PDF(Pubmed)
Abstract：
BACKGROUND: Arthritis is a common clinical condition seen in Ayurveda clinics. Clinical trials have reported Ayurvedic interventions to be of benefits in many arthritic conditions including Rheumatoid Arthritis (RA). No mechanistic details however are available about how such interventions on their own or as a combination of whole system Ayurveda might be working.
OBJECTIVE: The study aims to evaluate simultaneously the clinical outcome of Ayurveda whole system (AWS) intervention in RA patients and identifying the serum metabolic signatures which could be useful for diagnosing the disease and monitoring treatment response.
METHODS: RA patients (n = 37) simultaneously diagnosed as Amavata fulfilling the specific inclusion and exclusion criteria were recruited in the study and were given Ayurveda whole system (AWS) intervention comprised of oral medicines, local therapy and dietary recommendation for 3 months. The clinical and serum metabolic changes were investigated for pre-treatment RA patients (baseline RA group, n = 37) and post-treatment RA patients (following treatment of 6-weeks (RA_F, n = 26) and three months (RA_T, n = 36). For comparative serum metabolomics analysis, 57 normal healthy control (HC) subjects were also involved and the serum metabolic profiles were measured at high-field 800 MHz NMR spectrometer. The serum metabolic profiles were compared using multivariate statistical analysis and discriminatory metabolic features were evaluated for diagnostic potential using receiver operating characteristic (ROC) curve analysis.
RESULTS: A significant reduction in DAS-28 ESR, AAM Score, total swollen joints, total tender joints were observed following AWS intervention. The clinical outcomes were concordant with changes in metabolic profiles of RA patients as these were also shifting towards the normal levels following the intervention. Compared to healthy control (HC) subjects, the sera of baseline RA patients were characterised by increased circulatory level of succinate, lysine, mannose, creatine, and 3-Hydroxybutyrate (3-HB) and decreased levels of alanine. The present study also evaluated the serum metabolic ratios for their discriminatory and diagnostic potential and notably, six metabolic ratios (KHR, KThR, KVR, GHR, PTR and SHR) were found significantly altered (elevated) in baseline RA patients. However, in RA patients receiving AWS treatment, these metabolic changes showed marked convergence towards the metabolic signatures of healthy controls.
CONCLUSIONS: This first of its kind study clearly shows the clinical efficacy of Ayurvedic Whole System (AWS) intervention in the management of Rheumatoid Arthritis (RA), as demonstrated by significant improvements in key clinical parameters. The intervention not only alleviated symptoms but also induced a profound metabolic shifting towards normalization; thus, underscoring the potential of AWS intervention to modulate cellular metabolism in a manner that facilitates a return to homeostasis in RA patients. However, future studies are imperative to confirm these preliminary observations and delineate the underlying mechanisms of action of intervention in cases of RA.
OBJECTIVE: The study aims to evaluate simultaneously the clinical outcome of Ayurveda whole system (AWS) intervention in RA patients and identifying the serum metabolic signatures which could be useful for diagnosing the disease and monitoring treatment response.
METHODS: RA patients (n = 37) simultaneously diagnosed as Amavata fulfilling the specific inclusion and exclusion criteria were recruited in the study and were given Ayurveda whole system (AWS) intervention comprised of oral medicines, local therapy and dietary recommendation for 3 months. The clinical and serum metabolic changes were investigated for pre-treatment RA patients (baseline RA group, n = 37) and post-treatment RA patients (following treatment of 6-weeks (RA_F, n = 26) and three months (RA_T, n = 36). For comparative serum metabolomics analysis, 57 normal healthy control (HC) subjects were also involved and the serum metabolic profiles were measured at high-field 800 MHz NMR spectrometer. The serum metabolic profiles were compared using multivariate statistical analysis and discriminatory metabolic features were evaluated for diagnostic potential using receiver operating characteristic (ROC) curve analysis.
RESULTS: A significant reduction in DAS-28 ESR, AAM Score, total swollen joints, total tender joints were observed following AWS intervention. The clinical outcomes were concordant with changes in metabolic profiles of RA patients as these were also shifting towards the normal levels following the intervention. Compared to healthy control (HC) subjects, the sera of baseline RA patients were characterised by increased circulatory level of succinate, lysine, mannose, creatine, and 3-Hydroxybutyrate (3-HB) and decreased levels of alanine. The present study also evaluated the serum metabolic ratios for their discriminatory and diagnostic potential and notably, six metabolic ratios (KHR, KThR, KVR, GHR, PTR and SHR) were found significantly altered (elevated) in baseline RA patients. However, in RA patients receiving AWS treatment, these metabolic changes showed marked convergence towards the metabolic signatures of healthy controls.
