This study investigated the differential metabolites after rheumatoid arthritis (RA) rats were treated with Jinteng Qingbi granules. Collagen-induced arthritis rats were divided into three groups, namely normal group, model group, and Jinteng Qingbi granules group. Serum compounds were identified, annotated, and classified using metabolomics to explain the physicochemical properties and biological functions. The metabolites were screened using univariate and multivariate statistical analyses. There were differences in serum metabolites between RA and normal rats; Jinteng Qingbi granules improved RA and recovered the metabolite levels to normal. Compared to the normal group, 51 differential ions were screened, and 108 ions were changed in the Jinteng Qingbi granules group compared to the RA model. Eight metabolites were upregulated in the RA model group compared to the normal group, whereas 10 metabolites were downregulated. Treatment with Jinteng Qingbi granules increased the levels of 12 metabolites such as cinnamate and decreased the levels of 16 metabolites such as allamandin in the RA model. Differential ion enrichment was mainly related to the histidine metabolic pathway in amino acid metabolism. Jinteng Qingbi granules resulted in improvements in the RA model, which were mainly associated with lipids and lipid-like molecules, organic acids, and derivatives, providing a new possibility and basis for screening biomarkers for the diagnosis and treatment of RA.

目的 观察应用中药竹罐技术治疗肾虚督寒型强直性脊柱炎患者的临床疗效,为临床治疗提供可靠依据.方法 选取2020年1—12月中国中医科学院西苑医院风湿科病房收治的强直性脊柱炎患者76例,按照入组的先后顺序随机分配入组,按1:1的比例随机将患者分为观察组和对照组,每组各38例,对照组予非甾体抗炎药(塞来昔布或双氯芬酸钠缓释片)、中药汤剂等药物治疗,按内科强直性脊柱炎常规治疗.观察组在此基础加用中药竹罐治疗,治疗2周,观察治疗前后患者视觉模拟评分(visual analogue scale,VAS)、晨僵时间、中医证候积分等的差异.结果 治疗后,观察组在VAS、晨僵时间、枕墙距方面的改善明显优于对照组(P<0.01);在Schober征的改善上优于对照组(P<0.05);中医证候积分有明显改善,差异有显著性(P<0.01).结论 中药竹罐治疗可以辅助改善肾虚督寒型强直性脊柱炎患者脊柱功能及中医证候,增加活动度,提高患者生活质量.

目的:基于数据挖掘技术探讨房定亚教授治疗急性痛风性关节炎的临床用药规律.方法:收集 2014 年 10 月至 2019 年 12 月在中国中医科学院西苑医院房定亚教授特需门诊就诊的 78 例急性痛风性关节炎患者的中药处方,应用中医传承辅助平台(V2.5)临床采集系统,录入数据,采用复杂系统熵聚类、关联规则算法等数据挖掘的方法,分析房定亚教授治疗急性痛风性关节炎的组方特点和用药规律.结果:共纳入中药处方78首,辨证以湿热阻络为主,涉及药物93味,使用频次 ﹥30次的药物有葛根、土茯苓、车前草、马齿苋、玄参等 9 味,获得置信度为 1 的药物组合 24 个,提取核心药物组合 8 个,挖掘潜在治疗新处方 4 首.结论:房定亚教授治疗急性痛风性关节炎以清热利湿为主,佐以活血通络,体现其辨病与辨证相结合,专病专方治疗疾病的思想.

目的 研究金藤清痹颗粒通过调节免疫微环境对类风湿关节炎大鼠的干预作用及其机制.方法 通过注射牛Ⅱ型胶原和弗氏不完全佐剂建立胶原诱导型关节炎(CIA)大鼠模型,造模成功后随机分为模型组、甲氨蝶呤组、雷公藤多苷组及金藤清痹颗粒低、中、高剂量组,每组10只,另以10只正常大鼠作为正常组,给药组灌胃给予相应剂量药物,模型组和正常组灌胃给予等体积0.9％氯化钠注射液.每7 d进行1次足底厚度检测和关节指数评分,HE染色观察膝关节滑膜病理改变,免疫组化检测滑膜CD68、CD86、CD206表达,流式细胞术检测外周血中辅助性T细胞17(Th17)和调节性T细胞(Treg)比例,Western blot法检测TLR4/NF-κB信号通路蛋白表达,RT-qPCR法检测TLR4、IKKβmRNA表达.结果 金藤清痹颗粒与甲氨蝶呤、 雷公藤多苷均能减轻CIA大鼠四肢关节肿胀(P<0.05),降低M1/M2型巨噬细胞比例、Th17/Treg细胞比例、TLR4 mRNA及TLR4、p-IκBα、细胞核p65蛋白表达(P<0.05,P<0.01),升高IKKβ、 胞质p65蛋白及IKKβmRNA表达(P<0.05,P<0.01),并呈剂量依赖性.结论 金藤清痹颗粒能够通过影响M1/M2型巨噬细胞极化,调节Th17/Treg细胞平衡,调控TLR4/NF-κB信号通路表达,改善免疫微环境,从而缓解类风湿关节炎大鼠关节肿胀症状.

