Rheumatoid Arthritis In China Research Articles

Bulleyaconitine A Isolated from Aconitum Plant Displays Long-acting Local Anesthetic Properties In Vitro and In Vivo

Bulleyaconitine A (BLA) is an active ingredient of Aconitum bulleyanum plants. BLA has been approved for the treatment of chronic pain and rheumatoid arthritis in China, but its underlying mechanism remains unclear. The authors examined (1) the effects of BLA on neuronal voltage-gated Na channels in vitro under the whole cell patch clamp configuration and (2) the sensory and motor functions of rat sciatic nerve after single BLA injections in vivo. BLA at 10 microm did not affect neuronal Na currents in clonal GH3 cells when stimulated infrequently to +50 mV. When stimulated at 2 Hz for 1,000 pulses (+50 mV for 4 ms), BLA reduced the peak Na currents by more than 90%. This use-dependent reduction of Na currents by BLA reversed little after washing. Single injections of BLA (0.2 ml at 0.375 mm) into the rat sciatic notch not only blocked sensory and motor functions of the sciatic nerve but also induced hyperexcitability, followed by sedation, arrhythmia, and respiratory distress. When BLA at 0.375 mm was coinjected with 2% lidocaine (approximately 80 mm) or epinephrine (1:100,000) to reduce drug absorption by the bloodstream, the sensory and motor functions of the sciatic nerve remained fully blocked for approximately 4 h and regressed completely after approximately 7 h, with minimal systemic effects. BLA reduces neuronal Na currents strongly at +50 mV in a use-dependent manner. When coinjected with lidocaine or epinephrine, BLA elicits prolonged block of both motor and sensory functions in rats with minimal adverse effects.

Discovery and synthesis of new immunosuppressive alkaloids from the stem of Fissistigma oldhamii (Hemsl.) Merr.

Three new alkaloids ( 1– 3) and twenty-one known compounds were isolated from the stem of Fissistigma oldhamii (Hemsl.) Merr. which was the ruler herb in an approved Traditional Chinese herbal formula used for treatment of rheumatoid arthritis in China and synthesis of one new immunosuppressive alkaloid was achieved. These compounds, including the crude extracts of this herb, exhibited strong activities in the inhibition of T and B cell proliferation.

Rheumatology in China--brief introduction of the development of Chinese rheumatology

arthritis ranged from 0.26 to 0.5%, with an average of 0.36%. A study conducted in both the Northern and Southern parts of China estimated that the prevalence of ankylosing spondylitis was 0.26%. The positive rate of HLA-B27 in patients of ankylosing spondylitis was >90%, while the rate in the general population was only 6-7%. Another survey conducted in 30 000 textile workers in Shanghai showed that the prevalence of systemic lupus erythematosus in males was 70 per 100 000 persons; and in females, the rate was 113 per 100 000 persons. Data from hospitals in Beijing showed that among patients with systemic lupus erythematosus who visited a doctor, those aged 14-39 yrs comprised 70% of the population, and the male to female ratio was 1:13 while the ratio was 1:4 in patients aged between 40 and 59 yrs. An epidemiology investigation of osteoarthritis conducted in 13 451 steel workers in Shanghai showed that the prevalence of symptomatic osteoarthritis was 2.2% and asymptomatic osteoar- thritis was 53%. The prevalence of osteoarthritis was 11, 27 and 62% in the age groups 30-39, 40-49 and 50-59 yrs, respectively. Looking at primary Sjogren's syndrome, an investigation was conducted in 1992 in all adults (total 2060) living in a suburban region of Beijing, including screening with anti-nuclear antibodies (ANA), rheumatoid factor and anti-SSA(Ro)/anti-SSB(La) as well as a questionnaire. For those who were positive in any of the screen tests, additional tests for keratoconjunctivitis sicca and salivary gland involvement were performed. The results showed that the prevalence of primary Sjogren's syndrome in the Beijing area was 0.77% based on the Copenhagen criteria and 0.29% based on the San Diego criteria. Therefore, we concluded that primary Sjogren's syndrome is not a rare disease in China. Recently, another investigation was conducted to explore the current therapeutic strategy for rheumatoid arthritis in China. Eleven regions and 56 hospitals took part in this study. So far, 2202 patients with rheumatoid arthritis have been registered, 436 males and 1766 females, with the average age of 48.66 16.05 (8-90) yrs and mean disease duration of 86.49 98.47 (1-664) months. The involved joints at the onset of disease were hand (61.76%), knee (35.6%), wrist (34.29%), shoulder (18.89%), foot (17.71%), ankle (17.57%), elbow (15.03%), hip (5.00%) and spine (3.95%). The first drug taken by patients was non-steroidal anti- inflammatory drugs (NSAIDs) (53.04%), disease-modifying anti-rheumatic drugs (DMARDs) (21.21%), glucocorticosteroids (16.89%), Chinese traditional medicine (9.49%) and drugs with unknown component (11.99%). The first DMARD prescribed was methotrexate (60.81%), sulphasalazine (22.55%), leflunomide (16.01%), hydroxychloroquine (7.88%) D-penicillamine (7.29%), etc. The average time from joint pain to joint function impair- ment was 36.38 66.63 months, and the time to joint deformity was 55.61 73.87 months. Investigation also revealed that the average time from joint pain to DMARDs prescription in patients without joint deformity was 36.33 68.48 months, while the time was 75.69 98.43 months in patients with joint deformity, suggesting that early prescription of DMARDs could effectively prevent joint destruction. With the development of the Chinese economy and improvement of the living standards of the Chinese people, gout, a formerly rare disease, has become more and more common and been increasingly recognized since the 1990s. An epidemiology survey on gout is underway. It is also noteworthy that with the development of the Chinese economy, government investment on medical research has increased. Chinese medical society becomes more open

