Natural alternatives for rheumatoid arthritis

A recent medical study demonstrated that a standardized extract of a plant used in Chinese medicine is substantially better than the medication sulfasalazine for the treatment of rheumatoid arthritis.

Rheumatoid arthritis is an autoimmune disease that is characterized by chronic inflammation of the joints, often leading to complete joint destruction, pain, swelling, disability and increased mortality. There is no known cure for rheumatoid arthritis but treatment is focused on reducing inflammation.

In traditional medicine, steroids, nonsteroidal anti-inflammatories (like ibuprofen) and some chemotherapy medications are the mainstay of therapy. More powerful medications, like sulfasalazine, significantly affect the body's ability to produce inflammation and are increasingly used.

In Chinese medicine, extracts of the root of the plant Triptergium wilfordii Hook F (TwHF) are used to treat inflammatory conditions, autoimmune diseases and even cancer.

The root of TwHF contains a large number of compounds called terpines. Terpines have direct anti-inflammatory properties and serve as the starting point for the production of "natural" anti-inflammatory steroids by the body. Animal studies have demonstrated that TwHF prevents the production of inflammatory compounds and even suppresses the expression of pro-inflammation genes in the DNA - very powerful stuff. Although TwHF does have side effects, they appear to be less than commonly used medications.

However, is TwHF as effective as medications for the treatment of rheumatoid arthritis?

To answer this question, the National Institutes of Health, the University of Texas-Dallas and nine other rheumatology clinics nationwide collaborated in a large clinical trial and the results were published in the August 2009 issue of the Annals of Internal Medicine.

In the study, 121 patients with rheumatoid arthritis were randomized to receive TwHF or sulfasalazine. Patients were evaluated every two weeks for 24 weeks. At every evaluation point, those taking TwHF had significantly better results than those taking sulfasalazine. The TwHF group had less pain, disability and swelling than the sulfasalazine group. Blood markers of inflammation were significantly lower in the TwHF group, also. Interestingly, blood markers for stress - cortisol and adrenocorticotropic hormone - actually decreased in the TwHF group, while cortisol increased in the sulfasalazine group.

TwHF is one of a number of plants used in Chinese medicine for the treatment of inflammatory conditions. Since these plant preparations contain hundreds of compounds affecting inflammation, directly and indirectly, it is not surprising that the overall result may be better than using a single compound like sulfasalazine.

Although TwHF is a botanical-based therapy, it is not without side effects. One of the side effects is that TwHF causes temporary infertility in men. It is actively being tested as a male version of the birth control pill because it lowers total sperm count and reduces sperm motility. Although the compounds that affect male fertility appear to be different from those affecting inflammation, Chinese medicinal preparations do not separate these compounds.

I have often said that there is nothing in nature that does not have an antidote-if we look. The future of medication is not single agents like sulfasalazine but the richness of the combination therapy found in nature.

• Patrick B. Massey, M.D., Ph.D is medical director for complementary and alternative medicine for the Alexian Brothers Hospital Network.