大柴胡汤首载于《伤寒论》和《金匮要略》，是治疗少阳、阳明合病的经典方剂。房定亚教授善用大柴胡汤治疗符合少阳、阳明合病的各类疑难杂症，尤以肝胆疾病、胃肠疾病、肺系疾病、皮肤疾病为主。本文列举四则医案，体现房教授运用大柴胡汤的要点，并介绍本方与其他方剂合用的经验。

亚急性甲状腺炎(SAT)是一种以甲状腺肿大、疼痛伴发热为主要临床表现的甲状腺炎症疾病,针对SAT轻症患者,西医主要采用非甾体类抗炎药,严重者则合并使用糖皮质激素.西医治疗该病存在停药易反复、疗程长、不良反应多等问题.根据SAT临床表现,将其归属于中医"瘿病"范畴,中医药治疗SAT具有疗程短、疗效较好、不良反应少等优势.张广德教授认为SAT主要病因是外感温毒时邪伴情志失调,发病机制为少阳枢机不利,肝胆疏泄失常,气滞血凝痰结,主张从温病少阳证论治本病,以和解少阳、清热解毒为治疗大法,辅以疏泄肝胆、行气活血、化痰散结消痈药物,后期则注意顾护正气.

儿童进行性骨化性肌炎是一种先天性遗传性结缔组织病，临床较罕见，尚缺乏有效治疗手段。房定亚教授治疗本病在初期应用活血化痰、软坚散结兼顾补肾，后期患儿病情稳定，则从疾病病理出发，运用中药调节免疫，取得较好效果。附验案进行分析。

Background:Patients with acute gouty arthritis experienc severe pain and often have concomitant limited joint movement. High-dose intake of anti-inflammatory analgesics often results in adverse reactions, such as nausea, vomiting, and diarrhea, and might increase the risk of gastrointestinal bleeding. In order to reduce the adverse reactions by oral intake, local use of externally useddrugs with the same active ingredients as the oral intake is an option in clinical practice. However, externally useddrugs take effect slowly and efficacy to reduce painful feelingis unsatisfactory. Therefore, it is demanding to develop a safe and effective treatment plan. In this regard, researchers have put up a hypothesis. The skin of the human body has a dense stratum corneum, which is difficult for externally used drugs to penetrate effectively; if the keratin barrier of the skin around affected joints can be broken without further damaging the skin, externally applied drugs may safely and effectively alleviate the local symptoms of acute gouty arthritis. The nano plum blossom needle is made of a modern new material. The needle body is thin and the diameter of the needle tip is only 300 nm. The needle is used clinically to break through the keratin barrier of the human skin and promote the absorption of external medicine. Therefore, this trial was designed to preliminarily evaluate the safety and effectiveness of using the nano plum blossom needle for the introduction of diclofenac diethylamine emulgel in the treatment of acute gouty arthritis.Methods:A randomized controlled trial including 83 patients with acute gouty arthritis was conducted, who was assigned to three groups, the intervention group, control group 1, and control group 2 in a ratio of 2:2:1, respectively. The nano plum blossom needle was used for the introduction of diclofenac diethylamine emulgel in the intervention group; the nano plum blossom needle was used as a placebo along with the local use of diclofenac diethylamine emulgel in control group 1; and the nano plum blossom needle was used alone in control group 2. The treatments were applied once a day until the pain was completely relieved and the course of treatment lasted up to 7 days. The primary outcome measurement was the visual analog scale for evaluating the degree of pain. The secondary outcome indicators included scoring of the symptoms and signs with comprehensive consideration of the joint skin color, local tenderness, and degree of joint motion, the time and dose of emergency medication usage during trial, and adverse events.Discussion:This trial couldprovide preliminary evidence for evidence-based practice of using nano plum blossom needle transdermal drug delivery technology for diclofenac diethylamine emulgel for the treatment of acute gouty arthritis, and provide a reference for sample size calculation and experimental design of future clinical trials verifying the effectiveness and safety of such a technical scheme in a larger target population.Registration information:This study has been registered in the China Clinical Trial Registry Centerwith the registration code of ChiCTR-IOR-17012154.