Periplocoside E, an Effective Compound fromPeriploca sepiumBge, Inhibited T Cell Activation in Vitro and in Vivo

Periploca sepium Bge, a traditional Chinese herb medicine, is used for treating rheumatoid arthritis in China. Followed the bioactivity-guided isolation, the most potent immunosuppressive compound, periplocoside E (PSE), a pregnane glycoside, had been identified from P. sepium Bge. We investigated the immunosuppressive effects of PSE in vitro and in vivo. The results showed that PSE in a dose-dependent manner significantly inhibited the proliferation of splenocytes induced by concanavalin A and mixed lymphocyte culture reaction at no cytotoxic concentrations (<5 microM). Administration of PSE suppressed a delayed-type hypersensitivity reaction, and ovalbumin (OVA) induced antigen-specific immune responses in mice. In vivo treatment with PSE dose dependently suppressed OVA-induced proliferation and cytokine [interleukin (IL)-2 and interferon (IFN)-gamma] production from splenocytes in vitro. Purified T cells from OVA-immunized mice with PSE treatment showed its low ability for activation by OVA plus normal antigen presenting cell stimulation again in vitro. Further studies showed PSE dose dependently inhibited anti-CD3-induced primary T cell proliferation, activation for IL-2Ralpha (CD25) expression, and cytokine (IFN-gamma and IL-2) production also at the transcriptional level. PSE was highly specific and significantly inhibited the activation of extracellular signal-regulated kinase and Jun N-terminal kinase, whereas activation of p38 was not affected in T cells stimulated with anti-CD3. These results demonstrated that PSE is an immunosuppressive compound in P. sepium Bge, which directly inhibits T cell activation in vitro and in vivo. This study provided evidence to understand the therapeutic effects of P. sepium Bge and indicated that this herb is appropriate for treatment of T cell-mediated disorders, such as autoimmune diseases.

「通ひ霊」のＩＩ型コラーゲン誘発関節炎に対する作用

It was demonstrated that the oriental medication‘Tsu-hi-rei’is clinically useful and effective in treatment of patients with rheumatoid arthritis in China. This effect was supposed to be due to immunomodulation by decreasing of rheumatoid factor and immunoglobulin levels and various parameters of inflammation.So a basic experiment to investigate its mechanism of action was scheduled by using collageninduced arthritis in DBA/1J mice. From 4 weeks after booster injection of type II collagen, “Tsu-hi-rei”and western medication such as indomethacin and an immunomodulator were given, and their effects were compared by clinical observation, X-ray findings and pathologic examination. Anti-collagen antibody was also measured in each treatment group by ELISA.“Tsu-hi-rei”showed suppression of collagen-induced arthritis in frequency and severity. The soft X-ray study revealed decreased bone-destruction and, in sera, titers of anticollagen antibody were lower than in controls.These data suggest that“Tsu-hi-rei”has an antiinflammatory and immunosuppressive effect on collagen-induced arthritis.