Effect of Erchong Tongluo powder combined with Methotrexate in the treatment of rheumatoid arthritis bone lesions and its impact on inflammatory mediators and RANK/RANKL/OPG pathway

TANG Xihong; GAO Caixia; QIANG Jianhong; FENG Yanfei; YANG Xiaojie; LI Yanqin; LI Ke

doi:10.3969/j.issn.1002-3429.2025.20.019

Abstract：Objective To explore the effect of Erchong Tongluo powder combined with Methotrexate in the treatment of rheumatoid arthritis(RA)bone lesions and its impact on inflammatory mediators and the receptor activator of nuclear factor-κB(RANK)/receptor activator of nuclear factor-κB ligand(RANKL)/osteoprotegerin(OPG)pathway.Methods A total of 114 patients with RA bone lesions admitted from January 2019 to January 2021 were selected and divided into the observation group(n=57)and the control group(n=57)by random number table method.The observation group was treated with Erchong Tongluo powder combined with Methotrexate,and the control group was treated with Methotrexate;both groups were treated for 3 consecutive months.The clinical efficacy and adverse reactions of the two groups were observed,as well as the traditional Chinese medicine(TCM)syndrome scores,inflammatory mediators[erythrocyte sedimentation rate(ESR),interleukin-17(IL-17),anti-cyclic citrullinated peptide(CCP)antibody,rheumatoid factor(RF)],pain mediators[β-endorphin(β-EP),prostaglandin E2(PGE2),substance P(SP)],and RANK/RANKL/OPG pathway indicators before treatment and at 3 months after treatment.Results At 3 months after treatment,the total effective rate of the observation group was 92.98%,which was higher than that of the control group(75.44%)(P<0.05).At 3 months afer treatment,the scores of TCM syndromes in both groups decreased,and the scores were lower in the observation group than in the control group(P<0.05,P<0.01).At 3 months after treatment,IL-17,ESR,anti-CCP antibody and RF in the two groups decreased,which were lower in the observation group than in the control group(P<0.05,P<0.01).At 3 months after treatment,SP,PGE2 and β-EP in the two groups decreased,which were lower in the observation group than in the control group(P<0.05,P<0.01).At 3 months after treatment,RANKL and RANK decreased,while OPG increased in the two groups;RANKL and RANK in the observation group were lower than those in the control group,while OPG was higher than that in the control group(P<0.05,P<0.01).There was no significant difference in the total incidence of adverse reactions between the two groups during treatment(P>0.05).Conclusion Erchong Tongluo powder combined with Methotrexate in the treatment of RA bone lesions has significant effects,which can effectively reduce the clinical symptoms,reduce the levels of inflammatory mediators and pain mediators,regulate the RANK/RANKL/OPG pathway,delay bone lesions,and has good safety.