Rheumatoid arthritis - a condition that causes pain and swelling in the joints - affects around 1.5 million people in the US. Although there is no cure for the condition, medications, such as methotrexate, are used to reduce symptoms. But new research published in the BMJ suggests that a Chinese herbal remedy is just as effective as methotrexate.
To reach their findings, the research team, led by Dr. Xuan Zhang of the Peking Union Medical College Hospital at the Chinese Academy of Medical Sciences in China, assessed the effects of methotrexate (MTX) and a herbal remedy, called Triptergium wilfordii Hook F (TwHF), against rheumatoid arthritis in 207 patients with the condition.
TwHF is an herbal remedy used in traditional Chinese medicine for the treatment of swelling, inflammation and joint pain. The remedy comes from extracts of the Triptergium wilfordii plant, also known as the "thunder god vine."
All patients were randomized to one of three treatment groups for 24 weeks. The first group was required to take 12.5 mg of MTX once a week. The second group took 20 mg of TwHF three times a day, while the third group took a combination of both. The researchers note that around 98% of patients had never used DMARDs to treat their condition.
The team wanted to determine which of these three treatments was most effective in reducing symptoms of rheumatoid arthritis in line with the ACR (American College of Rheumatology) 50 response. This is a measure that determines when a patient reaches a 50% improvement in the number of tender and swollen joints they have, and a 50% improvement in other areas, such as pain, disability and disease severity.
Combination of MTX and TwHF most effective
Of the participants, 174 (84%) completed the full 24-week study period.
The researchers found that of the patients treated with MTX alone, almost 46.5% achieved the ACR 50 response, while 55% of those treated with TwHF reached ACR 50.
However, the biggest improvement was seen in patients treated with both MTX and TwHF, with almost 77% reaching the ACR 50 response.
The team points out that there was very little difference in the side effects experienced within each treatment group, although more women treated with TwHF experienced irregular periods.
Commenting on the findings, the researchers say:
"This TRIFRA (Tripterygium Wilfordii in Patients with Rheumatoid Arthritis) study showed that TwHF monotherapy was not inferior to, and combination therapy of MTX plus TwHF was better than, MTX monotherapy in controlling disease activity in patients with active rheumatoid arthritis.
These efﬁcacy results conﬁrm the results from the clinical effectiveness assessment and indicate that the combination of TwHF and MTX is a safe and efﬁcacious treatment for patients with active RA."
Several limitations noted
However, the research team notes that their study has several limitations. They point out that, although patients in Asia are usually given weekly 12.5-mg doses of MTX that were administered in this study, this dosage is lower than that prescribed in the West.
"Whether the results would have been altered if the patients had received higher doses of MTX is unknown," they add, "although this seems unlikely as the levels of responsiveness in this trial were much greater than previously reported in similar patients given MTX monotherapy."
The investigators note that since this trial lasted for 24 weeks, disease progression of patients was not measured in the long term. Therefore, the team plans to follow these patients for a further 2 years and assess disease progression once participants have completed treatment.
Furthermore, the researchers point out since placebo tablets were not available for this study, the treating doctors and patients in this study were not blinded to medication. They add that in future, a double-blind trial assessing the effects of TwHF is warranted.
Last year, Medical News Today reported on a study detailing the discovery of 42 new genetic markers associated with rheumatoid arthritis.