Objective:To investigate the clinical efficacy of traditional Chinese medicine(TCM)syndrome differentiation in the treatment of patients with gouty nephropathy.Methods:From June 2023 to December 2024,80 patients with ...Objective:To investigate the clinical efficacy of traditional Chinese medicine(TCM)syndrome differentiation in the treatment of patients with gouty nephropathy.Methods:From June 2023 to December 2024,80 patients with gouty nephropathy were selected as samples and randomly divided into two groups:group A received TCM syndrome differentiation treatment,while group B received conventional treatment.The efficacy,laboratory indicators,symptom scores,and safety were compared between the two groups.Results:The efficacy of group A was higher than that of group B(P<0.05).The uric acid,blood urea nitrogen,serum creatinine,and 24-hour urinary protein levels in group A were lower than those in group B(P<0.05).The symptom score of group A was lower than that of group B(P<0.05).The adverse reactions of gouty nephropathy in group A were lower than those in group B(P<0.05).Conclusion:TCM syndrome differentiation treatment for gouty nephropathy can alleviate symptoms,protect renal function,and is highly effective and feasible.展开更多
Objective To observe the clinical efficacy of fire needling and bloodletting at cleft points for acute gouty arthritis, and to explore its functional mechanism. Methods Thirty-five patients with acute gouty arthritis ...Objective To observe the clinical efficacy of fire needling and bloodletting at cleft points for acute gouty arthritis, and to explore its functional mechanism. Methods Thirty-five patients with acute gouty arthritis were enrolled into this study, and fire needling and bloodletting with 10 mL/ time were applied at cleft points of corresponding meridians and collaterals at the affected side. The treatment was conducted for once every other day, and treatment for three consecutive times was needed. Serum uric acid （UA） and pain score were tested in patients before treatment and on the 6th day after treatment, follow-up visit for 3 months was performed in patients who stopped treatment, and recurrence rate was calculated. Results Budzyuski 6-point behavioral rating scale was applied to score pain. T-test was conducted on mean and standard deviation of pain score before treatment （4.09 ＋ 0.82） and after treatment （1.14 ＋ 1.33）, showing that the difference was significant （P〈0.05）; t-test was also conducted on mean and standard deviation of serum UA before treatment [（555.34 ＋ 53.09） pmol/L] and after treatment [（414.23 ＋ 67.04） pmol/L], showing that the difference was significant （P〈0.05）; among the 35 patients with acute gouty arthritis, 14 patients were cured （40.0%）, improvement was found in 19 patients （54.3%）, and effectiveness was found in 33 patients （94.3%）. Based on follow-up visit for 3 months in 33 patients with efficacy, recurrence was found in 3 patients （9.1%）. Conclusion Fire needling and bloodletting at cleft points is an effective method in treatment of acute gouty arthritis with significant analgesic effect, efficacy of reducing serum UA, high cure rate and low recurrence rate, which is worth of being generalized clinically.展开更多
Objective To probe into the effects on acute gouty arthritis treated comprehensively with electroacupuncture (EA) and warming moxibustion. Methods 70 cases were randomized into treatment group (48 cases), in which the...Objective To probe into the effects on acute gouty arthritis treated comprehensively with electroacupuncture (EA) and warming moxibustion. Methods 70 cases were randomized into treatment group (48 cases), in which the EA+warming moxibustion was applied; and controlled group (22 cases), in which, colchicine was prescribed for oral administration. Results The statistical outcomes after 1 course treatment in treatment group: 28 cases were cured (58.33%), 18 cases improved (37.50%) and the total effective rate was 95.83%. In controlled group: 12 cases (54.55%) were cured, 8 cases improved (36.36%) and the total effective rate was 90.91%. The therapeutic effects of two groups were basically consistent, without significant different (P>0.05). But, concerning to side effect, there was no any toxic side effects in the group treated with EA+warming moxibustion, and the occurrence rate in the group treated with colchicine was 40.91%. Conclusion Electroacupuncture+warming moxibustion achieves good therapeutic effects without any side effects.展开更多
Uric acid is the end product of purine catabolism and its plasma levels are maintained below its maximum solubility in water(6–7 mg/dl).The plasma levels are tightly regulated as the balance between the rate of produ...Uric acid is the end product of purine catabolism and its plasma levels are maintained below its maximum solubility in water(6–7 mg/dl).The plasma levels are tightly regulated as the balance between the rate of production and the rate of excretion,the latter occurring in urine(kidney),bile(liver)and feces(intestinal tract).Reabsorption in kidney is also an important component of this process.Both excretion and reabsorption are mediated by specific transporters.Disruption of the balance between production and excretion leads to hyperuricemia,which increases the risk of uric acid crystallization as monosodium urate with subsequent deposition of the crystals in joints causing gouty arthritis.Loss-of-function mutations in the transporters that mediate uric acid excretion are associated with gout.The ATP-Binding Cassette exporter ABCG2 is important in uric acid excretion at all three sites:kidney(urine),liver(bile),and intestine(feces).Mutations in this transporter cause gout and these mutations occur at significant prevalence in general population.However,mutations that are most prevalent result only in partial loss of transport function.Therefore,if the expression of these partially defective transporters could be induced,the increased number of the transporter molecules would compensate for the mutation-associated decrease in transport function and hence increase uric acid excretion.As such,pharmacologic agents with ability to induce the expression of ABCG2 represent potentially a novel class of drugs for treatment of gouty arthritis.展开更多
OBJECTIVE:To evaluate the clinical efficacy and safety of external application of Traditional Chinese Medicine (EATCM) on acute gouty arthritis (AGA).METHODS:Six electronic data bases were retrieved from their incepti...OBJECTIVE:To evaluate the clinical efficacy and safety of external application of Traditional Chinese Medicine (EATCM) on acute gouty arthritis (AGA).METHODS:Six electronic data bases were retrieved from their inception to march 2017.15 randomized controlled clinical trials (RCTs) were included.The quality of the literatures was assessed according to Cochrane review criteria by using RevMan5.3 software;and related data was counted using Stata14.0 software.RESULTS:There was no significant difference in C-reactiveprotein (CRP) between experimental intervention group and control group [(WMD =1.093,95% C/(-2.514,4.701);P =0.553)].In terms of overall efficacy,the EATCM's treatment group was significantly superior to control group [(OR =3.692;95% CI (2.408,5.661);P <0.001)].The EATCM was better than western medicine treatments or other interventions in reducing the adverse reactions [(OR =0.135;95% CI (0.067,0.274);P < 0.001)].All these funnel plots showed unlikelihood of publishing bias.But due to excessive heterogeneity,the statistical results of serum uric acid and visual analogue scale and CRP between the two groups became uncertain.CONCLUSION:The results indicate that EATCM may have greater overall efficacy with fewer adverse drug reactions,although the evidence is weak owing to the low methodological quality and the small number of the included trials.展开更多
Objective:To evaluate the efficacy of boswellic acid against monosodium urate crystal-induced inflammation in mice.Methods:The mice were divided into four experimental groups.GroupⅠserved as control;mice in groupⅡwe...Objective:To evaluate the efficacy of boswellic acid against monosodium urate crystal-induced inflammation in mice.Methods:The mice were divided into four experimental groups.GroupⅠserved as control;mice in groupⅡwere injected with monosodium urate crystal;groupⅢconsisted of monosodium urate crystal-induced mice who were treated with boswellic acid(30mg/kg/b.w.);groupⅣcomprised monosodium urate crystal-induced mice who were treated with indomethacin(3mg/kg/b.w.).Paw volume and levels/activities of lysosomal enzymes,lipid peroxidation,anti-oxidant status and inflammatory mediator TNF-αwere determined in control and monosodium urate crystal-induced mice.In addition,the levels ofβ-glucuronidase and lactate dehydrogenase were also measured in monosodium urate crystal-incubated polymorphonuclear leucocytes(PMNL)in vitro.Results:The activities of lysosomal enzymes,lipid peroxidation,and tumour necrosis factor-αlevels and paw volume were increased significantly in monosodium urate crystal-induced mice,whereas the activities of antioxidant status were in turn decreased.However,these changes were modulated to near normal levels upon boswellic acid administration.In vitro,boswellic acid reduced the level ofβ-glucuronidase and lactate dehydrogenase in monosodium urate crystal-incubated PMNL in concentration dependent manner when compared with control cells.Conclusions:The results obtained in this study further strengthen the anti-inflammatory/antiarthritic effect of boswellic acid,which was already well established by several investigators.展开更多
