**6. Conclusion**

360 Rheumatoid Arthritis – Treatment

Taken together, these trials show that Tai Chi may provide some important components in the treatment of Rheumatoid Arthritis. Further research should focus on ideal dose and duration of intervention to provide valuable information about how Tai Chi may be best

In traditional Chinese medicine, extracts of the roots of Tripterygium Wilffordii Hook F (TwHF, *Lei Gong Teng*) has been widely used for the treatment of autoimmune and inflammatory disease in China. Several clinical trials have examined the therapeutic effects of TwHF in patients with rheumatoid arthritis (Cibere et al., 2003; Goldbach-Mansky et al., 2009; Tao et al., 2001; Tao et al., 2002; Vitetta et al., 2008). In an early nonrandomized controlled clinical trial, Tao and colleagues evaluated 13 patients with established rheumatoid arthritis who received a maximum dosage of 180 mg/day of TwHF. There were no adverse effects or disease improvements observed at that dosage and nine patients tolerated the extract up to a dosage of 570 mg/day. Eight of the nine patients who received the extract at doses over 360 mg/day experienced improvement in both clinical manifestations and laboratory findings and one patient met American College of Rheumatology criteria for remission (Tao et al., 2001). The results of this small trial suggested that the ethyl acetate extract of the Chinese herbal remedy was safe with tolerable side effects for most patients with rheumatoid arthritis who achieved clinical benefits. Subsequently, the same group of investigators used a prospective, double-blind, placebo-controlled trial for another 35 patients and found that eight patients in the 20-week low-dose (180 mg/day) group and four patients in the high-dose (360 mg/day) group met criteria for clinical response. The authors also concluded that the ethanol/ethyl acetate extract of TwHF, at a dosage of 360 mg/day, appeared to be safe in patients with rheumatoid arthritis (Tao et al., 2002). Another Chinese randomized double-blind placebocontrolled trial of 61 patients with rheumatoid arthritis suggested that six weeks of TwHF significantly improves American College of Rheumatology 20% response rate compared with

Recently, to compare the benefits and side effects of TwHF extract with those of sulfasalazine, a large randomized, controlled trial of 121 patients with active rheumatoid arthritis used TwHF extract 60mg, three times daily or sulfasalazine 1g, twice daily. Patients could continue stable doses of oral prednisone and non-steroidal anti-inflammatory drugs but not disease-modifying antirheumatic drugs. Among patients who continued treatment for 24 weeks, achievement of 20% improvement in American College of Rheumatology criteria was greater with TwHF than with sulfasalazine. Adverse event rates were similar. Also, patients receiving TwHF had significantly higher response rates for American College of Rheumatology 50% and American College of Rheumatology 70% criteria. In the TwHF group, significant improvement was demonstrated in all individual components of the American College of Rheumatology response, including the Health Assessment Questionnaire score. Interleukin-6 levels rapidly and significantly decreased in the TwHF

The long-term effects and toxicities of TwHF and the potential combination of TwHF with other antirheumatic therapies need to be further investigated. However, evidence demonstrates that treatment with a standardized extract from the peeled roots of the

**4. Benefit of tripterygium wilffordii hook F in patients with rheumatoid** 

used in clinical practice.

**4.1 Tripterygium wilffordii hook F therapeutics** 

placebo (TwHF 58% vs placebo 20%; P=0.002) (Cibere et al., 2003).

group (Goldbach-Mansky et al., 2009).

**arthritis** 

In summary, as a complex immunologically mediated disorder, rheumatoid arthritis is still a therapeutically challenging chronic condition to control. Emerging evidence from clinical trials reviewed here support that evidence-based complementary and alternative medicine or integrative medicine therapies may offer effective treatments for patients with Rheumatoid Arthritis. Integrative approaches combine the best of conventional medicine and the wisdom of complementary and alternative medical approaches. These modalities may lead to the development of better lifestyle modifying strategies, while mind-body medicine such as Tai Chi exercise could affect progression of disease and decrease morbidity and mortality among individuals with rheumatoid arthritis. While existing evidence regarding complementary and alternative medicine on rheumatoid arthritis remains limited and inconclusive, the promising results suggest that these complementary and alternative medicine treatments may be a safe adjunctive therapy for rheumatoid arthritis and warrant further exploration.

Complementary and Alternative Medicine in the Treatment of Rheumatoid Arthritis 363

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