Objective Iterative decomposition of water and fat with echo asymmetry and least-squares estimation-iron quantification (IDEAL-IQ) is a noninvasive and objective method used to quantitatively measure fat content. Although this technique has been used in the entire abdomen, IDEAL-IQ findings in the sacroiliac joint (SIJ) have rarely been reported. This preclinical study was performed to quantify the amount of fat in the SIJ in healthy volunteers by IDEAL-IQ. Methods From April to November 2017, 60 healthy volunteers with low back pain were included in this retrospective study. The participants were allocated into groups by age (15–30, 31–50, and ≥51 years), sex (male and female), and body mass index (BMI) (<18.5, 18.5–23.9, and ≥24.0 kg/m2). The iliac-side (Fi) and sacral-side (Fs) fat fractions were obtained in all groups. Two- and three-factor multivariate analyses were performed to analyze the effects of sex, age, and BMI on the Fi and Fs. Results The interaction among sex, age, and BMI had no statistically significant effect on the dependent variable. Both Fi and Fs were significantly influenced by age. Fs was significantly influenced by sex. Conclusion The IDEAL-IQ sequence can be used to quantitatively assess the SIJ fat content in healthy volunteers.

类风湿性关节炎可发生于任何年龄,对中老年人有一定的危害.目前治疗本病的药物很多,包括非甾体抗炎药、改善病情的抗风湿药、生物制剂、糖皮质激素、植物药制剂等.如果使用得当,可明显缓解患者病情,反之,可能产生严重的不良后果.特将类风湿药物治疗的用药重点介绍给大家.

目的:探索类风湿因子异常在原发性干燥综合征中的意义.方法:回顾性分析108例原发性干燥综合征患者的临床表现、体征、实验室指标,并根据类风湿因子的升高与否分为2组,将其临床资料进行对比分析.结果:108例原发性综合征患者中最常见的症状为口干(99.07％)、眼干(92.59％)、腮腺肿大(86.11％),大部分患者有关节炎表现(62.96％),合并有脾大、肺间质病变的比例较小,分别占4.63％ 和11.11％,仅有小部分患者行唇腺活检(12.96％).血清学检验中最常见的是抗SSA抗体阳性(72.22％),其次类风湿因子异常(68.52％)、抗SSB抗体阳性(49.07％)、贫血(38.89％)、白细胞低(32.41％).类风湿因子阳性组与阴性组患者比较分析,类风湿因子阳性组患者相对较年轻,更容易合并抗SSA抗体、抗SSB抗体阳性,且有较高的血清红细胞沉降率、C-反应蛋白及免疫球蛋白G水平.结论:类风湿因子在原发性干燥综合征病情的预后及发展中有重要作用,临床中可参考其是否升高来预测疾病的发展及活动度.

系统性红斑狼疮(systemic lupus erythematosus,SLE)是风湿科常见的、病情较重的疾病之一,可累及多个系统,严重危害人类健康.糖皮质激素及免疫抑制剂的使用在缓解病情、控制临床症状及改善预后等方面取得了一定的疗效,但是长期或大剂量应用会引起严重的毒副反应,如性腺抑制、感染、骨质疏松、无菌性骨坏死、高血压、高血糖、高血脂等[1].房定亚教授为著名的中医风湿病专家,在数十年的临床诊疗中,对于SLE患者应用西药的同时分期辨证选用中药,协同增效,减少西药的不良反应,取得了良好的效果,现将其经验介绍如下.

