Intervention Review

Herbal therapy for treating rheumatoid arthritis

  1. Melainie Cameron1,*,
  2. Joel J Gagnier2,
  3. Sigrun Chrubasik3

Editorial Group: Cochrane Musculoskeletal Group

Published Online: 16 FEB 2011

Assessed as up-to-date: 14 OCT 2010

DOI: 10.1002/14651858.CD002948.pub2


How to Cite

Cameron M, Gagnier JJ, Chrubasik S. Herbal therapy for treating rheumatoid arthritis. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD002948. DOI: 10.1002/14651858.CD002948.pub2.

Author Information

  1. 1

    Australian Catholic University, School of Exercise Science, Banyo, QLD, Australia

  2. 2

    University of Michigan, Department of Epidemiology, School of Public Health, Ann Arbor, MI, USA

  3. 3

    University of Freiburg, Freiburg, Germany; Herbal Medicines Research and Education Centre, Sydney University, Sydney, Australia

*Melainie Cameron, School of Exercise Science, Australian Catholic University, McAuley at Banyo, 1100 Nudgee Road, Banyo, QLD, 4014, Australia. Melainie.Cameron@acu.edu.au.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 16 FEB 2011

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Background

Herbal medicine interventions have been identified as having potential benefit in the treatment of rheumatoid arthritis (RA).

Objectives

To update an existing systematic (Cochrane) review of herbal therapies in RA.

Search methods

We searched electronic databases Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, AMED, CINAHL, Web of Science, Dissertation Abstracts (1996 to 2009), unrestricted by language, and the WHO International Clinical Trials Registry Platform in October 2010.

Selection criteria

Randomised controlled trials of herbal interventions compared with placebo or active controls in RA.

Data collection and analysis

Two authors selected trials for inclusion, assessed risk of bias and extracted data. 

Main results

Twelve new studies were added to the update, a total of 22 studies were included.

Evidence from seven studies indicate potential benefits of gamma linolenic acid (GLA) from evening primrose oil, borage seed oil, or blackcurrent seed oil, in terms of reduced pain intensity (mean difference (MD) -32.83 points, 95% confidence interval (CI) -56.25 to -9.42,100 point pain scale); improved disability (MD -15.75% 95% CI -27.06 to -4.44%); and an increase in adverse events (GLA 20% versus placebo 3%), that was not statistically different (relative risk 4.24, 95% CI 0.78 to 22.99).

Three studies compared Tripterygium wilfordii (thunder god vine) to placebo and one to sulfasalazine and indicated improvements in some outcomes, but data could not be pooled due to differing interventions, comparisons and outcomes. One study reported serious side effects with oral Tripterygium wilfordii Hook F. In the follow-up studies, all side effects were mild to moderate and resolved after the intervention ceased. Two studies compared Phytodolor® N to placebo but poor reporting limited data extraction. The remaining studies each considered differing herbal interventions.

Authors' conclusions

Several herbal interventions are inadequately justified by single studies or non-comparable studies in the treatment of rheumatoid arthritis. There is moderate evidence that oils containing GLA (evening primrose, borage, or blackcurrant seed oil) afford some benefit in relieving symptoms for RA, while evidence for Phytodolor® N is less convincing.Tripterygium wilfordii products may reduce some RA symptoms, however, oral use may be associated with several side effects. Many trials of herbal therapies are hampered by research design flaws and inadequate reporting. Further investigation of each herbal therapy is warranted, particularly via well designed, fully powered, confirmatory clinical trials that use American College of Rheumatology improvement criteria to measure outcomes and report results according to CONSORT guidelines.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Herbal therapy for rheumatoid arthritis

This summary of a Cochrane review presents what we know from research about the effects of herbal therapy for rheumatoid arthritis (RA).

The review shows that in people with RA:

- Evening primrose oil, borage seed oil, or blackcurrent seed oil (containing gamma-linolenic acid (GLA)) probably improve pain; may improve function; and probably does not increase adverse events (unwanted side effects).

- Tripterygium wilfordii Hook F may improve some symptoms of rheumatoid arthritis, and higher doses (180 mg - 350 mg daily) may be more effective than lower doses (60 mg daily). There are some adverse events associated with Tripterygium wilfordii Hook F.

- We are uncertain of the effects of other herbal therapies because only single studies were available, or important features of RA, such as changes in the number of swollen and tender joints, were not reported.

Often we do not have precise information about side effects and complications, particularly for rare but serious side effects. Possible side effects associated with Triperygium wilfordii Hook F may include painful periods in women, decreased fertility in men, insufficient urine excretion, and increased rate of infections. Possible side effects associated with GLA sourced from evening primrose oil include headache, nausea, and diarrhoea, and rare complications include allergy and seizures.

What is rheumatoid arthritis and what is herbal therapy?

