Dose-effect relationship of moxibustion for rheumatoid arthritis of liver and kidney deficiency and its effect on fatigue: a randomized controlled trial

ZHAO Hongfang; ZHAO Hui; WANG Miao; ZHU Yan

doi:10.13703/j.0255-2930.20230906-k0002

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Dose-effect relationship of moxibustion for rheumatoid arthritis of liver and kidney deficiency and its effect on fatigue: a randomized controlled trial

Clinical Research | 更新时间：2024-09-25

- Dose-effect relationship of moxibustion for rheumatoid arthritis of liver and kidney deficiency and its effect on fatigue: a randomized controlled trial
- Chinese Acupuncture & Moxibustion Vol. 44, Issue 9, Pages: 1001-1008(2024)
- 作者机构：
  
  1.安徽中医药大学研究生院，合肥　230012
  2.安徽中医药大学第二附属医院老年病一科，合肥　230061
- 作者简介：
- 基金信息：
- DOI：10.13703/j.0255-2930.20230906-k0002
  CLC：
- Received：06 September 2023，
  
  Online First：15 July 2024，
  
  Published：12 September 2024
- 稿件说明：
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ZHAO Hongfang, ZHAO Hui, WANG Miao, et al. Dose-effect relationship of moxibustion for rheumatoid arthritis of liver and kidney deficiency and its effect on fatigue: a randomized controlled trial[J]. Chinese Acupuncture & Moxibustion, 2024, 44(9): 1001-1008.
DOI：

ZHAO Hongfang, ZHAO Hui, WANG Miao, et al. Dose-effect relationship of moxibustion for rheumatoid arthritis of liver and kidney deficiency and its effect on fatigue: a randomized controlled trial[J]. Chinese Acupuncture & Moxibustion, 2024, 44(9): 1001-1008. DOI： 10.13703/j.0255-2930.20230906-k0002.

摘要

目的：

在西药治疗基础上，观察不同频次艾灸对肝肾亏虚型类风湿关节炎（RA）患者疾病活动度及疲劳状态的影响。

方法：

将135例肝肾亏虚型RA患者随机分为高频艾灸组（45例，脱落3例）、低频艾灸组（45例，脱落2例）和西药组（45例，脱落2例，中止1例）。西药组予来氟米特片口服，每日1次，每次20 mg。在西药组治疗基础上，高频艾灸组和低频艾灸组均予艾灸阿是穴和双侧肾俞、三阴交，每次15 min。高频艾灸组每日艾灸1次，每周5次；低频艾灸组隔日艾灸1次，每周3次。3组均连续治疗12周。于治疗前后观察3组患者28个关节疾病活动度（DAS28）评分、红细胞沉降率（ESR）、C反应蛋白（CRP）、类风湿因子（RF）、中医证候积分、双手平均握力（GS）、30 s坐立起身测试（STS）、起立-行走时间测试（TUG）、20 m步行测试（20MWT）、焦虑自评量表（SAS）评分、抑郁自评量表（SDS）评分，于治疗前后及治疗结束后1、3个月随访观察3组患者疲劳视觉模拟量表（VAS）评分、Bristol类风湿关节炎疲劳数值评定量表（BRAF-NRS）评分、Bristol类风湿关节炎疲劳多维度问卷（BRAF-MDQ）评分，于治疗后依据美国风湿病学会（ACR）20/50/70标准评定病情缓解情况。

结果：

治疗后，3组患者DAS28评分、ESR、CRP、RF、中医证候积分、TUG、20MWT、SAS评分、SDS评分均较治疗前降低（

0.01，

0.05），双手平均GS、STS较治疗前升高（

0.01，

0.05）。治疗后，高频艾灸组患者DAS28评分、ESR、CRP、中医证候积分、SAS评分、SDS评分均低于西药组及低频艾灸组（

0.01，

0.05），双手平均GS、STS高于西药组及低频艾灸组（

0.01，

0.05），TUG、20MWT低于西药组（

0.01，

0.05）；低频艾灸组DAS28评分、ESR、CRP、中医证候积分、TUG、SAS评分、SDS评分均低于西药组（

0.05，

0.01），双手平均GS高于西药组（

0.01）。治疗后各时点，3组患者疲劳VAS、BRAF-NRS评分较治疗前降低（

0.01），高频艾灸组和低频艾灸组患者BRAF-MDQ评分较治疗前降低（

0.01）；治疗后，西药组患者BRAF-MDQ评分较治疗前降低（

0.01）。高频艾灸组患者治疗后各时点疲劳VAS、BRAF-NRS及BRAF-MDQ评分均低于西药组（

0.01），治疗结束后1个月随访疲劳VAS、BRAF-NRS评分及治疗后BRAF-MDQ评分低于低频艾灸组（

0.01，

0.05）；低频艾灸组治疗后各时点疲劳VAS、BRAF-NRS及BRAF-MDQ评分低于西药组（

0.01，

0.05）。治疗后，高频艾灸组及低频艾灸组患者ACR20、ACR50比例均高于西药组（

0.01）；高频艾灸组患者ACR70比例高于低频艾灸组及西药组（

0.05，

0.01）；低频艾灸组ACR70比例高于西药组（

0.05）。

结论：

在西药治疗基础上，艾灸可有效降低肝肾亏虚型RA患者疾病活动度，改善疲劳状态，其疗效与灸频呈正相关。

Abstract

Objective

To observe the effects of moxibustion with different frequency on the disease activity and fatigue of rheumatoid arthritis (RA) with liver and kidney deficiency on the basis of western medication treatment.

