Rastogi Sanjeev, Verma Ankita, Trivedi Rimjhim, Shukla Anuj, Kumar Dinesh
Ayurveda -Arthritis Treatment and Advanced Research Center (A-ATARC), Department of Kaya Chikitsa, State Ayurvedibc College and Hospital, Lucknow University, Lucknow, 226003, India.
Ayurveda -Arthritis Treatment and Advanced Research Center (A-ATARC), Department of Kaya Chikitsa, State Ayurvedibc College and Hospital, Lucknow University, Lucknow, 226003, India.
J Ayurveda Integr Med. 2024 Jul-Aug;15(4):101009. doi: 10.1016/j.jaim.2024.101009. Epub 2024 Jul 6.
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.
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.
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.
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.
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.
关节炎是阿育吠陀诊所中常见的临床病症。临床试验报告称，阿育吠陀干预措施在包括类风湿性关节炎（RA）在内的许多关节炎病症中都有益处。然而，关于这些干预措施单独使用或作为整个阿育吠陀系统的组合如何发挥作用，尚无具体的机制细节。
本研究旨在同时评估阿育吠陀全系统（AWS）干预对类风湿性关节炎患者的临床疗效，并识别可用于疾病诊断和监测治疗反应的血清代谢特征。
本研究招募了37例同时被诊断为符合特定纳入和排除标准的阿玛瓦塔（Amavata，一种类风湿性关节炎类型）的类风湿性关节炎患者，并给予为期3个月的阿育吠陀全系统（AWS）干预，包括口服药物、局部治疗和饮食建议。对治疗前的类风湿性关节炎患者（基线类风湿性关节炎组，n = 37）以及治疗后的类风湿性关节炎患者（治疗6周后（RA_F，n = 26）和3个月后（RA_T，n = 36））的临床和血清代谢变化进行了研究。为了进行比较血清代谢组学分析，还纳入了57名正常健康对照（HC）受试者，并在800 MHz高场核磁共振光谱仪上测量血清代谢谱。使用多元统计分析比较血清代谢谱，并使用受试者工作特征（ROC）曲线分析评估具有鉴别能力的代谢特征的诊断潜力。
在AWS干预后，观察到DAS-28 ESR、AAM评分、总肿胀关节数和总压痛关节数显著降低。临床结果与类风湿性关节炎患者代谢谱的变化一致，因为干预后这些代谢谱也向正常水平转变。与健康对照（HC）受试者相比，基线类风湿性关节炎患者的血清中琥珀酸、赖氨酸、甘露糖、肌酸和3-羟基丁酸（3-HB）的循环水平升高，丙氨酸水平降低。本研究还评估了血清代谢比值的鉴别和诊断潜力，值得注意的是，发现基线类风湿性关节炎患者中有六个代谢比值（KHR、KThR、KVR、GHR、PTR和SHR）显著改变（升高）。然而，在接受AWS治疗的类风湿性关节炎患者中，这些代谢变化显示出明显向健康对照的代谢特征趋同。
这项同类研究中的首个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，关键临床参数有显著改善即证明了这一点。该干预不仅缓解了症状，还诱导了向正常化的深刻代谢转变；因此，强调了AWS干预以促进类风湿性关节炎患者恢复内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，并阐明RA病例中干预措施的潜在作用机制。
