title: Herbal therapy for treating rheumatoid arthritis.
abstract: BACKGROUND
  Herbal medicine interventions have been identified as having potential benefit in the treatment of rheumatoid arthritis (RA).
  
  
  OBJECTIVE
  To update an existing systematic (Cochrane) review of herbal therapies in RA.
  
  
  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.
  
  
  METHODS
  Randomised controlled trials of herbal interventions compared with placebo or active controls in RA.
  
  
  METHODS
  Two authors selected trials for inclusion, assessed risk of bias and extracted data.
  
  
  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.
  
  
  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.
authors.affiliation: School of Exercise Science, Australian Catholic University, McAuley at Banyo, 1100 Nudgee Road, Banyo, QLD, Australia, 4014.
authors.forename: Melainie
authors.initials: M
authors.lastname: Cameron
authors.forename: Joel J
authors.initials: JJ
authors.lastname: Gagnier
authors.forename: Sigrun
authors.initials: S
authors.lastname: Chrubasik
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D006801:Humans; D008517:Phytotherapy; D015990:Placebo Effect; D010938:Plant Oils / Q000627:therapeutic use*; D031825:Primula; D016032:Randomized Controlled Trials as Topic; D029757:Tripterygium; D017965:gamma-Linolenic Acid / Q000627:therapeutic use*
chemical_list: D018501:Antirheumatic Agents; D010938:Plant Oils; D017965:gamma-Linolenic Acid; C084865:black currant oil; C079363:borage oil