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Naturheilkunde: alternative Rheuma-Therapie.

Die rheumatoide Arthritis gehört im fortgeschrittenen Lebensalter zu den eher häufigen und sehr  schmerzhaften Erkrankungen. Durch die chronische Entzündung der Gelenke kommt es im Verlauf der Krankheit zu schweren deformierenden  Gelenkveränderungen und sogar zu einer erhöhten Gesamtsterblichkeit.
Jetzt haben Forscher in einer im renommierten Fachblatt Anals of Internal Medicine veröffentlichten Studie nachweisen können, dass das traditionelle chinesische Heilmittel   "lei gong teng" oder auf Englisch "thunder god vine") eine bessere Heilwirkung entfaltet als das Standard-Medikament Sulfasalazine.  

Der Pflanzenwirkstoff wird aus den Wurzeln des medizinischen Weins Tripterygium wilfordii Hook F (TwHF) hergestellt. Von den rund 380 aus der Wurzel isolierten Wirkstoffen sind 95% Terpenoide. Die drei häufigsten  sind Triptolide,  ^Tripdiolide und Triptonide . Diese sind für die immunsuppressive Wirkung des Medikaments verantwortlich.
Da die Zahl der Patienten die die Studie beendeten relativ klein war, kann diese Untersuchung nur die Annahme stützen, dass das chinesische Arzneimittel wahrscheinlich bei Arthritis eine gute Wirkung entfaltet. Für den endgültigen Beweis dieser Wirksamkeit  - und die gute Verträglichkeit - sind aber unbedingt noch einige größere zusätzliche Studien erforderlich.

18 August 2009 | Volume 151 Issue 4 | Pages 229-240

   Comparison of Tripterygium wilfordii Hook F Versus Sulfasalazine in   
   the Treatment of Rheumatoid Arthritis

     A Randomized Trial

Raphaela Goldbach-Mansky, MD, MHS; Mildred Wilson, RN; Roy Fleischmann,

MD; Nancy Olsen,

MD; Joel Silverfield, MD; Phillip Kempf, MD; Alan Kivitz, MD; Yvonne Sherrer,

MD; Frank Pucino, PharmD; Gyorgy Csako,

MD; Rene Costello, BS; Tuyet Hang Pham, MT; Christopher Snyder, BS;

Désirée van der Heijde, MD; Xuelian Tao, MD; Robert Wesley, PhD; and Peter E. Lipsky, MD
 

Background: Extracts of the medicinal plant Tripterygium wilfordii Hook F (TwHF) have been used in China for centuries to treat a spectrum of inflammatory diseases.

Objective: To compare the benefits and side effects of TwHF extract with those of sulfasalazine for the treatment of active rheumatoid arthritis.

Design: Randomized, controlled trial. A computer-generated code with random, permuted blocks was used to assign treatment.

Setting: 2 U.S. academic centers (National Institutes of Health, Bethesda, Maryland, and University of Texas, Dallas, Texas) and 9 rheumatology subspecialty clinics (in Dallas and Austin, Texas; Tampa and Fort Lauderdale, Florida; Arlington, Virginia; Duncanville, Pennsylvania; Wheaton and Greenbelt, Maryland; and Lansing, Michigan).

Patients: 121 patients with active rheumatoid arthritis and 6 or more painful and swollen joints.

Intervention: TwHF extract, 60 mg 3 times daily, or sulfasalazine, 1 g twice daily. Patients could continue stable doses of oral prednisone or nonsteroidal anti-inflammatory drugs but had to stop taking disease-modifying antirheumatic drugs at least 28 days before randomization.

Measurements: The primary outcome was the rate of achievement of 20% improvement in the American College of Rheumatology criteria (ACR 20) at 24 weeks. Secondary end points were safety; radiographic scores of joint damage; and serum levels of interleukin-6, cholesterol, cortisol, and adrenocorticotropic hormone.

Results: Outcome data were available for only 62 patients at 24 weeks. In a mixed-model analysis that imputed data for patients who dropped out, 65.0% (95% CI, 51.6% to 76.9%) of the TwHF group and 32.8% (CI, 21.3% to 46.0%) of the sulfasalazine group met the ACR 20 response criteria (P = 0.001). Patients receiving TwHF also had significantly higher response rates for ACR 50 and ACR 70 in mixed-model analyses. Analyses of only completers showed similar significant differences between the treatment groups. Significant improvement was demonstrated in all individual components of the ACR response, including the Health Assessment Questionnaire disability score. Interleukin-6 levels rapidly and significantly decreased in the TwHF group. Although not statistically significant, radiographic progression was lower in the TwHF group. The frequency of adverse events was similar in both groups.

Limitations: Only 62% and 41% of patients continued receiving TwHF extract and sulfasalazine, respectively, during the 24 weeks of the study. Long-term outcome data were not collected on participants who discontinued treatment.

Conclusion: In patients who continued treatment for 24 weeks and could also use stable oral prednisone and nonsteroidal anti-inflammatory drugs, attainment of the ACR 20 response criteria was significantly greater with TwHF extract than with sulfasalazine.

Primary Funding Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases.