Traditional Chinese Medicine Recommended for RA Treatment

The use of traditional Chinese medicine (TCM) treatment was associated with a lower risk of recurrent exacerbation in patients with rheumatoid arthritis (RA), according to a study published in Heliyon.¹

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In Western medicine, RA is often treated by disease-modifying antirheumatic drugs (DMARDs), biological agents, corticosteroids, and nonsteroidal anti-inflammatory drugs (NSAIDs). However, these drugs often come with adverse reactions, resulting in intolerance and other unsatisfactory effects, such as blood pressure changes, bleeding, and gastrointestinal reactions. In China, TCM is more commonly used to treat RA, including Chinese herbal medicines designed to combat inflammation and symptoms of arthritis.²

“Recently, a large-scale study demonstrated the frequent use and mode of TCM in RA treatment,” wrote a team of Chinese investigators led by Fanfan Wang, The First Affiliated Hospital, Anhui University of Chinese Medicine. “However, little is known about the effectiveness of TCM in delaying and even preventing the recurrent exacerbation of RA patients. Therefore, the aim of this large-scale retrospective controlled cohort study is to investigate the effect of TCM on the recurrence of patients with RA and provide a theoretical basis for the application of TCM in the treatment of RA.”

A retrospective analysis included 1383 patients diagnoses with RA between January 2013 and June 2021 with medical record information from the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine. Patients completed a questionnaire including demographic data and drug information. Laboratory tests included liver function indexes, inflammatory indexes, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), immune indexes, complement 3 (C3) and C4, and rheumatoid factor (RF). Patients were excluded if they had incomplete data, if they were pregnant or lactating, or had malignant tumors.

Patients with RA were encouraged to choose TCMs as the main treatment after discharge for at least 3 months. They were informed of the risks and benefits of TCM treatment and evaluated the advantages and disadvantages for themselves. TCMs included Chinese patent medicines, external medicines, and TCM decoction.

Patients were categorized as either TCM users (n = 997) and non-TCM users (n = 386) and were matched based on TCM use, death, surgery, gender, age, recurrent exacerbation, Chinese patent medicine, external medicine, organ lesions, and NSAIDs to minimize selection bias and confounding. A Cox regression model compared the hazard ratio (HR) of the risk of recurrent exacerbation.

The use of TCM had a statistically significant association with improved clinical indicators. TCM treatment was preferred in patients who were female and younger than <58 years. Recurrent exacerbation was reported in 61.461% of patients (n = 850) with RA.

The Cox proportional hazard model indicated that TCM was a protective factor for the recurrent exacerbation of patients with RA (HR = 50%, 95% confidence interval [CI] = .65 – .92, P <.01). According to the Kaplan Meier curves, the survival rate of TCM users was higher when compared with non-TCM users (log-rank P <.01).

Investigators noted although adjusting for potential confounding factors reduced the potential residual confounding effects, the reduction may not be the same in both cohorts. Further, other factors, such as lifestyle, weight, and urbanization, could not be evaluated during the follow-up period. There is also a possibility of recall bias when collecting previous information and data bias because the study only included local hospitals instead of involving multiple centers and hospitals.

“Our study provided evidence to the recommendation of TCM for the treatment of RA patients in order to reduce the risk of recurrent exacerbation,” investigators concluded.

References

1. ^{Wang F, Liu J, Fang Y, Li X, He M, Han Q. Traditional Chinese medicine may be associated with a reduced risk of recurrent exacerbation in patients with rheumatoid arthritis: A matched cohort study based on 1383 individuals. Heliyon. 2023;9(4):e15054. Published 2023 Apr 5. doi:10.1016/j.heliyon.2023.e15054}
2. ^{Venkatesha SH, Rajaiah R, Berman BM, Moudgil KD. Immunomodulation of autoimmune arthritis by herbal CAM. Evid. Bas. Comp. Alter. Me. 2011; (2011)986797}