OBJECTIVE:To explore the therapeutic effect and inflammatory mechanism of fire needles on gouty arthritis.METHODS:Sixty male Sprague-Dawley rats were divided into four groups,that is,control group,the model group,the ...OBJECTIVE:To explore the therapeutic effect and inflammatory mechanism of fire needles on gouty arthritis.METHODS:Sixty male Sprague-Dawley rats were divided into four groups,that is,control group,the model group,the colchicine group,and the fire needle treatment group.Acute gouty arthritis was prepared by injection of monosodium urate in the ankle joint.The inflammation-related protein[toll-like receptor 4(TLR4),pyrin domain-containing protein 3(NLRP3),interleukin(IL)-1β,myeloid differentiation factor 88(My D88),nuclear factorkappa B(NF-κB),phosphorylated NF-κB(p-NF-κB),caspase-1,and p-caspase-1]in swollen tissues,the inflammation-related m RNAs indicators(TLR4,NLRP3,NF-κB,and caspase-1)and the inflammatory factors[IL-1β,IL-6,IL-8,tumor necrosis factor-α(TNF-α),and C-reactive protein(CRP)]in the serum were detected by Western blot,real-time quantitative polymerase chain reaction,and enzyme-linked immunosorbent assay,respectively.RESULTS:The fire needle treatment could reduce joint swelling,increase mechanical pain threshold and decrease the inflammation index score in the fire needle treatment group.It could also significantly decreased the protein expression of IL-1β,TLR4,My D88,p-NF-κB and NLRP3 in joint tissue,markedly downregulated the m RNA levels of TLR4 and NLRP3 in joint tissue,and significantly reduce serum levels of IL-1β,IL-6,IL-8,TNF-α,and CRP.CONCLUSION:The fire needle treatment had positive effect of treating gouty arthritis,and its underlying mechanism might be associated with NF-κB activation and related inflammatory response.展开更多
Objective:To conduct the meta-analysis and trial sequential analysis(TSA) on clinical trials of fire needling therapy in treatment of gouty arthritis and review systematically the clinical therapeutic effect of fire n...Objective:To conduct the meta-analysis and trial sequential analysis(TSA) on clinical trials of fire needling therapy in treatment of gouty arthritis and review systematically the clinical therapeutic effect of fire needling therapy on gouty arthritis so as to provide the medical evidences of the extensive application of this therapy in treatment of gouty arthritis.Methods:The relevant clinical trials of fire needling therapy for treatment of gouty arthritis were searched from China National knowledge Infrastructure,Wanfang Data Knowledge Service Platform,Chinese Science and Technology Journal Database,American Medical Online,Dutch Medical Literature Database and International Evidence-Based Medical library.Using Review Manager 5.3 software,the quality of the included trials was assessed and meta-analysis was performed.With TSA v0.9 software,the trial sequential analysis was conduced on the appropriate outcomes.Results:A total of 10 trials were included with 775 patients involved.The analysis results showed that compared with the western medication,the total effective rate(RR=1.14’95%CI [1.09,1.20]),the curative rate(RR=1.59’95%CI [1.33,1.89]),the reduced VAS score(MD=-1.44’ 95%CI [-1.93,-0.951]) and the reduced incidence of adverse reaction(RR=0.27’ 95% CI [0.09,0.76]) of the fire needling therapy were different significantly(all P <0.05).Regarding the reduction of blood uric acid(MD=-40.47’ 95%CI [-80.21,-0.72]) and the score of symptoms and physical signs(MD=-1.38’95% CI [-3.71,0.95]),the effect of fire needling therapy was similar to that of western medication group(both P≥0.05).The trial sequential analysis suggested that the result was reliable,in which,the total effective rate of fire needling therapy was much higher than the western medication.But,it was potentially a false-positive finding,in which,fire needling therapy was much more advantageous at reducing blood uric acid as compared with the western medication.Conclusion:Based on the analytic results,it can be determined that fire needling therapy,as an effective approach to the treatment of gouty arthritis,has a certain advantage as compared with western medication.Given the low overall quality of trials,it still needs high-quality clinical trial to verify the findings of this study results.展开更多
Objective:To observe the clinical effect of a modified Simiao Tang (加味四妙汤 Modified Decoction of Four Wonderful Drugs) for gouty arthritis and its influence on uric acid in blood. Methods: 120 cases of gouty arthr...Objective:To observe the clinical effect of a modified Simiao Tang (加味四妙汤 Modified Decoction of Four Wonderful Drugs) for gouty arthritis and its influence on uric acid in blood. Methods: 120 cases of gouty arthritis were randomly divided into the treatment group and control group with 60 cases in each group. Modified Simiao Tang (MST) was orally administered to the patients in the treatment group and allopurinol tablet was orally administered to the patients in the control group. The clinical effects of two groups were evaluated after one-week treatment and uric acid (UA) and C-reactive protein (CRP) levels in blood were determined after 1-month treatment. Results: The total effective rate in the treatment group was significantly higher than in the control group, 86.7% vs. 68.3% (P< 0.01). And the treatment group was also significantly better than the control group in decreasing UA and CRP (P<0.05 or P<0.01). Conclusions: MST can significantly improve the symptoms and signs of gouty arthritis and decrease the levels of UA and CRP. It is good for gouty arthritis.展开更多
Creatinine, uric acid, hypoxanthine and xanthine are important diagnostic biomarkers in human urine for gouty arthritis or renal disease diacrisis. A simple method for simultaneous determination of these biomarkers in...Creatinine, uric acid, hypoxanthine and xanthine are important diagnostic biomarkers in human urine for gouty arthritis or renal disease diacrisis. A simple method for simultaneous determination of these biomarkers in urine based on reversed-phase high-performance liquid chromatography （RP-HPLC） with ultraviolet （UV） detector was proposed. After pretreatment by dilution, centrifugation and filtration, the biomarkers in urine samples were separated by ODS-BP column by elution with methanol/50 mM NaH2PO4 buffer solution at pH 5.26 （5：95）. Good linearity between peak areas and concentrations of standards was obtained for the biomarkers with correlation coefficients in the range of 0.9957-0.9993. The proposed analytical method has satisfactory repeatability （the recovery of data in a range of creatinine, uric acid, hypoxanthine and xanthine was 93.49-97.90%, 95.38-96.45%, 112.46-115.78%and 90.82-97.13%with standard deviation of o5%, respectively） and the limits of detection （LODs, S/N Z 3） for creatinine, uric acid, hypoxanthine, and xanthine were 0.010, 0.025, 0.050 and 0.025 mg/L, respectively. The established method was proved to be simple, accurate, sensitive and reliable for the quantitation of gouty arthritis＇ biomarkers in human urine samples. The ratio of creatinine to uric acid was found to be a possible factor for assessment of gouty arthritis.展开更多
Objective:To observe the therapeutic effect of blood-letting cupping plus herbal medicine for acute gouty arthritis.Methods:The 34 cases of acute gouty arthritis were treated by blood-letting cupping plus herbal medic...Objective:To observe the therapeutic effect of blood-letting cupping plus herbal medicine for acute gouty arthritis.Methods:The 34 cases of acute gouty arthritis were treated by blood-letting cupping plus herbal medicine.Results:21 cases were cured and 13 cases improved.Conclusion:The therapeutic effect of this therapy was satisfactory for gouty arthritis.展开更多
