Tripterygium Root Effective for Rheumatoid Arthritis

Tripterygium root for rheumatoid arthritis

Tripterygium root for rheumatoid arthritis. Image by Ryan Johnson

The root of the Tripterygium wilfordii plant is called “lei gone teng” in traditional Chinese medicine. Extracts from the root have been used for rheumatoid arthritis for centuries by herbalists around the world. The plant is also called “thunder god vine” by some.

Despite these odd names, the Tripterygium plant has been studied over the past few decades by scientists. Its purported anti-inflammatory properties have been confirmed. Yes, human clinical research has once again confirmed that herbal medicine is therapeutic.

In one study, as we’ll show below, treatment with Tripterygium was found to be more effective than a pharmaceutical medicine often prescribed for rheumatoid arthritis.

Some Tripterygium pharmacology

Researchers have been investigating this complex plant medicine in the laboratory for several decades. In the late 1980s, it was found the Tripterygium plant contains up to 380 metabolically active biochemicals. The most active of these include a number of terpenoids. These include at least three diterpenoids—triptolide, tripdiolide, and triptonide. Tripterygium also contains pentacyclic triterpene acid.

Since then, laboratory research has confirmed these terpenoids are responsible for much of the plant’s anti-inflammatory effects within the body.

Clinical research confirms effectiveness

A 2016 double-blinded multi-center study tested 174 rheumatoid arthritis patients. Half of the patients were treated with a topical application of Tripterygium root. They rubbed 20 grams on their sore joints every day for 8 weeks. The other half of the patient group rubbed a placebo cream on their sore joints.

The researchers utilized the visual analog scale for pain (VAS) to test the therapeutic effect of the Tripterygium. The VAS scale rates pain. It is the primary pain index used in clinical research. The research also measured disease activity scores of 28 joints (DAS28) among the patients. They also used the VAS for general health index (VAS for GH) to measure function and well-being among the patients.

By the fourth week, the researchers found that 79 of the 87 patients treated with the Tripterygium experienced significant joint pain relief. VAS scores and DDS28 scores and VAS for GH scores were also significantly improved compared to the beginning of treatment. These scores were also significantly higher compared to the placebo group.

The researchers also found that the herbal treatment reduced inflammation. The erythrocyte sedimentation rates (ESR) and C-reactive protein levels (hs-CRP) were also significantly improved in the Tripterygium treatment group.

The doctors concluded:

“External applying Compound TwHF [Tripterygium] was an effective and safe way to relieve-joint pain of RA patients, which could be taken as an adjuvant therapy.”

Oral Tripterygium also treats RA

Tripterygium root extract has also been proven effective when taken orally – internally.

A 2015 study published in the journal Nature was a double-trial study that took place over a four-year period. The studies included 167 and then 218 patients with rheumatoid arthritis. The second study was a randomized placebo-controlled clinical trial.

Each trial tested the patients for 24 weeks. The doctors gave the patients 1,500 to 2,000 milligrams of Tripterygium root extract orally per day. They started with 500 mg three times a day and then increased dosages to 1,000 mg twice a day thereafter.

The researchers measured the success of the treatment using the American College of Rheumatology criteria. This is also referred to as the ACR score – followed by the percent improvement. The doctor assesses 68 tender and 66 swollen joints. For ACR 20, the patient must have 20% or more improvement among all the tender and swollen joints. They also have to have improvement of 20% or more for three or more assessments by the physician regarding global health, patient pain scores using VAS, function scores, and C-reactive protein scores. In other words, an ACR 20 shows real improvement of RA symptoms.

The researchers found that 82.6 percent of the positive-predictor patients treated with Tripterygium achieved ACR 20 improvement scores. This was higher than the number of patients treated with placebos or Methotrexate and Sulfasalazine.

Positive-predictor patients were determined by their type of arthritis symptoms. These included diuresis, excessive sweating and night sweats. Yellow-tongue symptom and thermalgia (heat) in the joints were found as negative predictors.

Tripterygium beats two RA pharma drugs

Notice in the study above that Tripterygium root extract treatment out-performed the Methotrexate and Sulfasalazine combination treatment. However, this result was possibly confused by the positive-predictor element of the study, which separated patient results by symptoms. Another study showed that Tripterygium definitely out-performed a pharmaceutical treatment.

But a 2015 did compare Tripterygium root treatment directly with Methotrexate. In a clinical trial of 207 patients, researchers treated rheumatoid arthritis patients with Tripterygium root, Methotrexate, or both combined for 24 weeks. The researchers found that 55 percent of the Tripterygium group achieved ACR 20. This compared to 46 percent in the Methotrexate group. The researchers concluded that Tripterygium therapy out-performed Methotrexate “in controlling disease activity in patients with RA.”