When you have RA, your immune system, which normally fights infection, attacks the lining of your joints. This makes your joints swollen, stiff and painful. The small joints of your hands and feet are usually affected first. There is no cure for rheumatoid arthritis at present, so treatments are used to relieve pain and stiffness and improve your ability to move.

Herbal interventions are defined as any plant preparation (whole, powder, extract, standardised mixture) used for medicinal purposes. Historically, many herbal therapies have been used to treat RA. Like conventional non-herbal drugs, many herbal therapies are believed to act by blocking the activity of these immune cells and substances and reducing inflammation in the joints, and some people believe they have fewer side effects. 

Best estimate of what happens to people with rheumatoid arthritis: 

Pain (higher scores mean worse or more severe pain):

-People who took eveing primrose oil, primrose oil, borage seed oil, or blackcurrent seed oil (wih the active ingredient GLA) rated their pain to be 33 points lower (9 to 56 points lower) on a scale of 0 to 100 after 6 months of treatment (33% absolute improvement).

-People who took placebo rated their pain to be 19 points lower after treatment.

Physical function (higher score means greater disability):

-People who took GLA rated their disability 16% better.

-People who placebo rated their disability 5% better.

 

Resumen

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Antecedentes

Tratamiento a base de hierbas para la artritis reumatoide

Se ha demostrado que las intervenciones con hierbas medicinales pueden implicar beneficios para el tratamiento de la artritis reumatoide (AR).

Objetivos

Actualizar una revisión (Cochrane) sistemática existente sobre tratamientos a base de hierbas para la AR.

Estrategia de búsqueda

Se hicieron búsquedas en las bases de datos electrónicas Registro Cochrane Central de Ensayos Controlados (Cochrane Central Register of Controlled Trials) (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, AMED, CINAHL, Web of Science, Dissertation Abstracts (1996 a 2009), sin restricciones de idioma, y en la WHO International Clinical Trials Registry Platform en octubre 2010.

Criterios de selección

Ensayos controlados aleatorios de intervenciones con hierbas medicinales comparadas con placebo o controles activos para la AR.

Obtención y análisis de los datos

Dos autores seleccionaron los ensayos para la inclusión, evaluaron el riesgo de sesgo y extrajeron los datos.

Resultados principales

Se añadieron 12 nuevos estudios a la actualización, se incluyó un total de 22 estudios.

Las pruebas de siete estudios indican efectos beneficiosos potenciales del ácido gammalinolénico (AGL) obtenido a partir del aceite de prímula, del aceite de semilla de borraja o del aceite de semilla de grosella en cuanto a la reducción de la intensidad del dolor (diferencia de medias [DM] −32,83 puntos; intervalo de confianza [IC] del 95%: −56,25 a −9,42; en una escala de dolor de 100 puntos); mejoría de la discapacidad (DM −15,75%; IC del 95%: −27,06 a −4,44%); y un aumento de los eventos adversos (AGL 20% versus placebo 3%), que no fue estadísticamente diferente (riesgo relativo 4,24; IC del 95%: 0,78 a 22,99).

Tres estudios compararon Tripterygium wilfordii (vid trueno de dios) con placebo y uno con sulfasalazina e indicaron mejorías en algunos resultados, pero no fue posible agrupar los datos debido a que las intervenciones, comparaciones y resultados fueron diferentes. Un estudio informó efectos secundarios graves con Tripterygium wilfordii Hook F oral. En los estudios de seguimiento todos los efectos secundarios fueron leves a moderados y se resolvieron después que finalizó la intervención. Dos estudios compararon Phytodolor® N con placebo, pero el informe deficiente limitó la extracción de los datos. Los estudios restantes consideraron diferentes intervenciones con hierbas medicinales.

Conclusiones de los autores

Varias intervenciones con hierbas medicinales están justificadas de forma inadecuada por estudios aislados o por estudios no comparables en el tratamiento de la artritis reumatoide. Hay pruebas moderadas de que los aceites que contienen AGL (aceite de prímula, aceite de semilla de borraja o aceite de semilla de grosella) brindan algún beneficio en el alivio de los síntomas de la AR, mientras que las pruebas para Phytodolor® N son menos convincentes. Los productos con Tripterygium wilfordii pueden reducir algunos síntomas de la AR; sin embargo, su uso oral se puede asociar con varios efectos secundarios. Muchos ensayos de tratamientos a base de hierbas están afectados por los defectos en el diseño y el informe inadecuado. Se justifican investigaciones adicionales de cada tratamiento a base de hierbas, en particular mediante ensayos clínicos confirmatorios bien diseñados, con un poder estadístico adecuado y que utilicen los criterios de mejoría del American College of Rheumatology para medir los resultados e informarlos según las guías CONSORT.

Traducción

Traducción realizada por el Centro Cochrane Iberoamericano