OBJECTIVE: To evaluate the indicators of an animal model of gouty arthritis(GA) with dampness heat accumulation and the intervention effect of Tongfeng Qingxiao formula(痛风清消方, TFQXF). METHODS: Seventy-two healthy...OBJECTIVE: To evaluate the indicators of an animal model of gouty arthritis(GA) with dampness heat accumulation and the intervention effect of Tongfeng Qingxiao formula(痛风清消方, TFQXF). METHODS: Seventy-two healthy adult Sprague-Dawley male rats were selected and randomly divided into a normal group, model group, low-dose group, mediumdose group, high-dose group, and diclofenac group using a random number table method, with 12 rats in each group. After group intervention, the general condition of the rats in each group was monitored and recorded, and the swelling index was measured. After separating the serum, the changes in glutamic pyruvic transaminase (ALT), glutamic oxaloacetic transaminase(AST), carbamide(UREA), creatinine(CREA), triglyceride(TG), total serum cholesterol(TC), low density lipoprotein cholesterol(LDL-C), and high density lipoprotein cholesterol(HDL-C) in the serum of the rats in each group were measured using an automatic biochemical analyzer. The levels of motilin(MTL), gastrin(GAS), endothelin(ET), calcitonin gene-related peptide(CGRP), heat shock protein 70(HSP70), interleukin(IL)-1β, and nuclear factor kappa-B(NF-κB) in the serum of the rats in each group were evaluated using enzyme-linked immunosorbent assay(ELISA) kits. Kidney tissues were used to evaluate the protein and m RNA expression of aquaporin(AQP) 1 and AQP2. Colon tissue was used to evaluate the protein and m RNA expression of AQP3 and AQP4 by Western blotting(WB) assay and real-time quantitative polymerase chain reaction(RT-q PCR). The levels of ALT, AST, UREA, and CREA were used to evaluate the liver and kidney function of rats. The levels of MTL and GAS were used to evaluate the gastrointestinal function of rats. The levels of TG, TC, LDL-C, HDL-C, AQP1, AQP2, AQP3, and AQP4 were used to evaluate the "dampness" syndrome performance in rats. The levels of ET, CGRP, and HSP70 were used to evaluate the "heat" syndrome performance in rats. The levels of IL-1β and NF-κB were used to evaluate the degree of inflammation in rats. The pathological changes in synovial and colonic tissues were observed by hematoxylin and eosin staining. RESULTS: Except for the normal group, after modeling treatment, the ankle joint of rats in both the model group and drug treatment groups gradually swelled, reaching a peak at 12 h, and then gradually began to subside. The results of biochemical analyzer detection indicated that the serum ALT, AST, UREA, CREA, TG, TC and LDL-C levels were significantly higher, but the HDL-C level was significantly lower in the rats of the model group than in the rats of the normal group(P < 0.05). The serum ALT, AST, UREA, CREA, MTL, TC and LDL-C levels were significantly lower, but the HDL-C level was significantly higher in the rats of all drug treatment groups than in the rats of the model group(P < 0.05). The results of ELISA detection indicated that the MTL, GAS, ET, HSP70, IL-1β,and NF-κB levels were significantly higher, but the CGRP level was significantly lower in the rats of the model group than in the rats of the normal group(P < 0.05). The levels of MTL, GAS, ET, HSP70, IL-1β, and NF-κB were significantly lower, but CGRP was significantly higher in the rats of the drug treatment groups than in the rats of the model group(P < 0.05). The results of WB and RTq PCR indicated that compared to the normal group, the levels of AQP1 and AQP2 in the model group were significantly higher in the kidney tissue, whereas the levels of AQP3 and AQP4 were significantly lower in the colon tissue(P < 0.05). Compared to those in the model group, the levels of AQP1 and AQP2 in the drug treatment groups were significantly lower in the kidney tissue, whereas the levels of AQP3 and AQP4 were significantly higher in the colon tissue(P < 0.05). In the model group, erosion of the colonic mucosal surface and inflammatory exudate occurred. Some mucosal epithelium had fallen off, the number of glands in the lamina propria was lower, many inflammatory cells infiltrated the interstitial layer, the connective tissue in the submucosa became loose and edematous, and lymph follicles developed. We found a significant proliferation of synovial cells in the ankle joint, an increase in cell density and neovascularization, and visible infiltration of inflammatory cells. The cartilage surface was not smooth. However, each drug group could improve the pathological changes in intestinal and synovial tissues to varying degrees. CONCLUSIONS: Blood lipid metabolism indexes and AQPs could be used as objective evaluation indexes for the "dampness" syndrome performance of damp-heat accumulation type GA. ET, HSP70 and CGRP could be used as objective evaluation indexes for the "heat" syndrome performance, and the immune inflammation index could be used as objective evaluation indexes for the inflammation degree. The overall efficacy of TFQXF in the treatment of damp-heat accumulation-type GA could be determined by adjusting the above objective evaluation indexes. It provided some ideas and directions for clinical risk assessments and drug development of GA.展开更多
Background:Acute gouty arthritis(AGA)is an inflammatory joint disease with a high prevalence.Typical medical interventions,including nonsteroidal anti-inflammatory drugs,colchicine and glucocorticoids,can have serious...Background:Acute gouty arthritis(AGA)is an inflammatory joint disease with a high prevalence.Typical medical interventions,including nonsteroidal anti-inflammatory drugs,colchicine and glucocorticoids,can have serious adverse reactions.Huzhang Granule(HZG),a compound Chinese herbal medicine,has been used to treat AGA for more than 30 years with satisfactory effects and no significant adverse reactions.However,the efficacy and safety of HZG in AGA patients remains unknown.Objective:The present investigation was designed to examine the efficacy and safety profile of HZG in managing AGA patients.Design,setting,participants and interventions:The current study was conducted as a noninferiority,randomized controlled clinical trial on 180 eligible enrolled participants.Participants were randomly assigned into the HZG and etoricoxib groups.Treatments were administered for 5 d,during which the HZG group received HZG and placebo etoricoxib,while the etoricoxib group received etoricoxib and placebo HZG in the same ratio(1:1).Main outcome measures:The primary outcome was pain experienced by the patient in the gout-afflicted joint from days 2 to 5 of the treatment window.The pain level was measured via a visual analogue scale,ranging from 0 mm to 100 mm.The secondary outcomes comprised joint tenderness and swelling,reduction of inflammatory biomarkers,and the patient’s and investigator’s global evaluations of therapeutic response.Results:The mean reduction in pain was-51.22 mm(95%confidence interval[CI],[-53.42,-49.03]mm)for the HZG and-52.00 mm(95%CI,[-54.06,-49.94]mm)for the etoricoxib groups.The mean difference between the two groups was 0.78 mm(95%CI,[-2.25,3.81]mm).All additional efficacy endpoints,covering decreased inflammation and pain relief,yielded compelling proof of noninferiority.Patients in the HZG group exhibited a comparatively lower rate of adverse events compared to those in the etoricoxib group(4.44%vs 13.33%;P≤0.05).Conclusion:HZG and etoricoxib groups demonstrated similar levels of analgesic effectiveness.The safety and efficacy of HZG indicates that it can be used as a potential therapeutic option for treating AGA.展开更多
BACKGROUND Gouty tophus is rarely reported in the head and neck areas.To the best of our knowledge,this is the first report on multiple gouty tophi in the head and neck with normal serum uric acid(SUA)levels.CASE SUMM...BACKGROUND Gouty tophus is rarely reported in the head and neck areas.To the best of our knowledge,this is the first report on multiple gouty tophi in the head and neck with normal serum uric acid(SUA)levels.CASE SUMMARY We report a case of multiple gouty tophi in the nasal dorsal and auricle regions with normal SUA levels.The patient was admitted to the hospital with a chief complaint of recurrent nasal swelling and pain for 3 years,which was aggravated for 3 d.The patient’s SUA level had been regularly reviewed in the outpatient department and had been successfully controlled for several years.Resection of the nasal masses was performed.Cartilage from the right ear cavity was used to repair the nasal defects.The pathological report confirmed a nasal gouty tophus.No recurrence or deformity was found after a 1 year follow-up.CONCLUSION Normal SUA cannot completely negate the diagnosis of gouty tophus,especially in some rare regions.展开更多
Objective: To observe the clinical effect of Rebixiao granule (热痹消颗粒剂, RBXG) in treating repeatedly attacking acute gouty arthritis and through experimental study on blood uric acid to explore RBXG's therape...Objective: To observe the clinical effect of Rebixiao granule (热痹消颗粒剂, RBXG) in treating repeatedly attacking acute gouty arthritis and through experimental study on blood uric acid to explore RBXG's therapeutic mechanism. Methods: Ninety repeatedly attacking acute gouty arthritis patients were divided into the treated group ( n =60) and control group ( n =30). The treated group was treated with RBXG, and the control group was treated with Futalin tablets (diclofenac sodium). The baseline treatment including good rest, low purine diet, sufficient water drinking and urine alkalization, etc. was then given to both groups. Hypoxanthine 600 mg/kg and niacin 100 mg/kg was applied to hyperuricemic mice by gastrogavage to establish the animal models. Results: The clinical effective rate of the treated group was 95.0% and that of the control 90.0%. Good therapeutic effects were won, insignificant difference ( P >0.05)was shown between the two groups. However, the cure rate of the treated group was 26.7% while that of the control group was 10.0%, with significant difference ( P <0.01) shown between them. The treated group had its blood uric acid lowered, which was significantly different ( P <0.05) from that of the control group. The animal experiment indicated that all the three groups treated with different dosages of RBXG, as well as the Ash bark and Smilax glabra rhizome groups had their blood uric acid content reduced in the hyperuricemic mice. Conclusion: RBXG has a quicker initiation and better treatment effects than sole anti-inflammatory and analgesic agents on the treatment of repeatedly attacking acute gouty arthritis, showing no obvious toxic or adverse reactions and therefore good for long-term administration and likely to be a safe TCM preparation to control the symptoms and reduce the onsets of repeatedly attacking of acute gouty arthritis. The animal experiment shows that both the compound preparation and part of the single ingredients in the recipe have the function of reducing blood uric acid. However, the compound recipe has better therapeutic effects, proving to be superior to single drugs.展开更多
