Herbal therapy for treating rheumatoid arthritis.
BACKGROUND
The increasing popularity of the use of complementary and alternative interventions or treatments appears to be particularly evident amongst people with chronic disease. In the treatment of rheumatoid arthritis, one therapy that has been identified as having potential benefit, is herbal medicine (phytotherapy).


OBJECTIVE
To assess the effectiveness of herbal therapies in the treatment of rheumatoid arthritis.


METHODS
We developed a search strategy using terms to include all forms of arthritis combined with herbal medicine. We searched the following electronic databases from 1966 to 2000: MEDLINE, EMBASE, CISCOM, AMED, CINAHL, Cochrane Controlled Trials Register (CCTR), Cochrane Musculoskeletal specialized register, Dissertation Abstracts, BIDS ISI and the Cochrane Complementary Medicine Fields Specialized Register. This was supplemented by searching the reference lists from retrieved trials.


METHODS
All randomized trials of herbal interventions in rheumatoid arthritis, compared to placebo. Two reviewers independently read and selected each potential study according to the criteria published in an a priori protocol. Papers of any language were included.


METHODS
Data were extracted independently by the same two reviewers and an assessment of methodological quality was conducted.


RESULTS
Eleven studies met the inclusion criteria. Seven of the studies compared gamma-linolenic acid (GLA) to placebo although three of these were not suitable for data pooling. The remaining studies considered four different herbal interventions and were assessed individually. All of the GLA studies found some improvement in clinical outcomes but methodology and study quality was variable, making it difficult to draw conclusive results. However, the better quality studies suggest potential relief of pain, morning stiffness and joint tenderness. With the exception of one intervention (Tripterygium wilfordii hook F), no serious side effects were reported.


CONCLUSIONS
There appears to be some potential benefit for the use of GLA in rheumatoid arthritis although further studies are required to establish optimum dosage and duration of treatment. The single studies are inconclusive.
Institute of Health & Community Studies, Bournemouth University, Bournemouth House, Bournemouth University, 17 Christchurch Road, Bournemouth, Dorset, UK, BH1 3LG. clittle@bournemouth.ac.uk
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D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D006801:Humans; D008517:Phytotherapy; D015990:Placebo Effect; D016032:Randomized Controlled Trials as Topic; D017965:gamma-Linolenic Acid / Q000627:therapeutic use
D017965:gamma-Linolenic Acid