痛风性关节炎是以血尿酸升高沉积于关节引起的急性关节炎,根据其发作情况分为急性发作期和慢性缓解期.中国中医科学院房定亚教授为著名的风湿病专家,经过长期的临床实践提出分期辨证论治痛风性关节炎,即急性发作期关节表现为红肿热痛时治宜清热利湿,以自拟痛风方加减,并配合自制外敷药清热消肿;慢性缓解期宜从本论治、补益脾肾,常选清宫寿桃丸;若合并出现尿蛋白者以芡实合剂加减,并认为瘀血贯穿痛风性关节炎疾病的始终,治疗需活血化瘀,可应用血府逐瘀汤加减取得良好临床疗效.

Sini Powder was used to treat the symptoms of cold limbs caused by yang-qi depression. Nowadays it is used to sooth the liver and relieve depression as well as regulate the function of liver and spleen. On the basis of syndrome differentiation of TCM combined with modern pharmacological research, Professor FANG Ding-ya uses Sini Powder in a variety of diseases, such as mental disease, lower abdomen disease, and digestive system diseases, and modifies according to different clinical symptoms, with good efficacy.

目的:观察中西医结合治疗方案对老年高血压患者生活质量的影响.方法:130例老年高血压患者随机分为观察组与对照组.对照组采用西医治疗,观察组在其基础上实施中医辨证治疗(痰瘀阻络型1号方、阴虚阳亢型2号方、肾虚型3号方).连续观察6个月,比较两组治疗前后24h动态血压监测(ABPM)、生活质量和临床体征.结果:两组治疗后ABPM各血压目标值均较治疗前显著下降(P＜0.01),两组间差异无统计学意义(P＞0.05).与治疗前比较,观察组的躯体化症状、工作状态、睡眠状况、强迫状况、生理症状评分及总分均有明显改善(P＜0.05),而对照组仅生理症状评分有明显改善(P＜0.05).治疗后观察组较对照组在躯体化症状、睡眠状况、人际关系敏感、压抑、强迫状况、敌对、生理症状及总分等方面的改善更为显著(P＜0.05或P＜0.01).结论:在西医基础治疗上辨证加服中药治疗方案可以明显改善患者的生理症状、躯体化症状、强迫状况、压抑、睡眠状况、人际关系敏感、敌对等方面积分,提高患者的生活质量和改善预后症状.

白塞病是一种慢性复杂性血管炎性疾病,其临床表现复杂,可累及周身多系统.本文从验案入手,所选验案则分别以复发性口腔溃疡、结节性红斑、关节痛等不同临床表现为切入点,回顾性分析了白塞病辨证论治的过程.

This article briefly introduces FANG Dingya's experience in preventing and treating urarthritis with the idea of "preventive treatment of disease",which has three aspects,including preventing disease before it arises,controlling the development of existing disease and preventing the recurrence after cure.During the asymptomatic hyperuricemia period,physicians should focus on "preventing disease before it arises" with the health education for patients,meanwhile clearing heat,draining dampness,draining turbid and expelling stones are the main therapeutic principles,to prevent and treat the acute onset of gout and the formation of urinary stones.During the intermission period and the chronic period,"controlling the development of existing disease" is important,the therapeutic principles are regulating Qi,invigorating blood,dissolving stasis and unblocking the collaterals.For the remission period,tonifying liver and kidney should be emphasized based on "preventing the recurrence after cure".

白塞病累及眼部者常表现为葡萄膜炎，预后不佳，需要局部或者全身运用激素治疗。房定亚教授为著名的风湿病专家，临床中根据白塞病血管炎的病理表现，以甘草泻心汤加减治疗白塞病合并葡萄膜炎急性期，以四妙勇安汤加减治疗缓解期，取得较好疗效。

Lobular panniculitis is a rarely - seen non - suppurative inflammation primarily occurring at fat lobules,characterized as recurrent occurrence of painful nodules and fever. In western medicine in sub-cutaneous fat. Corticosteroids and immunosuppressive agents are commonly used,but with many adverse reac-tions. The integration of Chinese and western medicine plays the co - work on the therapeutic effects and ef-fectively reduces the side effects induced by western medicine. Prof. Fang Dingya is the famous expert on rheumatic disorders and believes that the basic pathological manifestations of panniculitis include vasculitis and panniculitis nodules. The internal accumulation of heat toxin is involved in the acute stage and heat toxin consuming qi and yin involved in the recovery stage. The modified simiao yongan decoction and the empirical formula"san liang san"are adopted in different stages for detoxification and removing masses. The therapeutic effects are satisfactory.