efficacy was evaluated after 3 treatment courses. Results： The markedly effective rate was 38.9% and the total effective rate was 96.6% in the treatment group versus 11.9% and 67.8% in the control group. The markedly effective rate and total effective rate in the treatment group were significantly higher than those in the control group （p〈o.os）. Conclusion： Heat-sensitive moxibustion combining with acupoint injection has better therapeutic efficacy than oral medication in treating AS, and it＇s easy-to-operate without adverse reactions.

Moxibustion on Governor Vessel for ankylosing spondylitis due to kidney yang deficiency:a clinical controlled study

Objective： To observe the clinical effect of moxibustion on Governor Vessel for ankylosing spondylitis（AS） due to kidney yang deficiency.Methods： A total of 60 patients of AS due to kidney yang deficiency were randomly divided into a treatment group and a control group by random digital table, 30 cases in each group. Both of the two groups were treated by oral administration of Sulfasalazine tablets. Additionally, the treatment group was given moxibustion on Governor Vessel, and the control group was given sham moxibustion. The treatment was given once every other day, 4 weeks constituted one course, 2 courses in total. Before treatment, after 1-course and 2-course treatments, the quantified scores of traditional Chinese medicine（TCM） syndromes and the symptoms scores recommended by AS International Society [including Bath ankylosing spondylitis disease activity index（BASDAI）, visual analogue scale（VAS）, Bath ankylosing spondylitis functional index（BASFI） and Bath ankylosing spondylitis metrology index（BASMI）] were respectively observed and recorded, and the change of safety item was monitored. Results： After 1-course and 2-course treatments, the quantified scores of TCM syndromes were obviously improved than those before treatment in the two groups（P〈0.05）, and the score was improved better in the treatment group than that in the control group（P〈0.05）. In comparison within the group, there were no statistical differences between the scores after 1-course treatment and 2-course treatment in the two groups（P〈0.05）. After 1-course treatment, the items of the symptoms scores were improved than those before treatment in the two groups（P〉0.05）. After 2-course treatment, the therapeutic effect was more remarkable in the treatment group, with a statistical difference between the two groups（P〈0.05）. During treatment, no obvious abnormality in all safety items was noticed in the two groups. Conclusion： Moxibustion on Governor Vessel can effectively relieve the clinical symptoms of AS patients, without obvious adverse reaction.

Clinical study of warm needling moxibustion plus intra-articular injection of sodium hyaluronate for hip involvement in ankylosing spondylitis

Objective:To observe the efficacy of warm needling moxibustion plus intra-articular injection of sodium hyaluronate for hip involvement in ankylosing spondylitis(AS).Methods:A total of 60 patients with hip involvement in AS were randomly divided into a control group and an observation group,with 30 cases in each group.The patients in the control group were given an intra-articular injection of sodium hyaluronate,once a week.The patients in the observation group were given additional warm needling moxibustion,once a day,with a 2-day interval after five consecutive days of treatment.After 5 weeks,changes in such indicators as visual analog scale(VAS)score,Harris score,Bath ankylosing spondylitis disease activity index(BASDAI),Bath ankylosing spondylitis functional index(BASFI),serum cartilage oligomeric matrix protein(COMP),interleukin(IL)-17 were observed,and the efficacy was evaluated.Six months after treatment,Bath ankylosing spondylitis radiology index-hip(BASRI-hip)was evaluated.Results:After treatment,the total effective rate in the observation group was higher than that in the control group(P<0.05).After treatment,the VAS scores in both groups were lower than those before treatment(P<0.05),and the score of the observation group was lower than that of the control group(P<0.05).After treatment,the Harris scores of both groups were higher than those before treatment(P<0.05),and the score of the observation group was higher than that of the control group(P<0.05).Six months after treatment,the BASRI-hip score of the control group was higher than that before treatment(P<0.05),while the score of the observation group was not significantly different from that before treatment(P>0.05)and was lower than that of the control group(P<0.05).After treatment,the scores of BASDAI and BASFI of both groups were lower than those before treatment(P<0.05),and the scores of the observation group were lower than those of the control group(P<0.05).After treatment,the levels of serum COMP and IL-17 of both groups were lower than those before treatment(P<0.05),and the levels of the observation group were lower than those of the control group(P<0.05).Conclusion:The efficacy of warm needling moxibustion plus intra-articular injection of sodium hyaluronate for hip involvement in AS is better than the intra-articular injection of sodium hyaluronate alone.This combined approach can alleviate hip pain,improve hip functions,delay the destruction of the hip,prevent AS development,and reduce the levels of serum COMP and IL-17.

Clinical Observation on Long Snake Moxibustion for Ankylosing Spondylitis

Objective： To observe the clinical effect of long snake moxibustion for ankylosing spondylitis （AS）. Methods： A total of 58 AS cases were randomized into a long snake moxibustion group and a Western medication group, 29 in each group. The cases in the former group received long snake moxibustion and Western medication, whereas cases in the latter group received Western medication alone. Results： The total effective rate in the long snake moxibustion group was 93.1%, versus 62.1% in the Western medication group, showing a statistical significance （P〈0.01）; after the treatment, the scores of Bath Ankylosing Spondylitis Disease Activity Index （BASDAI） and Bath Ankylosing Spondylitis Function Index （BASFI） were improved in both groups; however, the improvements of BASDAI and BASFI results in the long snake moxibustion group were more significant than those in the Western medication group （P〈0.05）. Conclusion： Long snake moxibustion and Western medication can significantly improve the clinical effect on AS, coupled with a remarkable effect in enhancing the patients＇ functions.

Effects of acupuncture plus spinal manipulations on physical functioning and biochemical indicators in patients with ankylosing spondylitis

Objective To observe the effects of acupuncture plus spinal manipulations on the physical functioning and levels of alkaline phosphatase(ALP),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)and osteoprotegerin(OPG)in patients with ankylosing spondylitis(AS).Methods A total of 128 AS cases were allocated into a control group and an observation group using random number table method,with 64 cases in each group.Patients in both groups took sulfasalazine and meloxicam.Patients in the observation group received additional acupuncture plus spinal manipulations.The efficacy,Bath AS functional index(BASFI),Bath AS disease activity index(BASDAI),and the levels of ALP,ESR,CRP and OPG were compared between the two groups after eight weeks of treatment.Results After treatment,the symptom scores of traditional Chinese medicine in both groups were decreased(all P<0.05),and these scores in the observation group were significantly lower than in the control group(all P<0.05);the VAS,BASFI and BASDAI scores in both groups were decreased(all P<0.05),and these scores in the observation group were significantly lower than in the control group(all P<0.05);and the ALP,ESR,CRP and OPG levels in both groups were decreased(all P<0.05),and these levels in the observation group were significantly lower than in the control group(all P<0.05).The total efficacy rate was 92.2%in the observation group,versus 78.1%in the control group,presenting a statistical significance(P<0.05).Conclusion Conventional medication combined with acupuncture and spinal manipulations can improve clinical symptoms,accelerate the recovery of physical functioning,and reduce the ALP,ESR,CRP and OPG levels.