Evidence of effectiveness of herbal medicinal products in the treatment of arthritis. Part 2: Rheumatoid arthritis

Evidence of effectiveness of herbal medicinal products in the treatment of arthritis. Part 2: Rheumatoid arthritis.

Herbal medicinal products (HMPs) that interact with the mediators of inflammation are used in the treatment of rheumatoid arthritis (RA). The aim of this study was to update a previous systematic review published in 2000. We searched electronic databases (MEDLINE, EMBASE, CISCOM, AMED, CINAHL, Cochrane registers) to June 2007, unrestricted by date or language, and included randomized controlled trials that compared HMPs with inert (placebo) or active controls in patients with rheumatoid arthritis. Five reviewers contributed to data extraction. Disagreements were discussed and resolved by consensus with reference to Cochrane guidelines and advice from the Cochrane Collaboration. Twenty studies (10 identified for this review update, and 10 of the 11 studies of the original review) investigating 14 HMPs were included. Meta-analysis was restricted to data from previous seven studies with oils from borage, blackcurrant and evening primrose containing gamma linolenic acid (GLA). GLA doses equal or higher than 1400 mg/day showed benefit in the alleviation of rheumatic complaints whereas lower doses ( approximately 500 mg) were ineffective. Three studies compared products from Tripterygium wilfordii (thunder god vine) to placebos and returned favorable results but data could not be pooled because the interventions and measures differed. Serious adverse effects occurred in one study. In a follow-up study all side effects were mild to moderate and resolved after the intervention ceased, but time to resolution was variable. Two studies comparing Phytodolor NR to placebo were of limited use because some measures were poorly defined. The remaining studies, each considering differing HMPs, were assessed individually. For most HMPs used in the treatment of RA, the evidence of effectiveness was insufficient to either recommend or discourage their use. Interventions with HMPs containing GLA or Tripterygium wilfordii extract appear to produce therapeutic effects but further investigations are warranted to prove their effectiveness and safety.

gamma-Linolenic acid treatment of rheumatoid arthritis. A randomized, placebo-controlled trial.

To assess the clinical efficacy and adverse effects of gamma-linolenic acid (GLA), a plant seed oil-derived unsaturated fatty acid that suppresses inflammation and joint tissue injury in animal models, in the treatment of active rheumatoid arthritis (RA).

METHODS:

Fifty-six patients with active RA were randomized to treatment groups in a 6-month, double-blind trial of GLA versus placebo. This was followed by a 6-month, single-blind trial during which all patients received GLA. Patients were treated with 2.8 gm/day of GLA as the free fatty acid or with sunflower seed oil (placebo) administered in identical capsules.

RESULTS:

Treatment with GLA for 6 months resulted in statistically significant and clinically relevant reductions in the signs and symptoms of disease activity in patients with RA. Overall meaningful responses (at least 25% improvement in 4 measures) were also better in the GLA treatment group (14 of 22 patients versus 4 of 19 in the placebo group; P = 0.015). During the second 6 months, both groups exhibited improvement in disease activity. Thus, patients taking GLA during the entire study showed progressive improvement during the second 6 months. In this group, 16 of 21 patients showed meaningful improvement at 12 months compared with study entry.

CONCLUSION:

GLA at doses used in this study is a well-tolerated and effective treatment for active RA. GLA is available as a component of several plant seed oils and is usually taken in far lower doses than were used in this trial. It is not approved in the United States for the treatment of any condition, and should not be viewed as therapy for any disease. Further controlled studies of its in RA are warranted.

гамма-Линоленовая кислота лечения ревматоидного артрита. Рандомизированное, плацебо-контролируемое испытание.
Для оценки клинической эффективности и побочных эффектах, гамма-линоленовая кислота (GLA), растительного масла семян-производные ненасыщенных жирных кислот, что подавляет воспаление и совместных повреждения ткани животных моделях, на лечение активного ревматоидного артрита (РА).
МЕТОДЫ:Пятьдесят шесть пациентов с активным РА были рандомизированы по группам лечения в течение 6 месяцев, двойным слепым методом GLA по сравнению с плацебо. За этим последовало в течение 6 месяцев, простое слепое испытание, во время которого все больные получали GLA. Пациенты получали 2.8 г/день арендуемой площади, как и свободные жирные кислоты или подсолнечное масло (плацебо), управляемых в одинаковых капсулы.
РЕЗУЛЬТАТЫ:Лечение GLA за 6 месяцев привело к статистически значимым и клинически значимые сокращения признаков и симптомов активности заболевания у пациентов с РА. В целом осмысленные ответы (по крайней мере, 25% увеличение в 4 меры) также были лучше в GLA группе лечения (14 из 22 пациентов против 4 19 в группе плацебо; Р = 0,015). Во второй 6 месяцев, обе группы выставлены улучшение активности заболевания. Таким образом, пациенты, принимающие арендуемой площади в течение всего исследования показали постепенное улучшение, во втором 6 месяцев. В этой группе, 16 из 21 больных показал значительного улучшения на 12 месяцев по сравнению с включения в исследования.
ВЫВОД:GLA в дозах, используемые в этом исследовании-это хорошо переносится и эффективного лечения активного РА. GLA доступен в качестве компонента несколько растительного масла семян и, как правило, принимается в гораздо меньших дозах, чем было задействовано в этом процессе. Он не будет одобрен в США для лечения любого заболевания, и их не следует рассматривать в качестве терапии любого заболевания. Далее-контролируемые исследования ее в РА являются оправданными.

Przegl Lek. 2007;64(2):100-2.

жүктеу/скачать 3.28 Mb.

Достарыңызбен бөлісу: