Keishikajutsubuto (Guizhi-shu-fu-tang) treatment for refractory accumulation of synovial fluid in a patient with pustulotic arthro-osteitis.

We present a patient, a sixty-seven-year-old woman, who had refractory accumulation of synovial fluid in the knee joints with pustulotic arthro-osteitis for more than 10 years. Fifty ml of synovial fluid from her right knee contained 6,480 pg/ml of interleukin-8 (IL-8) and 15,000/mm3 of neutorophils. At first, she was treated with 400 mg/day of indomethacin farnesil (a prodrug that is converted to indomethacin after intestinal absorption) for 24 weeks. Although, the volume of synovial fluid in her right knee had decreased to 35 ml at the 16th week, it increased to 50 ml at the 24th week again. She was treated with Kampo medicine, Keishikajutsubuto (Guizhi-shu-fu-tang). In the present case, Keishikajutsubuto showed more therapeutic effect to pustulotic arthro-osteitis to reduce volume of synovial fluid to almost 0 ml, IL-8 concentration to 673 pg/ml and number of neutrophils to 660/mm3. Our data showed that Keishikajutsubuto might be suitable for this patient to regulate synovial fluid volume, reduce IL-8 concentration in synovial fluid, and block neutrophils migration to synovial fluid compared to indomethacin therapy.