If gouty nephropathy is not treated properly,repeated attacks can gradually lead to nephrotic syndrome.This may bring pain to patients and affect their quality of life.The main goal of Western medicine in the treatmen...If gouty nephropathy is not treated properly,repeated attacks can gradually lead to nephrotic syndrome.This may bring pain to patients and affect their quality of life.The main goal of Western medicine in the treatment of gouty nephropathy is to stop acute attacks,control serum uric acid and avoid recurrence.Yet there are many adverse reactions to long-term use.Dai medicine has unique efficiency in improving clinical symptoms and controlling relapses.Meanwhile it can avoid the potential risks associated with too low control of blood uric acid.Therefore,this paper reviewed the research status of Dai and Western medicine in the treatment of gouty nephropathy in order to provide reference for clinical medication.展开更多
Objective:To evaluate the efficacy and safety of Jiawei Simiao powder(JWSMP)combined with celecoxib for the treatment of acute gouty arthritis by conducting a meta-analysis of randomized controlled trials(RCTs).Method...Objective:To evaluate the efficacy and safety of Jiawei Simiao powder(JWSMP)combined with celecoxib for the treatment of acute gouty arthritis by conducting a meta-analysis of randomized controlled trials(RCTs).Methods: The Chinese National Knowledge Infrastructure Databases,Chinese Scientific Journal Database,Wanfang,Cochrane Library,EMBASE,PubMed,and Web of Science databases were searched from inception until December 2023.Continuous variables were analyzed using the mean difference(MD)for analysis,and dichotomous variables were used as risk ratios.Data with similar characteristics were pooled for meta-analysis,and heterogeneity was assessed using I2.The Cochrane Handbook was used to assess the risk of bias and quality.RevMan 5.3 software was used to perform the meta-analysis.Results: Thirteen RCTs involving 1007 patients were included in the study.The quality of the included studies was low(unclear randomization processes and insufficient blinding reporting).The group receiving JWSMP combined with celecoxib showed significantly lower levels of serum uric acid(SUA,MD=−66.32,95%confidence interval(CI):−80.97 to−51.67,P<.001),erythrocyte sedimentation rate(ESR,MD=−6.05,95%CI:−8.29 to−3.82,P<.001),C-reactive protein(CRP,MD=−7.39,95%CI:−11.15,−3.63,P<.001),and joint pain score(VAS score,MD=−2.14,95%CI:−2.4 to−1.88,P<.001)compared to celecoxib alone.Additionally,the JWSMP combined group had a higher total effective rate(risk ratio=1.22,95%CI:1.14 to 1.29,P<.001)and fewer adverse compared to celecoxib alone.Conclusions: JWSMP combined with celecoxib is more effective than celecoxib alone in improving the total efficacy rate,alleviating joint pain,and improving SUA,ESR,and CRP levels.JWSMP also reduced the occurrence of adverse events caused by celecoxib.However,the quality of the included studies was low,highlighting the need for further high-quality research with larger sample sizes and robust methodologies,such as double-blind randomization,to confirm these findings.展开更多
BACKGROUND Chronic synovitis due to chronic knee gouty arthritis(KGA)resulting in synovial hyperplasia has not been documented in the current literature,and thus the optimal management for this condition remains uncle...BACKGROUND Chronic synovitis due to chronic knee gouty arthritis(KGA)resulting in synovial hyperplasia has not been documented in the current literature,and thus the optimal management for this condition remains unclear.This case report discusses a 34-year-old man with a history of chronic KGA who presented with recurrent knee effusion resulting from synovial hyperplasia.CASE SUMMARY A 34-year-old man presented to our outpatient clinic with a 5-year recurrent knee effusion and a history of chronic KGA.Symptoms persisted despite serial aspiration and urate-lowering medication(febuxostat 80 mg once daily)for 2 months.Diagnostic arthroscopy was performed due to the recalcitrant symptoms.Intraoperatively,tophi deposition and excessive thickening of the synovial membrane were observed.Synovial biopsy and partial synovectomy were performed,revealing chronic synovitis with synovial hyperplasia that was consistent with chronic KGA.At follow-up after 6 months,the patient reported no further episode of knee effusion.CONCLUSION Arthroscopic synovectomy for synovial hyperplasia in chronic KGA sufficiently eradicates the symptoms of recurrent knee effusion.展开更多
External application of traditional Chinese medicine has a long history and definite curative effect on gout.By searching the latest literature on the treatment of acute gouty arthritis by external treatment of tradit...External application of traditional Chinese medicine has a long history and definite curative effect on gout.By searching the latest literature on the treatment of acute gouty arthritis by external treatment of traditional Chinese medicine,the research progress of external treatment of acute gouty arthritis in recent years was summarized.According to the existing research results,the external treatment of Chinese medicine in the treatment of acute gout has better efficacy and higher safety,and has a broad application prospect.展开更多
Objective To compare the efficacy difference in treatment of acute gouty arthritis between acupuncture combined with infrared irradiation and Indomethachin, as well as to observe the impacts on liver function. Methods...Objective To compare the efficacy difference in treatment of acute gouty arthritis between acupuncture combined with infrared irradiation and Indomethachin, as well as to observe the impacts on liver function. Methods One hundred and sixty cases of gout were randomized into an acupuncture group （80 cases） and an Indomethachin group （80 cases）. In the acupuncture group, acupuncture was applied to Zusanli（足三里 ST 36）, SanyTnjiao （三阴交 SP 6）, Quchi （曲池LI 11）, Xuehai （血海 SP 10）, Yanglingquan （阳陵泉 GB 34） and Ashi points （阿是穴）. Additionally, infrared irradiation was used in the local area. The treatment was given once daily. In the Indomethachin group, Indomethachin was taken orally, 25 mg each time, three times per day. The treatment lasted for 5 days in either group. Separately, before and after treatment, pain severity and the levels of blood uric acid （BUA）, erythrocyte sedimentation rate （ESR）, alanine aminotransferase （ALT） and aspartate aminotransferase （AST） were detected. Additionally, the efficacy and the impacts on liver function were assessed. Results The cured rate was 52.5% （42/80） in the acupuncture group, which was superior to 22.5% （18/80） in the Indomethachin group （P〈0.01）. In the acupuncture group, the analgesic efficacy was better than that in the Indomethachin group （P〈0.01） and the effect on reducing BUA and ERS levels was same as that in the Indomethachin group （all P〉0.05）. After treatment, ALT and AST levels had no changes in the acupuncture group, but they increased apparently in the Indomethachin group （all P〈0.01）. Conclusion Acupuncture combined with infrared irradiation achieves a superior efficacy on acute gouty arthritis as compared with oral medication of Indomethachin and the therapy provides a significant effect on analgesia and does not bring the damage of liver function.展开更多
文摘Objective:To investigate the clinical efficacy of traditional Chinese medicine(TCM)syndrome differentiation in the treatment of patients with gouty nephropathy.Methods:From June 2023 to December 2024,80 patients with gouty nephropathy were selected as samples and randomly divided into two groups:group A received TCM syndrome differentiation treatment,while group B received conventional treatment.The efficacy,laboratory indicators,symptom scores,and safety were compared between the two groups.Results:The efficacy of group A was higher than that of group B(P<0.05).The uric acid,blood urea nitrogen,serum creatinine,and 24-hour urinary protein levels in group A were lower than those in group B(P<0.05).The symptom score of group A was lower than that of group B(P<0.05).The adverse reactions of gouty nephropathy in group A were lower than those in group B(P<0.05).Conclusion:TCM syndrome differentiation treatment for gouty nephropathy can alleviate symptoms,protect renal function,and is highly effective and feasible.
