Effect of Chinese Herbal Medicines on Hearing Loss Risk in Rheumatoid Arthritis Patients: Retrospective Claims Analysis

Hsin-Hua Li,Wei-Jen Chen,Hanoch Livneh,Wen-Lin Fan,Tzung-Yi Tsai,Ming-Chi Lu,How-Ran Guo

doi:10.3389/fmed.2021.683211

Abstract

Objectives: Patients with rheumatoid arthritis (RA) are at a higher risk of extra-articular manifestations, especially hearing loss (HL). Although Chinese herbal medicines (CHM) are proven safe and effective treatments for inflammatory conditions, the effect of CHM use on HL in RA patients is unknown. This cohort study aims to determine the relationship between CHM use and the subsequent risk of HL among RA patients.Methods: From health insurance claims data in Taiwan, a total of 6,905 persons aged 20–80 years with newly-diagnosed RA in 2000–2009 were identified. Of these, we recruited 2,765 CHM users and randomly selected 2,765 non-CHM users who matched with the users by the propensity score. Both cohorts were followed up until the end of 2012 to estimate the incidence of HL. Cox proportional hazards regression was used to estimate the adjusted hazard ratio (HR) for HL.Results: The incidence of HL was lower in the CHM users than in the comparison cohort (8.06 vs. 10.54 per 1,000 person-years) (adjusted HR, 0.77; 95% CI, 0.63–0.94). Those who received CHM for more than 2 years had the greatest benefit against the onset of HL, with over 50% risk reduction. Prescriptions of Hai Piao Xiao, Yan Hu Suo, San-Qi, Huang Qin, Dang Shen, Jia-Wei-Xiao-Yao-San, Shu-Jing-Huo-Xue-Tang, and Dang-Gui-Nian-Tong-Tang were found to be associated with a reduced risk of HL.Conclusions: Our findings suggest that adding CHM to conventional therapy may reduce the subsequent risk of HL in RA patients. Prospective randomized trials are recommended to further clarify whether the association revealed in this study supports such a causal relationship.

Highlights

Rheumatoid arthritis (RA) is a common autoimmune disease that attacks multiple joints throughout the body
The data used in this retrospective cohort study were obtained from the Longitudinal Health Insurance Database (LHID), a sub-dataset of the National Health Insurance Research Database (NHIRD) of Taiwan made up of 1 million randomly-sampled people who registered with the National Health Insurance (NHI) program in 2000
We observed that Chinese herbal medicines (CHM) users had a lower incidence of hearing loss (HL) (8.06/1,000 PY) compared to the non-CHM users (10.52/1,000 PY), with an adjusted hazard ratio (HR) of 0.77 (Table 2)

Summary

Introduction

Rheumatoid arthritis (RA) is a common autoimmune disease that attacks multiple joints throughout the body. The clinical hallmarks of RA include swelling, tenderness, and damage in synovial joints, that cause progressive functional limitations and physical disability in the affected patients. According to an analysis by the National Health Interview Survey 2011–2013, arthritis/rheumatism ranked among the top three conditions reported to cause work disability, regardless of age or sex, imposing a tremendous socioeconomic burden [1]. One meta-analysis of 12 studies demonstrated that individuals with RA had more than double the likelihood of developing HL than did the general public [4]. A recent longitudinal follow-up study using a national population sample showed that individuals with HL were over four times more likely to die than the general population [7]. When managing patients with RA, preventing or treating HL is critical

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Methods

Results