关键词:

类风湿性肩关节炎, 超声引导针刀, 秦息痛, 临床疗效

Abstract:

Objective　To analyze the clinical effect of ultrasound-guided acupotomy combined with Qinxitong in the treatment of rheumatoid shoulder arthritis. Methods　This study was a randomized controlled trial. A total of 120 patients with rheumatoid shoulder arthritis treated in Xi'an Fifth Hospital from September 2021 to March 2023 were selected and were divided into group A, B, and C by the random number table method, with 40 cases in each group. Group A included 8 males and 32 females, aged (52.43±11.77) years, with a course of disease of (55.40±33.89） months. Group B included 11 males and 29 females， aged （51.48±11.91） years， with a course of disease of (56.25±40.41) months. Group C included 10 males and 30 females, aged (53.18±10.47) years, with a course of disease of (55.88±41.52) months. All the three groups took methotrexate tablet 10.0-12.5 mg/time, once a week, and leflunomide tablet 10-20 mg/time, once a day. Group A was treated with ultrasound-guided acupotomy once a week for 3 consecutive weeks. Group B took Qinxitong orally, 1.08-1.80 g/time, twice a day. Group C was treated with ultrasound-guided acupotomy combined with Qinxitong, and the treatment plan was consistent with group A and B. All the three groups were treated for 12 weeks. The Visual Analogue Scale (VAS) score, Constant-Murley Shoulder Joint Function Score (CMS), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), 28 joint disease activity score-erythrocyte sedimentation rate (DAS28-ESR), and 28 joint disease activity score-C reactive protein (DAS28-CRP) were compared among the three groups before treatment, 4 weeks after treatment, and 12 weeks after treatment, as well as clinical efficacy and adverse effects. χ² test, analysis of variance, and generalized estimation equation were used for statistical analysis. Results　The effective rate of group C was 97.50% (39/40), higher than those of group A [77.50% (31/40)] and B [77.50% (31/40)], with a statistically significant difference (χ²=8.004, P=0.018). After 4 weeks and 12 weeks of treatment, the VAS, ESR, CRP, DAS28-ESR, and DAS28-CRP of the three groups showed a decreasing trend compared to before treatment, and those in group C were lower than those in group A and B; the CMS showed an upward trend, and that in group C was higher than those in group A and B (all P<0.05). The incidences of adverse reactions in group A, B, and C were 12.50% (5/40), 17.50% (7/40), and 20.00% (8/40), respectively, with no statistically significant difference (P>0.05). Conclusion　The combination of ultrasound-guided acupotomy and Qinxitong in the treatment of rheumatoid arthritis can relieve shoulder joint pain, improve shoulder joint function, reduce inflammation level and disease activity, and improve clinical efficacy, with relatively high safety in clinical application.

Key words:

Rheumatoid shoulder arthritis, Ultrasound-guided acupotomy, Qinxitong, Clinical efficacy