Combining a “herbal” and conventional disease-modifying anti-rheumatic drug for treating rheumatoid arthritis.

This study explored the effectiveness and safety of tripterygium glycosides (TG) as a disease-modifying anti-rheumatic drug (DMARD) when combined with conventional DMARDs for treating rheumatoid arthritis (RA). The authors concluded that good safety and better improvements in RA symptoms were observed when TG was combined with a conventional DMARD compared to conventional treatment alone.

RA is a chronic, inflammatory disease that causes damaged joints, disabilities, and impaired quality of life (QoL). RA treatment mainly involves the use of DMARDs. DMARDs can be conventional synthetic DMARDs, biological DMARDs, or targeted synthetic DMARDs.

In traditional Chinese medicine, TG is considered to be a “herbal” DMARD. It is extracted from a vine-like plant known as tripterygium wilfordii Hook F (TwHF). TwHF is recognized for its anti-inflammatory effects and ability to suppress immune responses. TG has been combined with conventional DMARDs to treat different inflammatory conditions in Chinese medicine. However, a standardized approach has not been used for many of these studies. There is a need for a more in-depth analysis of the effectiveness of TG as a DMARD used in combination with a conventional DMARD.  

This analysis included 38 randomized, controlled trials with 3283 participants diagnosed with RA. Patients received TG combined with one conventional DMARD (treatment group) or a conventional DMARD alone (control group). Results were evaluated based on RA joint signs, symptoms, inflammatory indicators such as the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and overall health. The follow-up period varied between 4 and 24 weeks.

Significant improvements in DAS 28 and ACR 50 scores (RA activity scales) were seen in the treatment group compared to the control group. A significant decrease in inflammatory indicators occurred when TG was combined with one DMARD. Improvements were seen in tender joint count (TJC), swollen joint count (SJC), pain score, ESR, CRP,  and disease activity in the treatment group.

No significant differences were seen in the occurrence of side effects between the treatment and control groups.

The study showed that a combination of TG with one conventional DMARD resulted in improved RA joint signs, symptoms, inflammatory indicators, and overall health compared to treatment with one conventional DMARD alone.

The studies used in this analysis included participants of different ages. There were differences in the conventional DMARD combinations used and in treatment duration. This may have influenced the results.