In 2009, researchers from the U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases and Clinical Center at the National Institutes of Health tested 121 patients with rheumatoid arthritis. Again, this was a double-blind clinical trial.

The patients were treated by rheumatology medical doctors in several NIH centers in the U.S. Each day for 24 weeks, half the patients were treated with 180 milligrams (60 mg thrice daily) of oral Tripterygium root extract. The other half were given 2,000 milligrams (1 gram twice a day) of the sulfa rheumatoid arthritis drug sulfasalazine.

The researchers found that over 67 percent of the patients treated with Tripterygium achieved the ACR 20 scores. In comparison, only 36 percent of the sulfasalazine group achieved ACR 20 scores. The researchers also found that the Tripterygium treatments beat the sulfasalazine treatments using ACR 50 and ACR 70 criteria. The researchers concluded:

“After 24 weeks of treatment, 67.57% of patients who received TwHF [Tripterygium] and completed the study and 36.00% of patients who received sulfasalazine and completed the study achieved at least a 20% improvement in disease activity as determined by the ACR 20 response.”

The researchers also found that inflammation levels were significantly lower in the Tripterygium group. The researchers stated:

“Plasma interleukin-6 levels were significantly lower after 4 weeks of treatment with TwHF [Tripterygium] and remained low at 24 weeks. At 6 months, interleukin-6 levels in the TwHF group had decreased by 24.81 pg/mL compared with 4.63 pg/mL in the sulfasalazine group.”

Note that sulfasalazine is considered an anti-inflammatory drug. Take another look at the difference between the Tripterygium treatment and sulfasalazine treatment in terms of interleukin-6 levels. Now tell me which is the strongest anti-inflammatory medicine.

In both of the above studies, adverse effects were minimal for Tripterygium treatment. The researchers stated:

“Significantly more patients in the sulfasalazine group than the TwHF [Tripterygium] group experienced adverse events classified as moderate to severe by the investigator.”

Other clinical studies confirm findings

These aren’t the only studies showing the effectiveness of Tripterygium treatment for rheumatoid arthritis.

In 2002, another National Institutes of Health study gave a placebo, 360 milligrams a day or 180 mg/day of Tripterygium extract to 35 patients for 20 weeks.

The research found the root extract resulted in ACR 20 achievement for 8 of 10 in the high-dose group and 4 of 10 people in the low-dose (180 mg/day) group. None of the placebo group achieved the ACR 20 scores.

The researchers concluded:

“The ethanol/ethyl acetate extract of TWHF shows therapeutic benefit in patients with treatment-refractory RA. At therapeutic dosages, the TWHF extract was well tolerated by most patients in this study.”

In 2001, 13 patients were treated in a Phase I clinical study. The researchers gave the patients 180 mg/day of Tripterygium extract orally for the first four weeks, and then 360 mg/day thereafter. The research took place at the University of Texas Southwestern Medical Center.

After taking 180 mg/day, 60 percent of the patients showed clinical improvement. After taking at least 360 mg per day, 88 percent showed clinical improvement. They also showed significant reduction in inflammation.

One of the nine patients who completed the 16 week treatment went into complete remission.

“The extract of TWHF [Tripterygium] at dosages up to 570 mg/day appeared to be safe, and doses more than 360 mg/day were associated with clinical benefit in patients with rheumatoid arthritis.”

A clinical meta-analysis review published in 2013 found ten randomized clinical trials up until then that included 733 RA patients. The researchers found that Tripterygium extracts resulted in the significant improvement of patients and improved grip strength.

Efficacy of traditional herbal medicine for RA

These studies show that rheumatoid arthritis can be significantly improved using herbal medicines. Herbal treatments such as Tripterygium wilfordii root and others have been proven to reduce pain and improve function. We have also shown that rheumatoid arthritis is linked to gut bacteria.

The combination of studies above illustrate that Tripterygium root extract can also be effective by taking internally as well as rubbed on externally.

We should note the 2015 study also showed that Tripterygium root extract will be more effective for RA patients with certain symptoms. Take another look at that study for those predictors. Talk with your doctor before you consider changing medications.

Discover other herbal therapies for RA and other forms of arthritis:

Arthritis - The Botanical Solution by Case Adams Naturopath

Discover: Tripterygium Wilfordii (Thunder God Vine) Root Extract 20:1 Tripterygium Wilfordii

REFERENCES:

Jiao J, Tang XP, Yuan J, Liu X, Liu H, Zhang CY, Wang LY, Jiang Q. Effect of External Applying Compound Tripterygium wilfordii Hook F. on Joint Pain of Rheumatoid Arthritis Patients. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2016 Jan;36(1):29-34.

