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Abstract
Background Rheumatoid arthritis (RA) is an autoimmune disease characterized by multijoint swelling, pain, and destruction of the synovial joints. Treatments are available but new therapies are still required. One source of new therapies is natural products, including herbs used in traditional medicines. In China and neighbouring countries, natural products have been used throughout recorded history and are still in use for RA and its symptoms. This study used text-mining of a database of classical Chinese medical books to identify candidates for future clinical and experimental investigations of therapeutics for RA. Methods The database Encyclopaedia of Traditional Chinese Medicine (Zhong Hua Yi Dian) includes the full texts of over 1,150 classical books. Eight traditional terms were searched. All citations were assessed for relevance to RA. Results and Conclusions. After removal of duplications, 3,174 citations were considered. After applying the exclusion and inclusion criteria, 548 citations of traditional formulas were included. These derived from 138 books written from 206 CE to 1948. These formulas included 5,018 ingredients (mean, 9 ingredients/formula) comprising 243 different natural products. When these text-mining results were compared to the 18 formulas recommended in a modern Chinese Medicine clinical practice guideline, 44% of the herbal formulas were the same. This suggests considerable continuity in the clinical application of these herbs between classical and modern Chinese medicine practice. Of the 15 herbs most frequently used as ingredients of the classical formulas, all have received research attention, and all have been reported to have anti-inflammatory effects. Two of these 15 herbs have already been developed into new anti-RA therapeutics—sinomenine from Sinomenium acutum (Thunb.) Rehd. & Wils and total glucosides of peony from Paeonia lactiflora Pall. Nevertheless, there remains considerable scope for further research. This text-mining approach was effective in identifying multiple natural product candidates for future research.
Highlights
Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease characterized by multijoint swelling and pain and destruction of the synovial joints, leading to severe disability and increased mortality [1,2,3]. e global prevalence was estimated at 0.24% but it is higher in some populations [4], with 0.5–1% of adults in the United States being affected [5]
Traditional treatment methods are widely used in China often in combination with disease modifying antirheumatic drugs (DMARDs) and/or biologics [10]. is is Evidence-Based Complementary and Alternative Medicine likely due to a combination of concerns about the side effects of DMARD combination therapy, the high cost of biological agents in China, the ready availability of traditional treatments in the hospital system [11], and public awareness of the increasing literature on the evidence base for traditional treatments such as herbal formulations and acupuncture [12,13,14,15,16]
Along with the increasing application of clinical trial methodologies for the evaluation of traditional medicines for RA and other diseases, there has been increasing attention to the systematic assessment of the premodern and classical medical literature using text-mining approaches [20]. Such studies have focused on drug discovery from compounds found in the natural products used in traditional medicines [21,22,23]; identification of instances of long-term traditional use of natural products for certain diseases or symptoms [24,25,26,27]; the logic underlying ancient acupuncture prescriptions [28]; and investigations of continuities and differences between the classical and modern Chinese medicine approaches to certain diseases [29, 30]
Summary
Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease characterized by multijoint swelling and pain and destruction of the synovial joints, leading to severe disability and increased mortality [1,2,3]. e global prevalence was estimated at 0.24% but it is higher in some populations [4], with 0.5–1% of adults in the United States being affected [5]. Along with the increasing application of clinical trial methodologies for the evaluation of traditional medicines for RA and other diseases, there has been increasing attention to the systematic assessment of the premodern and classical medical literature using text-mining approaches [20]. Ese formulas included 5,018 ingredients (mean, 9 ingredients/formula) comprising 243 different natural products When these text-mining results were compared to the 18 formulas recommended in a modern Chinese Medicine clinical practice guideline, 44% of the herbal formulas were the same
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