Correlations Between Symptoms as Assessed in Traditional Chinese Medicine (TCM) and ACR20 Efficacy Response

In Brief Objective: This research was designed to explore the role of joint and nonarticular clinical manifestations traditionally evaluated in Chinese herbal medicine in predicting efficacy of treatment for rheumatoid arthritis. Methods: Three hundred ninety-six patients were randomly divided to receive Western medicine (WM) therapy, 197 cases; and traditional Chinese herbal medicine (TCM), 199 cases. A complete physical examination and 18 clinical manifestations typically assessed in TCM were recorded before the randomization. The WM therapy included diclofenac extended action tablets, methotrexate, and sulfasalazine. The TCM therapy included Glucosidorum Tripterygll Totorum tablets and Yishen Juanbi tablets. The American College of Rheumatology (ACR) response criteria were used for efficacy evaluation. All data were analyzed using the SPSS11.5 statistical package. Results: ACR20 and 50 responses with WM treatment were higher at 24 weeks than in the TCM group. In the WM group, 89% achieved ACR20 whereas 65.8% on TCM reached this response In the WM group, efficacy was negatively related to subjective symptoms of dizziness, and positively related to joint tenderness and thirst as recorded at entry. In contrast, in the TCM group the efficacy was positively related to joint tenderness and joint pain, and negatively related to the joint stiffness and more nocturia. Conclusion: Symptoms including those not directly related to joints and those inquired about in TCM may have influence on the efficacy of therapy, and might merit further study to ascertain if they can be helpful to guide specific therapy. Patients with RA given methotrexate and sulfasalazine achieved ACR20 scores at 24 weeks in 80.7% of cases vs. 65.8% with TCM herbs (p=0.001). Symptoms as assessed in TCM are suggested as possible predictors of response.