Traditional Chinese medicine versus western medicine as used in China in the management of rheumatoid arthritis: a randomized, single-blind, 24-week study

Abstract

This study is designed to compare the efficacy and safety of traditional Chinese medicine (TCM) with western medicine (WM) in the management of rheumatoid arthritis (RA). This is a 24-week, randomized, multicenter, single-blind study comparing TCM with WM (as used in China) carried out between June 2002 and December 2004 in nine research centers in China, involving 489 patients. Patients were randomized to receive TCM (n = 247), MTX and SSZ (n = 242). MTX was started at a dose of 5 mg to a final dose of 7.5-15 mg weekly. The maintenance dose was 2.5-7.5 mg weekly. The starting dose of SSZ was 0.25 g bid, increasing by 0.25 g a day once a week to a final dose of 0.5-1 g qid. The maintenance dose was 0.5 g tid to qid. Primary end point was the proportion of patients with response according to the American College of Rheumatology 20 % improvement criteria (ACR20) at weeks 24. At 24 weeks, ACR20 responses were 53.0 % in TCM group and 66.5 % in WM group, (P < 0.001) at 24 weeks. ACR 50 responses were 31.6 % of TCM group and 42.6 % in WM group, (P = 0.01). ACR70 responses were 12.6 % in TCM group and 17.4 % in WM group, (P = 0.14). Side effects were observed more frequently in WM group. In this study, ACR20, ACR50 responses at 24 weeks were significantly better in the WM treated group, by intention to treat (ITT) and per protocol analysis. The ACR 70 response showed no significant difference between the two groups. TCM, while effective in treating RA, appears to be less effective than WM in controlling symptoms, but TCM is associated with fewer side effects.

Systematic review of the methodological quality of controlled trials evaluating Chinese herbal medicine in patients with rheumatoid arthritis

“…Of those, 119 RCTs were included5 24–141 evaluating 18 919 patients. Figure 1 shows the number of studies screened, assessed for eligibility and included in the review, with reasons for exclusion at each stage.…”

“…In traditional Chinese medicine (TCM), RA belongs to the category of ‘bi syndrome’; that is, it is believed to be caused by attacks of wind, cold, dampness or heat, which cause disharmony between bodily systems 34 Patients are classified as having a particular TCM syndrome according to their symptoms and then treated with CHMs to decrease inflammation by restoring the affected system or to ameliorate the side effects of disease-modifying antirheumatic drugs 5. TCM guidelines have been developed by the Chinese government for the diagnosis and treatment of these syndromes 6–8…”

Traditional Chinese medication for rheumatoid arthritis: more than what meets the eye

“…There is an increasing interest in the role of complementary and alternative medicine (CAM) in rheumatoid arthritis (RA) [1][2][3]. However, their application in routine care needs careful consideration of safety and reliability.…”

Traditional Chinese medicine Biqi capsule compared with leflunomide in combination with methotrexate in patients with rheumatoid arthritis: a randomized controlled trial

“…Traditional Chinese medicine (TCM) has been practiced in China for thousands of years and it offers a holistic approach to patient management. A variety of TCMs have been used for the treatment of RA in China for centuries, and their efficacy and safety were inferred from clinical experience and tested in clinical trials [14,15]. Biqi capsule is a well-recognized traditional TCM formula that has been approved by the State Food and Drug Administration as an add-on therapy for RA due to its clinical benefits and low side effects [16].…”