Methods

A total of 135 RA patients with liver and kidney deficiency were randomly divided into a high-frequency moxibustion group (45 cases

3 cases dropped out)

a low-frequency moxibustion group (45 cases

2 cases dropped out) and a western medication group (45 cases

2 cases dropped out

1 case discontinued). Leflunomide tablet was taken orally in the western medication group

once a day

20 mg a time. On the basis of the treatment in the western medication group

moxibustion was applied at

ashi

points and bilateral Shenshu (BL 23) and Sanyinjiao (SP 6) in the two moxibustion groups

15 min a time. The treatment was given once a day

5 times a week in the high-frequency moxibustion group and once every other day

3 times a week in the low-frequency moxibustion group. A total of 12-week treatment was required in the 3 groups. Before and after treatment

the 28 joint disease activity score (DAS28)

erythrocyte sedimentation rat

e (ESR)

C-reactive protein (CRP)

rheumatoid factor (RF)

TCM syndrome score

average grip strength (GS) of both hands

30-second sit-to-stand (STS)

timed up and go (TUG)

20-meter walk test (20MWT)

self rating anxiety scale (SAS) score and self rating depression scale (SDS) score were observed; before treatment

after treatment and in follow-up of 1

3 months after treatment completion

the scores of fatigue visual analogue scale (VAS)

Bristol rheumatoid arthritis fatigue numerical rating scale (BRAF-NRS) and Bristol rheumatoid arthritis fatigue multi-dimensional questionnaire (BRAF-MDQ) were observed

and the relieving of disease was evaluated by American College of Rheumatology (ACR)20/50/70 standards in the 3 groups.

Results

After treatment

the DAS28 scores

ESR

CRP

TCM syndrome scores

TUG

20MWT

SAS scores and SDS scores were decreased compared with those before treatment (

0.01

0.05)

while the average GS of both hands and STS were increased compared with those before treatment (

0.01

0.05) in the 3 groups. After treatment

in the high-frequency moxibustion group

the DAS28 score

ESR

CRP

TCM syndrome score

SAS score and SDS score were lower (

0.01

0.05)

while the average GS of both hands and STS were higher (

0.01

0.05) than those in the low-frequency moxibustion group and the western medication group; the TUG and 20MWT were decreased compared with those in the western medication group (

0.01

0.05). After treatment

in the low-frequency moxibustion group

the DAS28 score

ESR

CRP

TCM syndrome score

TUG

SAS score and SDS score were lower (

0.05

0.01)

while the average GS of both hands was higher (

0.01) than those in the western medication group. In each time point after trea

tment

the scores of fatigue VAS and BRAF-NRS were decreased compared with those before treatment in the 3 groups (

0.01)

while the BRAF-MDQ scores were decreased compared with those before treatment in the high-frequency moxibustion group and the low-frequency moxibustion group (

0.01). After treatment

the BRAF-MDQ score was decreased compared with that before treatment in the western medication group (

0.01). In the high-frequency moxibustion group

the scores of fatigue VAS

BRAF-NRS and BRAF-MDQ of each time point after treatment were lower than those in the western medication group (

0.01)

the scores of fatigue VAS and BRAF-NRS in follow-up of 1 month after treatment completion as well as the BRAF-MDQ score after treatment were lower than those in the low-frequency moxibustion group (

0.01

0.05). In the low-frequency moxibustion group

the scores of fatigue VAS

BRAF-NRS and BRAF-MDQ of each time point after treatment were lower than those in the western medication group (

0.01

0.05). After treatment

the proportions of ACR20 and ACR50 in the high-frequency moxibustion group and the low-frequency moxibustion group were higher than those in the western medication group (

0.01)

the proportion of ACR70 in the high-frequency moxibustion group was higher than those in the low-frequency moxibustion group and the western medication group (

0.05

0.01)

and the proportion of ACR70 in the low-frequency moxibustion group was higher than that in the western medication group (

0.05).

Conclusion

On the basis of the western medication treatment

moxibustion can effectively reduce the disease activity and improve fatigue status in RA patients with liver and kidney deficiency

and its efficacy is positively correlated with treatment frequency.

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