文摘Objective To observe the clinical efficacy of fire needling and bloodletting at cleft points for acute gouty arthritis, and to explore its functional mechanism. Methods Thirty-five patients with acute gouty arthritis were enrolled into this study, and fire needling and bloodletting with 10 mL/ time were applied at cleft points of corresponding meridians and collaterals at the affected side. The treatment was conducted for once every other day, and treatment for three consecutive times was needed. Serum uric acid （UA） and pain score were tested in patients before treatment and on the 6th day after treatment, follow-up visit for 3 months was performed in patients who stopped treatment, and recurrence rate was calculated. Results Budzyuski 6-point behavioral rating scale was applied to score pain. T-test was conducted on mean and standard deviation of pain score before treatment （4.09 ＋ 0.82） and after treatment （1.14 ＋ 1.33）, showing that the difference was significant （P〈0.05）; t-test was also conducted on mean and standard deviation of serum UA before treatment [（555.34 ＋ 53.09） pmol/L] and after treatment [（414.23 ＋ 67.04） pmol/L], showing that the difference was significant （P〈0.05）; among the 35 patients with acute gouty arthritis, 14 patients were cured （40.0%）, improvement was found in 19 patients （54.3%）, and effectiveness was found in 33 patients （94.3%）. Based on follow-up visit for 3 months in 33 patients with efficacy, recurrence was found in 3 patients （9.1%）. Conclusion Fire needling and bloodletting at cleft points is an effective method in treatment of acute gouty arthritis with significant analgesic effect, efficacy of reducing serum UA, high cure rate and low recurrence rate, which is worth of being generalized clinically.
文摘Objective To probe into the effects on acute gouty arthritis treated comprehensively with electroacupuncture (EA) and warming moxibustion. Methods 70 cases were randomized into treatment group (48 cases), in which the EA+warming moxibustion was applied; and controlled group (22 cases), in which, colchicine was prescribed for oral administration. Results The statistical outcomes after 1 course treatment in treatment group: 28 cases were cured (58.33%), 18 cases improved (37.50%) and the total effective rate was 95.83%. In controlled group: 12 cases (54.55%) were cured, 8 cases improved (36.36%) and the total effective rate was 90.91%. The therapeutic effects of two groups were basically consistent, without significant different (P>0.05). But, concerning to side effect, there was no any toxic side effects in the group treated with EA+warming moxibustion, and the occurrence rate in the group treated with colchicine was 40.91%. Conclusion Electroacupuncture+warming moxibustion achieves good therapeutic effects without any side effects.
基金This work was supported by the National Institutes of Health grant R41 AR074854the Welch Endowed Chair in Biochemistry,Grant No.BI-0028,at Texas Tech University Health Sciences Center.
文摘Uric acid is the end product of purine catabolism and its plasma levels are maintained below its maximum solubility in water(6–7 mg/dl).The plasma levels are tightly regulated as the balance between the rate of production and the rate of excretion,the latter occurring in urine(kidney),bile(liver)and feces(intestinal tract).Reabsorption in kidney is also an important component of this process.Both excretion and reabsorption are mediated by specific transporters.Disruption of the balance between production and excretion leads to hyperuricemia,which increases the risk of uric acid crystallization as monosodium urate with subsequent deposition of the crystals in joints causing gouty arthritis.Loss-of-function mutations in the transporters that mediate uric acid excretion are associated with gout.The ATP-Binding Cassette exporter ABCG2 is important in uric acid excretion at all three sites:kidney(urine),liver(bile),and intestine(feces).Mutations in this transporter cause gout and these mutations occur at significant prevalence in general population.However,mutations that are most prevalent result only in partial loss of transport function.Therefore,if the expression of these partially defective transporters could be induced,the increased number of the transporter molecules would compensate for the mutation-associated decrease in transport function and hence increase uric acid excretion.As such,pharmacologic agents with ability to induce the expression of ABCG2 represent potentially a novel class of drugs for treatment of gouty arthritis.
基金Supported by National Natural Science Foundation of China Youth Science Foundation(No.81503598)
文摘OBJECTIVE:To evaluate the clinical efficacy and safety of external application of Traditional Chinese Medicine (EATCM) on acute gouty arthritis (AGA).METHODS:Six electronic data bases were retrieved from their inception to march 2017.15 randomized controlled clinical trials (RCTs) were included.The quality of the literatures was assessed according to Cochrane review criteria by using RevMan5.3 software;and related data was counted using Stata14.0 software.RESULTS:There was no significant difference in C-reactiveprotein (CRP) between experimental intervention group and control group [(WMD =1.093,95% C/(-2.514,4.701);P =0.553)].In terms of overall efficacy,the EATCM's treatment group was significantly superior to control group [(OR =3.692;95% CI (2.408,5.661);P <0.001)].The EATCM was better than western medicine treatments or other interventions in reducing the adverse reactions [(OR =0.135;95% CI (0.067,0.274);P < 0.001)].All these funnel plots showed unlikelihood of publishing bias.But due to excessive heterogeneity,the statistical results of serum uric acid and visual analogue scale and CRP between the two groups became uncertain.CONCLUSION:The results indicate that EATCM may have greater overall efficacy with fewer adverse drug reactions,although the evidence is weak owing to the low methodological quality and the small number of the included trials.
文摘Objective:To evaluate the efficacy of boswellic acid against monosodium urate crystal-induced inflammation in mice.Methods:The mice were divided into four experimental groups.GroupⅠserved as control;mice in groupⅡwere injected with monosodium urate crystal;groupⅢconsisted of monosodium urate crystal-induced mice who were treated with boswellic acid(30mg/kg/b.w.);groupⅣcomprised monosodium urate crystal-induced mice who were treated with indomethacin(3mg/kg/b.w.).Paw volume and levels/activities of lysosomal enzymes,lipid peroxidation,anti-oxidant status and inflammatory mediator TNF-αwere determined in control and monosodium urate crystal-induced mice.In addition,the levels ofβ-glucuronidase and lactate dehydrogenase were also measured in monosodium urate crystal-incubated polymorphonuclear leucocytes(PMNL)in vitro.Results:The activities of lysosomal enzymes,lipid peroxidation,and tumour necrosis factor-αlevels and paw volume were increased significantly in monosodium urate crystal-induced mice,whereas the activities of antioxidant status were in turn decreased.However,these changes were modulated to near normal levels upon boswellic acid administration.In vitro,boswellic acid reduced the level ofβ-glucuronidase and lactate dehydrogenase in monosodium urate crystal-incubated PMNL in concentration dependent manner when compared with control cells.Conclusions:The results obtained in this study further strengthen the anti-inflammatory/antiarthritic effect of boswellic acid,which was already well established by several investigators.
