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Die
werbe-freie online Enzyklopädie Wikipedia
zum Thema Arthrose
hier
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.
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