Lv QW, Zhang W, Shi Q, Zheng WJ, Li X, Chen H, Wu QJ, Jiang WL, Li HB, Gong L, Wei W, Liu H, Liu AJ, Jin HT, Wang JX, Liu XM, Li ZB, Liu B, Shen M, Wang Q, Wu XN, Liang D, Yin YF, Fei YY, Su JM, Zhao LD, Jiang Y, Li J, Tang FL, Zhang FC, Lipsky PE, Zhang X. Comparison of Tripterygium wilfordii Hook F with methotrexate in the treatment of active rheumatoid arthritis (TRIFRA): a randomised, controlled clinical trial. Ann Rheum Dis. 2015 Jun;74(6):1078-86. doi: 10.1136/annrheumdis-2013-204807.

Jiang M, Zha Q, Zhang C, Lu C, Yan X, Zhu W, Liu W, Tu S, Hou L, Wang C, Zhang W, Liang Q, Fan B, Yu J, Zhang W, Liu X, Yang J, He X, Li L, Niu X, Liu Y, Guo H, He B, Zhang G, Bian Z, Lu A. Predicting and verifying outcome of Tripterygium wilfordii Hook F. based therapy in rheumatoid arthritis: from open to double-blinded randomized trial. Sci Rep. 2015 Apr 15;5:9700. doi: 10.1038/srep09700.

Goldbach-Mansky R, Wilson M, Fleischmann R, Olsen N, Silverfield J, Kempf P, Kivitz A, Sherrer Y, Pucino F, Csako G, Costello R, Pham TH, Snyder C, van der Heijde D, Tao X, Wesley R, Lipsky PE. Comparison of Tripterygium wilfordii Hook F versus sulfasalazine in the treatment of rheumatoid arthritis: a randomized trial. Ann Intern Med. 2009 Aug 18;151(4):229-40, W49-51.

Tao X, Younger J, Fan FZ, Wang B, Lipsky PE. Benefit of an extract of Tripterygium Wilfordii Hook F in patients with rheumatoid arthritis: a double-blind, placebo-controlled study. Arthritis Rheum. 2002 Jul;46(7):1735-43.

Tao X, Cush JJ, Garret M, Lipsky PE. A phase I study of ethyl acetate extract of the chinese antirheumatic herb Tripterygium wilfordii hook F in rheumatoid arthritis. J Rheumatol. 2001 Oct;28(10):2160-7.

Liu Y, Tu S, Gao W, Wang Y, Liu P, Hu Y, Dong H. Extracts of Tripterygium wilfordii Hook F in the Treatment of Rheumatoid Arthritis: A Systemic Review and Meta-Analysis of Randomised Controlled Trials. Evid Based Complement Alternat Med. 2013;2013:410793. doi: 10.1155/2013/410793.

Tao X, Younger J, Fan FZ, Wang B, Lipsky PE. Benefit of an extract of Tripterygium Wilfordii Hook F in patients with rheumatoid arthritis: a double-blind, placebo-controlled study. Arthritis Rheum. 2002 Jul;46(7):1735-43.

Tao X, Cai JJ, Lipsky PE. The identity of immunosuppressive components of the ethyl acetate extract and chloroform methanol extract (T2) of Tripterygium wilfordii Hook. F. J Pharmacol Exp Ther. 1995 Mar;272(3):1305-12.

Zheng JR, Fang JL, Gu KX, Yin YQ, Xu LF, Gao JW, Guo HZ, Yu YH, Sun HZ. Screening of active anti-inflammatory-immunosuppressive and antifertile components from Tripterygium wilfordii. II. Screening of 5 monomers from total glucosides of Tripterygium wilfordii (TII). Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 1987 Oct;9(5):323-8.

Case Adams is a California Naturopath with a PhD in Natural Health Sciences, and Board Certified Alternative Medicine Practitioner. He has authored 26 books on natural healing strategies. “My journey into writing about alternative medicine began about 9:30 one evening after I finished with a patient at the clinic I practiced at over a decade ago. I had just spent the last two hours explaining how diet, sleep and other lifestyle choices create health problems and how changes in these, along with certain herbal medicines and other natural strategies can radically yet safely turn ones health around. As I drove home that night, I realized I needed to get this knowledge out to more people. So I began writing about health with a mission to reach those who desperately need this information. The strategies in my books and articles are backed by scientific evidence along with wisdom handed down through traditional medicines for thousands of years.” Case connects with the elements by surfing, hiking and being a beach bum.

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