基金Supported by the National Natural Science Foundation of China:Research on the Mechanism of Chinese Herbal Compound Up-regulating Salivary Gland AQP5 and Increasing Intracellular Ca2+in Salivary Gland Cells based on the Theory of"Homology of Jin and Blood"(No.81273714)the Priority Academic Program Development of Jiangsu Higher Education Institutions(PAPD)the Priority Nursing Discipline Project of Jiangsu Province:Study on the Mechanism of Fire Needle Regulating Acute Gouty Arthritis NLRP3 Inflammasome Activation(No.2019YSHL001)。
文摘OBJECTIVE:To explore the therapeutic effect and inflammatory mechanism of fire needles on gouty arthritis.METHODS:Sixty male Sprague-Dawley rats were divided into four groups,that is,control group,the model group,the colchicine group,and the fire needle treatment group.Acute gouty arthritis was prepared by injection of monosodium urate in the ankle joint.The inflammation-related protein[toll-like receptor 4(TLR4),pyrin domain-containing protein 3(NLRP3),interleukin(IL)-1β,myeloid differentiation factor 88(My D88),nuclear factorkappa B(NF-κB),phosphorylated NF-κB(p-NF-κB),caspase-1,and p-caspase-1]in swollen tissues,the inflammation-related m RNAs indicators(TLR4,NLRP3,NF-κB,and caspase-1)and the inflammatory factors[IL-1β,IL-6,IL-8,tumor necrosis factor-α(TNF-α),and C-reactive protein(CRP)]in the serum were detected by Western blot,real-time quantitative polymerase chain reaction,and enzyme-linked immunosorbent assay,respectively.RESULTS:The fire needle treatment could reduce joint swelling,increase mechanical pain threshold and decrease the inflammation index score in the fire needle treatment group.It could also significantly decreased the protein expression of IL-1β,TLR4,My D88,p-NF-κB and NLRP3 in joint tissue,markedly downregulated the m RNA levels of TLR4 and NLRP3 in joint tissue,and significantly reduce serum levels of IL-1β,IL-6,IL-8,TNF-α,and CRP.CONCLUSION:The fire needle treatment had positive effect of treating gouty arthritis,and its underlying mechanism might be associated with NF-κB activation and related inflammatory response.
基金Supported by National Natural Science Foundation of China:81460763,81960908.
文摘Objective:To conduct the meta-analysis and trial sequential analysis(TSA) on clinical trials of fire needling therapy in treatment of gouty arthritis and review systematically the clinical therapeutic effect of fire needling therapy on gouty arthritis so as to provide the medical evidences of the extensive application of this therapy in treatment of gouty arthritis.Methods:The relevant clinical trials of fire needling therapy for treatment of gouty arthritis were searched from China National knowledge Infrastructure,Wanfang Data Knowledge Service Platform,Chinese Science and Technology Journal Database,American Medical Online,Dutch Medical Literature Database and International Evidence-Based Medical library.Using Review Manager 5.3 software,the quality of the included trials was assessed and meta-analysis was performed.With TSA v0.9 software,the trial sequential analysis was conduced on the appropriate outcomes.Results:A total of 10 trials were included with 775 patients involved.The analysis results showed that compared with the western medication,the total effective rate(RR=1.14’95%CI [1.09,1.20]),the curative rate(RR=1.59’95%CI [1.33,1.89]),the reduced VAS score(MD=-1.44’ 95%CI [-1.93,-0.951]) and the reduced incidence of adverse reaction(RR=0.27’ 95% CI [0.09,0.76]) of the fire needling therapy were different significantly(all P <0.05).Regarding the reduction of blood uric acid(MD=-40.47’ 95%CI [-80.21,-0.72]) and the score of symptoms and physical signs(MD=-1.38’95% CI [-3.71,0.95]),the effect of fire needling therapy was similar to that of western medication group(both P≥0.05).The trial sequential analysis suggested that the result was reliable,in which,the total effective rate of fire needling therapy was much higher than the western medication.But,it was potentially a false-positive finding,in which,fire needling therapy was much more advantageous at reducing blood uric acid as compared with the western medication.Conclusion:Based on the analytic results,it can be determined that fire needling therapy,as an effective approach to the treatment of gouty arthritis,has a certain advantage as compared with western medication.Given the low overall quality of trials,it still needs high-quality clinical trial to verify the findings of this study results.
文摘Objective:To observe the clinical effect of a modified Simiao Tang (加味四妙汤 Modified Decoction of Four Wonderful Drugs) for gouty arthritis and its influence on uric acid in blood. Methods: 120 cases of gouty arthritis were randomly divided into the treatment group and control group with 60 cases in each group. Modified Simiao Tang (MST) was orally administered to the patients in the treatment group and allopurinol tablet was orally administered to the patients in the control group. The clinical effects of two groups were evaluated after one-week treatment and uric acid (UA) and C-reactive protein (CRP) levels in blood were determined after 1-month treatment. Results: The total effective rate in the treatment group was significantly higher than in the control group, 86.7% vs. 68.3% (P< 0.01). And the treatment group was also significantly better than the control group in decreasing UA and CRP (P<0.05 or P<0.01). Conclusions: MST can significantly improve the symptoms and signs of gouty arthritis and decrease the levels of UA and CRP. It is good for gouty arthritis.
基金supported by the National Natural Science Foundation of China(No.21275088)
文摘Creatinine, uric acid, hypoxanthine and xanthine are important diagnostic biomarkers in human urine for gouty arthritis or renal disease diacrisis. A simple method for simultaneous determination of these biomarkers in urine based on reversed-phase high-performance liquid chromatography （RP-HPLC） with ultraviolet （UV） detector was proposed. After pretreatment by dilution, centrifugation and filtration, the biomarkers in urine samples were separated by ODS-BP column by elution with methanol/50 mM NaH2PO4 buffer solution at pH 5.26 （5：95）. Good linearity between peak areas and concentrations of standards was obtained for the biomarkers with correlation coefficients in the range of 0.9957-0.9993. The proposed analytical method has satisfactory repeatability （the recovery of data in a range of creatinine, uric acid, hypoxanthine and xanthine was 93.49-97.90%, 95.38-96.45%, 112.46-115.78%and 90.82-97.13%with standard deviation of o5%, respectively） and the limits of detection （LODs, S/N Z 3） for creatinine, uric acid, hypoxanthine, and xanthine were 0.010, 0.025, 0.050 and 0.025 mg/L, respectively. The established method was proved to be simple, accurate, sensitive and reliable for the quantitation of gouty arthritis＇ biomarkers in human urine samples. The ratio of creatinine to uric acid was found to be a possible factor for assessment of gouty arthritis.
文摘Objective:To observe the therapeutic effect of blood-letting cupping plus herbal medicine for acute gouty arthritis.Methods:The 34 cases of acute gouty arthritis were treated by blood-letting cupping plus herbal medicine.Results:21 cases were cured and 13 cases improved.Conclusion:The therapeutic effect of this therapy was satisfactory for gouty arthritis.
