THE QUESTION To ease the pain and swelling of rheumatoid arthritis, how might an ancient Chinese herbal remedy, made from an extract of thunder god vine, compare with methotrexate, a modern drug commonly prescribed to treat the disease?
THIS STUDY involved 207 adults (average age, 51) with rheumatoid arthritis who were randomly assigned to take the herb (officially known as Tripterygium wilfordii Hook F, or TwHF) in pill form three times a day, methotrexate once a week, or a combination of the herb and the drug. After six months, the herb and methotrexate yielded similar results, with 55 percent of the herbal group and 46 percent of the methotrexate group registering at least a 50 percent improvement in symptoms such as painful, swollen joints. People who took both the drug and the herb fared best, with 77 percent of that group achieving improvement of 50 percent or more. Roughly half of all participants experienced side effects, most often gastrointestinal problems, with those taking the drug affected somewhat more often than the others. A few women developed irregular menstrual periods, more so among those taking the herb than among women on methotrexate.
WHO MAY BE AFFECTED? People with rheumatoid arthritis, which causes pain and swelling in the joints, most often in the hand, making the joints stiff and difficult to use. This type of arthritis is an autoimmune disease, meaning the immune system turns on the body for undetermined reasons, attacking it rather than protecting it. In the United States, disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate and newer, genetically engineered biologic drugs are most often used, sometimes in combination, to treat symptoms and delay progression of the disease. However, treatment can be costly and does not work for all people. In China, TwHF is approved for treating rheumatoid arthritis.
CAVEATS Data on pain came from the participants’ assessments. The study was too short to assess whether the herbal preparation slowed the course of the disease, which methotrexate can do. Participants were given doses of methotrexate that are standard for China, where the study was done, but that are lower than doses usually prescribed by U.S. doctors. Citing research from the 1980s that found temporary fertility problems among women taking TwHF, the study authors suggested that the herb be given only to post-menopausal women and those who do not want to have children. Extracts of thunder god vine are made from the skinned root of the plant, but much of the rest of it is poisonous and can be fatal.
FIND THIS STUDY April 14 online issue of Annals of the Rheumatic Diseases at ard.bmj.com.
The research described in Quick Study comes from credible, peer-reviewed journals. Nonetheless, conclusive evidence about a treatment's effectiveness is rarely found in a single study. Anyone considering changing or beginning treatment of any kind should consult with a physician.