Sahbaa M. Ahmed, Nour H. Madbouly, Soheir S. Maklad and Eman A. Abu-Shady
Department of Microbiology, Faculty of Medicine "for Girls”,
This study was carried out in order to evaluate the
efficiency of blood-letting cupping (BLC) therapy as a complementary therapy in
management of rheumatoid arthritis (RA) and to investigate its modulatory
effects on natural killer cells (NK) and soluble interleukin-2 receptor
(SIL-2R). Two groups of RA patients diagnosed according to American
Rheumatology Association were included: Group I included 20 patients who
received the conventional medicinal therapy of RA, Group II included 30
patients who received combined conventional and BLC therapy. Ten age and sex
matched normal controls were also included, as group III. Visual analogue score
(VAS), tender joint count (TJC), swollen joint count (SJC), disease activity
scores (DAS), laboratory markers of disease activity [erythrocyte sedimentation
rate (ESR), C-reactive protein (CRP), Rheumatoid factor (RF)] were evaluated on
3 successive months, NK cell (%) measured by flowcytometry and SIL -2R
concentrations measured by ELISA were also assessed. After one month of
combined therapy there was significant (P < 0.001) reduction in VAS (5.16 ±
0.28), TJC (11.62 ± 1.03), SJC (10.13 ± 1.02) and DAS (5.35 ± 0.14). Early and
marked reductions in laboratory markers of disease activity (26.90 ± 3.68) for
CRP, (51.46 ± 6.06) for RF and (40.56 ±3.36) for ESR were also detected as
compared to base line, while the effects of conventional therapy appeared late
after 3 months of treatment. Conventional therapy induced significant
depression in white blood cell (WBC %) (p<0.001) whereas combined therapy
induced marked (p<0.001) elevation since the first month (8.44 ± 1.58)
compared to base line (6.94 ± 1.58). There was a significant (P<0.05)
lowering in NK cell (%) with conventional therapy while combined therapy
induced significant (P<0.001) increase (11.33 ± 0.4.7) compared to base line
level (8.50 ± 0.46). Additionally, combined therapy resulted in marked
reduction (P < 0.001) in SIL-2R conc. after 3 months of treatment (1790+68.11)
compared to base line (2023 ± 92.95), while insignificant reduction was
detected with the conventional therapy. The improvement rate (%) of clinical,
laboratory cellular & immunological parameters were significantly higher
with combined therapy than with conventional therapy. Moreover, strong positive
correlations (p<o.ooo1) were detected between SIL-R conc. and clinical
parameters VAS (r=0.890), TJC (r = 0.905), SJC (r= 0.872) and DAS (r=0.923) and
also between SIL-R conc. and ESR (r=0.973), CRP (r=0.933), RF (r=0.941), while
a strong negative correlation was found with NK count cell % (r=0.927). In
conclusion, BLC therapy combined with conventional therapy may improve the
clinical condition of patients with RA. It has modulatory effects on the innate
(NK %) and adaptive cellular (SIL-2R conc.) immune responses that could be used
as monitoring tools for disease activity and prognosis.