Objective

2

To explore the possible mechanism of

Qinjiao Dihuang Tongbi Decoction

（秦艽地黄通痹汤， QDTD） in the treatment of active rheumatoid arthritis （RA） with damp-heat toxin accumulation syndrome.

Methods

2

Twenty-seven patients with active RA and damp-heat toxin accumulation syndrome were included to be treated with oral QDTD， one dose daily， for 12 weeks. The serum samples collected from patients before and after treatment with QDTD were analyzed using ultra performance liquid chromatography-quadrupole time-of-flight/mass spectrometry （UPLC-Q-TOF/MS）. Principal components analysis （PCA） and orthogonal partial least squares-discriminant analysis （OPLS-DA） were performed to screen differential metabolites， and MetaboAnalyst website was used to analyze the relevant metabolic pathways.

Results

2

The serum metabolites were presented in different distributions before and after the treatment of QDTD， and six differential metabolites including D-mannose， L（-）-altrose， palmitic acid， stearamide， galactitol and oleoyl phosphocholine were initially identified. Compared to those before treatment， the serum D-mannose， L（-）-altrose， palmitic acid and oleoyl phosphocholine decreased after treatment， and the stearamide and galactitol levels increased （

P

＜0.05）. Seven metabolic pathways were identified， which were galactose metabolism， glycerolipid metabolism， fructose and mannose degradation， fatty acid extension in mitochondria， fatty acid biosynthesis， fatty acid metabolism， and bile acid biosynthesis. Among them， the galactose metabolism pathway was significantly correlated with the differential metabolites galactitol and D-mannose （

P

＜0.05）.

Conclusion

2

QDTD may play its role in the treatment of active RA with damp-heat toxin accumulation syndrome by activating the galactose metabolism pathway in the liver and indirectly improve the energy metabolism process.