目的:观察针灸治疗类风湿性关节炎(RA)的疗效

并与西药甲氨蝶呤(MTX)的作用进行对比。方法:90例RA患者分为针灸治疗组45例

附子饼间接灸大椎、命门、肝俞、脾俞、肾俞

局部取穴温针灸受累关节

隔日1次;甲氨蝶呤对照组45例

肌注MTX 10 mg

每周1次。两组疗程均为5个月

观察项目有治疗前后的关节痛程度、晨僵、握力、血沉(ESR)、C-反应蛋白(CRP)、类风湿因子(RF)及临床总体疗效、起效时间和不良反应。结果:针灸组的关节痛程度、晨僵、握力、ESR、CRP、RF等指标改善情况明显优于MTX对照组(P<0.05)。针灸组显效13例

有效17例

改善9例

无效6例

总有效率86.7%;MTX组显效12例

有效14例

改善8例

无效11例

总有效率75.6%;两组相比有显著性差异(P<0.05)。起效时间针灸组较MTX组明显缩短(P<0.05)

且针灸组未见明显不良反应。结论:针灸治疗类风湿性关节炎优于甲氨蝶呤。Objective: To observe the therapeutic effect of acu-moxibustion in the treatment of rheumatoid arthritis.Methods: A total of 90 cases of rheumatoid arthritis patients were divided into acu-moxibustion group(n=45) and medication group(n=45) according to random number table method.For patients of acu-moxibustion group

Fuzi(附子Radix Aconiti Praeparata) cake-separated moxibustion was applied to bilateral Dazhui(GV 14)

Mingmen(GV 4)

Ganshu(BL 18)

Pishu(BL 20) and Shenshu (BL 23).Acupoints around the affected joints were punctured with filiform needles which were twirled

lifted and thrust repeatedly for a while followed by attaching ignited moxa cones to the handle of the needle(30 min).The treatment was given once every other day

with 1 month being a therapeutic course

5 months altogether.The patients of medication group were treated by intramuscular injection of Methotrexate((10 mg))

once every week

5 months altogether.Joint pain degree

morning stiffness duration

grip strength

erythrocyte sedimentation rate(ESR)

and serum C-reactive protein(CRP) and rheumatoid factor(RF) were detected before and every month after the treatment.The total therapeutic effect was judged by using the improved degrees of ESR and CRP [(values before treatment-those after treatment)/(values before treatment-normal value)] ×100%.Results: Before the treatment

there were no significant differences between two groups in joint pain degree

morning stiffness duration

grip strength

ESR

CRP and RF values

while after the treatment

self-comparison showed that the pain degree

morning stiffness duration

ESR

CRP and RF decreased significantly

while the grip strength increased remarkably in both groups(P<0.05).Comparison between two groups indicated that the therapeutic effect of acu-moxibustion group was significantly superior to that of medication group in these 6 indexes(P<0.05).Results of the total therapeutic effect revealed that of the two 45 cases in acu-moxibustion and medication groups

13(28.9%) and 12(26.7%) experienced significant improvement

17(37.8%) and 14(31.1%) had a moderate improvement

9(20.0%) and 8(17.8%) had mild improvement

6(13.3%) and 11(24.4%) failed

with the total effective rates being 86.7% and 75.6% respectively.In addition

the time for inducing therapeutic effect was significantly earlier than that of medication group(P<0.05).Conclusion: Acu-moxibustion is effective in the treatment of rheumatoid arthritis and its therapeutic effect is markedly superior to that of Methotrexate.