Objectives: To observe the clinical efficacy of moxibustion as an adjunctive treatment for rheumatoid arthritis (RA) based on conventional medication and its effects on serum sclerostin (SOST) and β-catenin levels, exploring the potential mechanisms by which moxibustion may protect joint bones in RA patients.
Methods: Seventy-six RA patients were randomly divided into an observation group (38 cases, 3 cases dropped out) and a control group (38 cases, 4 cases were eliminated, 2 cases dropped out). The patients in the control group were treated with conventional oral medication; based on the treatment of the control group, the patients in the observation group were treated with moxibustion. The direct moxibustion was applied at Zusanli (ST 36) on both sides and ashi points around small joints, and indirect moxibustion was applied at Shenshu (BL 23) on both sides and ashi points around large joints. The treatment was given three times a week for a total of 5 weeks. The count of pain and swollen joint, morning stiffness score, disease activity score of 28 joints (DAS28), visual analogue scale (VAS) score, health assessment questionnaire (HAQ) score, and serum levels of SOST, β-catenin, and tumor necrosis factor-α (TNF-α) were evaluated before and after treatment in the two groups.
Results: Compared those before treatment, after treatment, both groups showed a reduction in pain and swollen joint count (P<0.01, P<0.05), morning stiffness, DAS28, VAS, and HAQ scores (P<0.01, P<0.05), with the observation group having lower scores than the control group (P<0.01). Serum levels of SOST, β-catenin, and TNF-α after treatment in the observation group were lower than those in both before treatment and the control group (P<0.01, P<0.05). There was a positive correlation between the difference in serum β-catenin levels before and after treatment and the difference in serum SOST (r=0.578, P<0.001) and TNF-α (r=0.403, P<0.05) levels in the observation group.
Conclusions: In addition to medication, moxibustion as an adjunctive treatment could significantly alleviate joint pain and reduce disease activity in RA patients, suggesting a potential role in joint protection. This mechanism may be related to the inhibition of the inflammatory factor TNF-α, regulation of β-catenin levels, and reduction in the production of the endogenous negative regulator protein SOST within the Wnt/β-catenin signaling pathway.
目的: 观察在西药基础上艾灸辅助治疗类风湿关节炎（RA）的临床疗效及对患者血清硬化蛋白（SOST）、β-连环蛋白（β-catenin）含量的影响，探讨艾灸对RA患者关节骨保护可能的潜在机制。方法: 将76例类风湿关节炎患者随机分为观察组（38例，脱落3例）和对照组（38例，剔除4例、脱落2例）。对照组采用常规西药口服治疗，观察组在对照组治疗基础上予艾灸治疗，于双侧足三里和小关节处阿是穴直接灸、双侧肾俞和大关节处阿是穴隔物灸，每周3次，共治疗5周。分别于治疗前后观察两组患者压痛和肿胀关节计数、晨僵评分、28个关节疾病活动度（DAS28）评分、视觉模拟量表（VAS）评分、健康状况评估问卷（HAQ）评分及血清SOST、β-catenin、肿瘤坏死因子-α（TNF-α）含量。结果: 治疗后，两组患者压痛、肿胀关节计数较治疗前减少（P<0.01，P<0.05），晨僵、DAS28、VAS、HAQ评分较治疗前降低（P<0.01，P<0.05），且观察组均低于对照组（P<0.01）。观察组患者治疗后血清SOST、β-catenin、TNF-α含量低于治疗前及对照组（P<0.01，P<0.05）。观察组患者治疗前后血清β-catenin含量差值与血清SOST（r=0.578，P<0.001）、TNF-α（r=0.403，P<0.05）含量差值呈正相关。结论: 在西药基础上，艾灸辅助治疗能够明显缓解RA患者关节疼痛、降低疾病活动度，对RA患者存在潜在的骨保护作用。其机制可能与抑制炎性因子TNF-α产生、调控β-catenin水平、减少Wnt/β-catenin信号通路内源性负调节蛋白SOST生成有关。.
Keywords: Wnt/β-catenin signaling pathway; bone metabolism; moxibustion; rheumatoid arthritis (RA); sclerostin (SOST); tumor necrosis factor-α (TNF-α); β-catenin.