Abstract
Purpose: To compare, in a retrospective study, the effects and safety profiles of Tripterygii totorum and sulfasalazine in patients with rheumatoid arthritis (RA) following 24 weeks of treatment.
 Methods: RA patients (n = 164) who were treated with Tripterygii totorum or sulfasalazine from August 2012 to February 2016 were included in this study. The major end-point was ≥ 20 % improvement as per American College of Rheumatology (ACR) criterion (ACR 20 response) after 24 weeks. Moreover, ACR 50 and ACR 70 responses were studied. The safety parameters investigated comprised of adverse events, vital signs, as well as hematological and biochemical indices (blood counts, electrolyte levels, and kidney and liver function).
 Results: At 24 weeks, ACR 20 response was 57.32 % in patients on Tripterygii totorum, while the corresponding value in patients on sulfasalazine was 39.02 % (p = 0.02). In the Tripterygii totorum group, ACR 50 response was 41.46 %, while ACR 70 response was 29.27 %. In sulfasalazine group, ACR 50 response was identified in 26.83 % of the patients, while ACR 70 response was seen in 21.95 % of patients. Adverse events were greater in the Tripterygii totorum group than in sulfasalazine group.
 Conclusion: These results suggest that Tripterygii Totorum significantly mitigates RA, with a tolerable safety profile. However, there is need for long-term or controlled trials to ascertain the therapeutic potential of Tripterygii totorum in RA.
 Keywords: Traditional Chinese medicine, Tripterygii totorum, Sulfasalazine, Rheumatoid arthritis
Highlights
Rheumatoid arthritis (RA) is a chronic and systemic autoimmune inflammatory disease of uncertain etiology which affects about 1% of human population
Patients aged greater than 18 years, and who had RA for a minimum of 1 year were included if they met the American College of Rheumatology (ACR) criterion for RA in functional classes I, II, or III [6,7]
The baseline characteristics were similar in both groups, there were significant differences in age (p = 0.034) and RA duration (p < 0.001) among the older patients, and longer RA duration in the Tripterygii totorum group
Summary
Rheumatoid arthritis (RA) is a chronic and systemic autoimmune inflammatory disease of uncertain etiology which affects about 1% of human population. It results in disability and premature death. The management of RA involves pharmacological, non-pharmacological, invasive as well as surgical interventions. These treatments are often personalized, based on disorder manifestations such as physical activity, laboratory findings, symptoms, as well as prognostic indicators. As first-line therapy for RA, with immuneselective biologic agents as second-line anti-RA therapy. These drugs do not effectively provide therapy for RA. Newer drugs are needed, in view of inadequate responses, adverse reactions, and increased cost of current treatments [1,2]
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