基金the National Natural Science Foundation of China:a Study on the Use of Tongfengqingxiao for Treating Gouty Arthritis and Neutrophil Extracellular Traps Formation based on the Transforming Growth Factor-β1 Signaling Pathway (No. 81860857)a Study on the Mechanism by which Tongfeng Qingxiao Regulates the Toll-like receptors-myeloid Differentiation Factor 88-nuclear Factor Kappa-B Signaling Pathway in Gouty Arthritis Rats with Gut Dysbiosis and Dampness-Heat Syndrome based on the Gut-enteric-microbiota Axis (No. 82060871)National Natural Science Foundation of Jiangxi Province:a Study on the Regulatory Mechanism of the Toll-like receptors-Myeloid differentiation factor 88-nuclear factor kappa-B Signaling Pathway Related to Dysbacteriosis of the Intestinal Flora with Gouty Arthritis in Rats Mediated by Tongfengqingxiao,based on the “Gut-Microbiota” Axis (No. 20202BAB206071)。
文摘OBJECTIVE: To evaluate the indicators of an animal model of gouty arthritis(GA) with dampness heat accumulation and the intervention effect of Tongfeng Qingxiao formula(痛风清消方, TFQXF). METHODS: Seventy-two healthy adult Sprague-Dawley male rats were selected and randomly divided into a normal group, model group, low-dose group, mediumdose group, high-dose group, and diclofenac group using a random number table method, with 12 rats in each group. After group intervention, the general condition of the rats in each group was monitored and recorded, and the swelling index was measured. After separating the serum, the changes in glutamic pyruvic transaminase (ALT), glutamic oxaloacetic transaminase(AST), carbamide(UREA), creatinine(CREA), triglyceride(TG), total serum cholesterol(TC), low density lipoprotein cholesterol(LDL-C), and high density lipoprotein cholesterol(HDL-C) in the serum of the rats in each group were measured using an automatic biochemical analyzer. The levels of motilin(MTL), gastrin(GAS), endothelin(ET), calcitonin gene-related peptide(CGRP), heat shock protein 70(HSP70), interleukin(IL)-1β, and nuclear factor kappa-B(NF-κB) in the serum of the rats in each group were evaluated using enzyme-linked immunosorbent assay(ELISA) kits. Kidney tissues were used to evaluate the protein and m RNA expression of aquaporin(AQP) 1 and AQP2. Colon tissue was used to evaluate the protein and m RNA expression of AQP3 and AQP4 by Western blotting(WB) assay and real-time quantitative polymerase chain reaction(RT-q PCR). The levels of ALT, AST, UREA, and CREA were used to evaluate the liver and kidney function of rats. The levels of MTL and GAS were used to evaluate the gastrointestinal function of rats. The levels of TG, TC, LDL-C, HDL-C, AQP1, AQP2, AQP3, and AQP4 were used to evaluate the "dampness" syndrome performance in rats. The levels of ET, CGRP, and HSP70 were used to evaluate the "heat" syndrome performance in rats. The levels of IL-1β and NF-κB were used to evaluate the degree of inflammation in rats. The pathological changes in synovial and colonic tissues were observed by hematoxylin and eosin staining. RESULTS: Except for the normal group, after modeling treatment, the ankle joint of rats in both the model group and drug treatment groups gradually swelled, reaching a peak at 12 h, and then gradually began to subside. The results of biochemical analyzer detection indicated that the serum ALT, AST, UREA, CREA, TG, TC and LDL-C levels were significantly higher, but the HDL-C level was significantly lower in the rats of the model group than in the rats of the normal group(P < 0.05). The serum ALT, AST, UREA, CREA, MTL, TC and LDL-C levels were significantly lower, but the HDL-C level was significantly higher in the rats of all drug treatment groups than in the rats of the model group(P < 0.05). The results of ELISA detection indicated that the MTL, GAS, ET, HSP70, IL-1β,and NF-κB levels were significantly higher, but the CGRP level was significantly lower in the rats of the model group than in the rats of the normal group(P < 0.05). The levels of MTL, GAS, ET, HSP70, IL-1β, and NF-κB were significantly lower, but CGRP was significantly higher in the rats of the drug treatment groups than in the rats of the model group(P < 0.05). The results of WB and RTq PCR indicated that compared to the normal group, the levels of AQP1 and AQP2 in the model group were significantly higher in the kidney tissue, whereas the levels of AQP3 and AQP4 were significantly lower in the colon tissue(P < 0.05). Compared to those in the model group, the levels of AQP1 and AQP2 in the drug treatment groups were significantly lower in the kidney tissue, whereas the levels of AQP3 and AQP4 were significantly higher in the colon tissue(P < 0.05). In the model group, erosion of the colonic mucosal surface and inflammatory exudate occurred. Some mucosal epithelium had fallen off, the number of glands in the lamina propria was lower, many inflammatory cells infiltrated the interstitial layer, the connective tissue in the submucosa became loose and edematous, and lymph follicles developed. We found a significant proliferation of synovial cells in the ankle joint, an increase in cell density and neovascularization, and visible infiltration of inflammatory cells. The cartilage surface was not smooth. However, each drug group could improve the pathological changes in intestinal and synovial tissues to varying degrees. CONCLUSIONS: Blood lipid metabolism indexes and AQPs could be used as objective evaluation indexes for the "dampness" syndrome performance of damp-heat accumulation type GA. ET, HSP70 and CGRP could be used as objective evaluation indexes for the "heat" syndrome performance, and the immune inflammation index could be used as objective evaluation indexes for the inflammation degree. The overall efficacy of TFQXF in the treatment of damp-heat accumulation-type GA could be determined by adjusting the above objective evaluation indexes. It provided some ideas and directions for clinical risk assessments and drug development of GA.
基金supported by the Clinical Research Plan of SHDC(No.SHDC2020CR4053SHDC2022CRS053)+14 种基金Research Project of Shanghai Municipal Health Care Commission(No.20204Y0312)Shanghai Municipal Health Commission Health Industry Clinical Research Special Project(No.20234Y0075)Health Young Talents of Shanghai Municipal Health Commission(No.2022YQ026)the Clinical Research Program of Shanghai Municipal Health Commission(No.202240371)Shanghai Clinical Key Specialty Construction Project(No.shslczdzk05001)Three-year Action Plan of Shanghai to Further Accelerate the Inheritance and Innovation of Traditional Chinese Medicine(No.ZY[2021-2023]-0302)Jiangxi Provincial Natural Science Foundation(No.20224BAB216096)Shanghai Dermatology Research Center(No.2023ZZ02017)Shanghai Dermatology Hospital Demonstration Research Ward Project(No.SHDC2023CRW009)Xinglin Youth Scholar of Shanghai University of Traditional Chinese Medicine(No.RY411.33.10)Youth Talent Promotion Project of China Association of Traditional Chinese Medicine(2021–2023)Category A(No.CACM-2021-QNRC2-A10)‘‘Chen Guang”project supported by Shanghai Municipal Education Commission and Shanghai Education Development Foundation(No.22CGA50)High-level Chinese Medicine Key Discipline Construction Project(Integrative Chinese and Western Medicine Clinic)of National Administration of TCM(No.zyyzdxk-2023065)Shanghai Talent Development Fund(No.2021073)Shanghai Sailing Program(No.20YF1450500)。
文摘Background:Acute gouty arthritis(AGA)is an inflammatory joint disease with a high prevalence.Typical medical interventions,including nonsteroidal anti-inflammatory drugs,colchicine and glucocorticoids,can have serious adverse reactions.Huzhang Granule(HZG),a compound Chinese herbal medicine,has been used to treat AGA for more than 30 years with satisfactory effects and no significant adverse reactions.However,the efficacy and safety of HZG in AGA patients remains unknown.Objective:The present investigation was designed to examine the efficacy and safety profile of HZG in managing AGA patients.Design,setting,participants and interventions:The current study was conducted as a noninferiority,randomized controlled clinical trial on 180 eligible enrolled participants.Participants were randomly assigned into the HZG and etoricoxib groups.Treatments were administered for 5 d,during which the HZG group received HZG and placebo etoricoxib,while the etoricoxib group received etoricoxib and placebo HZG in the same ratio(1:1).Main outcome measures:The primary outcome was pain experienced by the patient in the gout-afflicted joint from days 2 to 5 of the treatment window.The pain level was measured via a visual analogue scale,ranging from 0 mm to 100 mm.The secondary outcomes comprised joint tenderness and swelling,reduction of inflammatory biomarkers,and the patient’s and investigator’s global evaluations of therapeutic response.Results:The mean reduction in pain was-51.22 mm(95%confidence interval[CI],[-53.42,-49.03]mm)for the HZG and-52.00 mm(95%CI,[-54.06,-49.94]mm)for the etoricoxib groups.The mean difference between the two groups was 0.78 mm(95%CI,[-2.25,3.81]mm).All additional efficacy endpoints,covering decreased inflammation and pain relief,yielded compelling proof of noninferiority.Patients in the HZG group exhibited a comparatively lower rate of adverse events compared to those in the etoricoxib group(4.44%vs 13.33%;P≤0.05).Conclusion:HZG and etoricoxib groups demonstrated similar levels of analgesic effectiveness.The safety and efficacy of HZG indicates that it can be used as a potential therapeutic option for treating AGA.
文摘BACKGROUND Gouty tophus is rarely reported in the head and neck areas.To the best of our knowledge,this is the first report on multiple gouty tophi in the head and neck with normal serum uric acid(SUA)levels.CASE SUMMARY We report a case of multiple gouty tophi in the nasal dorsal and auricle regions with normal SUA levels.The patient was admitted to the hospital with a chief complaint of recurrent nasal swelling and pain for 3 years,which was aggravated for 3 d.The patient’s SUA level had been regularly reviewed in the outpatient department and had been successfully controlled for several years.Resection of the nasal masses was performed.Cartilage from the right ear cavity was used to repair the nasal defects.The pathological report confirmed a nasal gouty tophus.No recurrence or deformity was found after a 1 year follow-up.CONCLUSION Normal SUA cannot completely negate the diagnosis of gouty tophus,especially in some rare regions.
