Tripterygium Glycosides for Treating Late-onset Rheumatoid Arthritis: A Systematic Review and Meta-analysis

Abstract

Context • Older- or late-onset rheumatoid arthritis (LORA) is defined as rheumatoid arthritis (RA) with an onset of symptoms at age 60 y or older, which includes a specific clinical course and features. To date, a specific therapeutic treatment for LORA is still a dilemma in modern medicine. Objective • The study aimed to assess the effectiveness and safety of Tripterygium glycosides for treating LORA. Design • Seven databases were searched from their inceptions until June 2015. The research team included randomized, controlled trials (RCTs) in which Tripterygium glycosides were employed, either alone or as an adjuvant treatment with disease-modifying antirheumatic drugs (DMARDs), in patients with LORA. The selection of studies, data extraction, and validation were performed independently by 2 reviewers. The Cochrane risk-of-bias criteria were used for evaluating the quality of the included studies. Settings • The study was conducted at Changzhou University (Changzhou, China), Nanjing University of Chinese Medicine (Nanjing, China), and the hospital affiliated with Nanjing University of Chinese Medicine (Nanjing, China). Participants • Studies including patients aged 60 y or older with RA in any of their peripheral joints were included in the meta-analysis. Intervention • All participants in the included studies were administered Tripterygium glycosides, either alone or together with other DMARDs, for at least 3 mo. Outcome Measures • The primary outcomes included (1) the swollen joint count (SJC) and (2) the tender joint count (TJC). The secondary outcomes included the erythrocyte sedimentation rate (ESR) and the level of C-reactive protein (CRP). Results • Four RCTs met the inclusion criteria, and most of them were of low methodological quality. The results of the current meta-analysis indicated that Tripterygium glycosides plus DMARD therapy, when compared with DMARD therapy alone, showed a favorable effect: (1) on the SJC, with the mean difference (MD) = -1.58, 95% confidence interval (CI) = -1.64 to -1.51, and P < .01; (2) on the TJC, with the MD = -1.71, 95% CI = -2.26 to -1.15, and P < .01; (3) on the CRP levels, with the MD = -9.96, 95% CI = -10.96 to -8.96, and P < .01; and (4) on the ESR, with MD = -10.74, 95% CI = -12.47 to -9.00, and P < .01. In addition, the groups treated with Tripterygium glycosides were not superior to the intervention groups that did not use Tripterygium glycosides in terms of decreasing adverse events. Conclusions • A lack of sufficient trials contributed to the small sample size of the combined, eligible RCTs, and it was difficult to draw firm conclusions on the positive effects of Tripterygium glycosides and on their efficacy as an effective intervention for treating RA. A high risk of bias existed among the available RCTs. Further work with more RCTs on a larger patient population is necessary to confirm the efficacy and safety of Tripterygium glycosides for treating LORA.