CONCLUSIONS: This first of its kind study clearly shows the clinical efficacy of Ayurvedic Whole System (AWS) intervention in the management of Rheumatoid Arthritis (RA), as demonstrated by significant improvements in key clinical parameters. The intervention not only alleviated symptoms but also induced a profound metabolic shifting towards normalization; thus, underscoring the potential of AWS intervention to modulate cellular metabolism in a manner that facilitates a return to homeostasis in RA patients. However, future studies are imperative to confirm these preliminary observations and delineate the underlying mechanisms of action of intervention in cases of RA.
摘要：
背景：关节炎是阿育吠陀诊所中常见的临床病症。临床试验报道阿育吠陀干预对包括类风湿性关节炎（RA）在内的许多关节炎疾病有益。然而，关于这些干预措施本身或作为整个系统的组合，阿育吠陀可能是如何工作的，没有机械细节。
目的：该研究旨在同时评估阿育吠陀全系统（AWS）干预RA患者的临床结果，并确定可用于诊断疾病和监测治疗反应的血清代谢特征。
方法：同时被诊断为符合特定纳入和排除标准的Amavata的RA患者（n=37）被纳入研究，并接受由口服药物组成的阿育吠陀整体系统（AWS）干预，3个月的局部治疗和饮食建议。研究治疗前RA患者的临床和血清代谢变化(基线RA组,n=37)和治疗后RA患者(治疗6周后(RA_F，n=26)和三个月(RA_T，n=36）。对于比较血清代谢组学分析，还涉及57名正常健康对照（HC）受试者，并在高场800MHzNMR光谱仪上测量了血清代谢谱。使用多变量统计分析比较血清代谢谱，并使用受试者工作特征（ROC）曲线分析评估歧视性代谢特征的诊断潜力。
结果：DAS-28ESR显着降低，AAM分数,关节总肿胀,AWS干预后观察到总压痛关节.临床结果与RA患者的代谢谱变化一致，因为干预后这些也向正常水平转移。与健康对照（HC）受试者相比，基线RA患者的血清以琥珀酸盐的循环水平升高为特征，赖氨酸，甘露糖,肌酸,和3-羟基丁酸（3-HB）和降低的丙氨酸水平。本研究还评估了血清代谢比的辨别和诊断潜力，六个代谢比率(KHR，KThR,KVR,GHR,在基线RA患者中发现PTR和SHR）显着改变（升高）。然而,在接受AWS治疗的RA患者中，这些代谢变化显示出与健康对照组的代谢特征显著趋同.
结论：这项首次研究清楚地表明了阿育吠陀全系统（AWS）干预在类风湿性关节炎（RA）管理中的临床疗效，关键临床参数的显著改善证明了这一点。干预不仅缓解了症状，而且诱导了深刻的代谢向正常化转变；因此，强调AWS干预以促进RA患者恢复稳态的方式调节细胞代谢的潜力。然而,未来的研究必须证实这些初步观察结果,并描述RA病例中干预的潜在作用机制.
目的：该研究旨在同时评估阿育吠陀全系统（AWS）干预RA患者的临床结果，并确定可用于诊断疾病和监测治疗反应的血清代谢特征。
方法：同时被诊断为符合特定纳入和排除标准的Amavata的RA患者（n=37）被纳入研究，并接受由口服药物组成的阿育吠陀整体系统（AWS）干预，3个月的局部治疗和饮食建议。研究治疗前RA患者的临床和血清代谢变化(基线RA组,n=37)和治疗后RA患者(治疗6周后(RA_F，n=26)和三个月(RA_T，n=36）。对于比较血清代谢组学分析，还涉及57名正常健康对照（HC）受试者，并在高场800MHzNMR光谱仪上测量了血清代谢谱。使用多变量统计分析比较血清代谢谱，并使用受试者工作特征（ROC）曲线分析评估歧视性代谢特征的诊断潜力。
结果：DAS-28ESR显着降低，AAM分数,关节总肿胀,AWS干预后观察到总压痛关节.临床结果与RA患者的代谢谱变化一致，因为干预后这些也向正常水平转移。与健康对照（HC）受试者相比，基线RA患者的血清以琥珀酸盐的循环水平升高为特征，赖氨酸，甘露糖,肌酸,和3-羟基丁酸（3-HB）和降低的丙氨酸水平。本研究还评估了血清代谢比的辨别和诊断潜力，六个代谢比率(KHR，KThR,KVR,GHR,在基线RA患者中发现PTR和SHR）显着改变（升高）。然而,在接受AWS治疗的RA患者中，这些代谢变化显示出与健康对照组的代谢特征显著趋同.
结论：这项首次研究清楚地表明了阿育吠陀全系统（AWS）干预在类风湿性关节炎（RA）管理中的临床疗效，关键临床参数的显著改善证明了这一点。干预不仅缓解了症状，而且诱导了深刻的代谢向正常化转变；因此，强调AWS干预以促进RA患者恢复稳态的方式调节细胞代谢的潜力。然而,未来的研究必须证实这些初步观察结果,并描述RA病例中干预的潜在作用机制.