基金Supported by Project of Science and Technology Commis sion Foundation of Jiangsu Province in 1998
文摘Objective: To observe the clinical effect of Rebixiao granule (热痹消颗粒剂, RBXG) in treating repeatedly attacking acute gouty arthritis and through experimental study on blood uric acid to explore RBXG's therapeutic mechanism. Methods: Ninety repeatedly attacking acute gouty arthritis patients were divided into the treated group ( n =60) and control group ( n =30). The treated group was treated with RBXG, and the control group was treated with Futalin tablets (diclofenac sodium). The baseline treatment including good rest, low purine diet, sufficient water drinking and urine alkalization, etc. was then given to both groups. Hypoxanthine 600 mg/kg and niacin 100 mg/kg was applied to hyperuricemic mice by gastrogavage to establish the animal models. Results: The clinical effective rate of the treated group was 95.0% and that of the control 90.0%. Good therapeutic effects were won, insignificant difference ( P >0.05)was shown between the two groups. However, the cure rate of the treated group was 26.7% while that of the control group was 10.0%, with significant difference ( P <0.01) shown between them. The treated group had its blood uric acid lowered, which was significantly different ( P <0.05) from that of the control group. The animal experiment indicated that all the three groups treated with different dosages of RBXG, as well as the Ash bark and Smilax glabra rhizome groups had their blood uric acid content reduced in the hyperuricemic mice. Conclusion: RBXG has a quicker initiation and better treatment effects than sole anti-inflammatory and analgesic agents on the treatment of repeatedly attacking acute gouty arthritis, showing no obvious toxic or adverse reactions and therefore good for long-term administration and likely to be a safe TCM preparation to control the symptoms and reduce the onsets of repeatedly attacking of acute gouty arthritis. The animal experiment shows that both the compound preparation and part of the single ingredients in the recipe have the function of reducing blood uric acid. However, the compound recipe has better therapeutic effects, proving to be superior to single drugs.
文摘If gouty nephropathy is not treated properly,repeated attacks can gradually lead to nephrotic syndrome.This may bring pain to patients and affect their quality of life.The main goal of Western medicine in the treatment of gouty nephropathy is to stop acute attacks,control serum uric acid and avoid recurrence.Yet there are many adverse reactions to long-term use.Dai medicine has unique efficiency in improving clinical symptoms and controlling relapses.Meanwhile it can avoid the potential risks associated with too low control of blood uric acid.Therefore,this paper reviewed the research status of Dai and Western medicine in the treatment of gouty nephropathy in order to provide reference for clinical medication.
基金supported by the National Administration of Traditional Chinese Medicine Young Qi Huang Scholars support project.
文摘Objective:To evaluate the efficacy and safety of Jiawei Simiao powder(JWSMP)combined with celecoxib for the treatment of acute gouty arthritis by conducting a meta-analysis of randomized controlled trials(RCTs).Methods: The Chinese National Knowledge Infrastructure Databases,Chinese Scientific Journal Database,Wanfang,Cochrane Library,EMBASE,PubMed,and Web of Science databases were searched from inception until December 2023.Continuous variables were analyzed using the mean difference(MD)for analysis,and dichotomous variables were used as risk ratios.Data with similar characteristics were pooled for meta-analysis,and heterogeneity was assessed using I2.The Cochrane Handbook was used to assess the risk of bias and quality.RevMan 5.3 software was used to perform the meta-analysis.Results: Thirteen RCTs involving 1007 patients were included in the study.The quality of the included studies was low(unclear randomization processes and insufficient blinding reporting).The group receiving JWSMP combined with celecoxib showed significantly lower levels of serum uric acid(SUA,MD=−66.32,95%confidence interval(CI):−80.97 to−51.67,P<.001),erythrocyte sedimentation rate(ESR,MD=−6.05,95%CI:−8.29 to−3.82,P<.001),C-reactive protein(CRP,MD=−7.39,95%CI:−11.15,−3.63,P<.001),and joint pain score(VAS score,MD=−2.14,95%CI:−2.4 to−1.88,P<.001)compared to celecoxib alone.Additionally,the JWSMP combined group had a higher total effective rate(risk ratio=1.22,95%CI:1.14 to 1.29,P<.001)and fewer adverse compared to celecoxib alone.Conclusions: JWSMP combined with celecoxib is more effective than celecoxib alone in improving the total efficacy rate,alleviating joint pain,and improving SUA,ESR,and CRP levels.JWSMP also reduced the occurrence of adverse events caused by celecoxib.However,the quality of the included studies was low,highlighting the need for further high-quality research with larger sample sizes and robust methodologies,such as double-blind randomization,to confirm these findings.
文摘BACKGROUND Chronic synovitis due to chronic knee gouty arthritis(KGA)resulting in synovial hyperplasia has not been documented in the current literature,and thus the optimal management for this condition remains unclear.This case report discusses a 34-year-old man with a history of chronic KGA who presented with recurrent knee effusion resulting from synovial hyperplasia.CASE SUMMARY A 34-year-old man presented to our outpatient clinic with a 5-year recurrent knee effusion and a history of chronic KGA.Symptoms persisted despite serial aspiration and urate-lowering medication(febuxostat 80 mg once daily)for 2 months.Diagnostic arthroscopy was performed due to the recalcitrant symptoms.Intraoperatively,tophi deposition and excessive thickening of the synovial membrane were observed.Synovial biopsy and partial synovectomy were performed,revealing chronic synovitis with synovial hyperplasia that was consistent with chronic KGA.At follow-up after 6 months,the patient reported no further episode of knee effusion.CONCLUSION Arthroscopic synovectomy for synovial hyperplasia in chronic KGA sufficiently eradicates the symptoms of recurrent knee effusion.
基金the Subject of Wuxi Health and Family Planning Commission(ZXZL201803)Youth Lift Plan of Wuxi Hospital of Traditional Chinese Medicine(ZYY2017B005).
文摘External application of traditional Chinese medicine has a long history and definite curative effect on gout.By searching the latest literature on the treatment of acute gouty arthritis by external treatment of traditional Chinese medicine,the research progress of external treatment of acute gouty arthritis in recent years was summarized.According to the existing research results,the external treatment of Chinese medicine in the treatment of acute gout has better efficacy and higher safety,and has a broad application prospect.
文摘Objective To compare the efficacy difference in treatment of acute gouty arthritis between acupuncture combined with infrared irradiation and Indomethachin, as well as to observe the impacts on liver function. Methods One hundred and sixty cases of gout were randomized into an acupuncture group （80 cases） and an Indomethachin group （80 cases）. In the acupuncture group, acupuncture was applied to Zusanli（足三里 ST 36）, SanyTnjiao （三阴交 SP 6）, Quchi （曲池LI 11）, Xuehai （血海 SP 10）, Yanglingquan （阳陵泉 GB 34） and Ashi points （阿是穴）. Additionally, infrared irradiation was used in the local area. The treatment was given once daily. In the Indomethachin group, Indomethachin was taken orally, 25 mg each time, three times per day. The treatment lasted for 5 days in either group. Separately, before and after treatment, pain severity and the levels of blood uric acid （BUA）, erythrocyte sedimentation rate （ESR）, alanine aminotransferase （ALT） and aspartate aminotransferase （AST） were detected. Additionally, the efficacy and the impacts on liver function were assessed. Results The cured rate was 52.5% （42/80） in the acupuncture group, which was superior to 22.5% （18/80） in the Indomethachin group （P〈0.01）. In the acupuncture group, the analgesic efficacy was better than that in the Indomethachin group （P〈0.01） and the effect on reducing BUA and ERS levels was same as that in the Indomethachin group （all P〉0.05）. After treatment, ALT and AST levels had no changes in the acupuncture group, but they increased apparently in the Indomethachin group （all P〈0.01）. Conclusion Acupuncture combined with infrared irradiation achieves a superior efficacy on acute gouty arthritis as compared with oral medication of Indomethachin and the therapy provides a significant effect on analgesia and does not bring the damage of liver function.
