Most of the common rheumatic diseases, such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), and psoriatic arthritis (PsA), are considered as autoimmune disorders. Today, there is no cure for these rheumatic diseases although substantial advances have been made to develop effective drugs for the treatment of these diseases. Thus, the treatment goal of rheumatic diseases is to achieve a low disease activity.
Effective treatment of rheumatic diseases like RA requires the use of disease-modifying anti-rheumatic drugs (DMARDs) that have benefitted a large number of patients but have also brought unwanted side effects, such as myelosuppression as well as liver and kidney injury. Traditional medicines like Chinese medicine, especially herbal medications, has gained attention as alternative remedies as they are believed to be efficacious, safe and have been used for over a thousand years traditionally in treating patients. For example, there was a 24-week, randomized, multicenter, single-blind study comparing Chinese medicine with Western medicine (DMARDs) carried out between June 2002 and December 2004 in nine research centers in China, involving 489 patients, and the result showed that Chinese medicine while effective in treating RA, appears to be less effective than DMARDs in controlling symptoms, but Chinese medicine is associated with fewer side effects.
In 2015 the herbal medication Tripterygium wilfordii Hook f (TwHF) tested in an open-label, randomized clinical trial was found non-inferior to methotrexate (MTX), which is an anchor DMARD in treatment of active RA. Subsequently, a meta-analysis and review published in 2016, in which a total of 22 trials (5255 participants) were identified, has confirmed that TwHF is effective and also safer than MTX in the treatment of rheumatic diseases. These observations received much attention from rheumatologists and pharmacologists. As traditional medicines have a rich resource of bioactive components, there could be potentially many different botanic agents and herbal extracts that are still to be discovered and used for the treatment of rheumatic diseases.
In addition to single active components or herbal extracts, there are many preparations and decoctions of Traditional medicines that have been tested to be effective in the treatment of rheumatic diseases. For example, by analyzing clinical trials conducted in China, we reported last year that several Chinese medicinal formula, mainly Chinese herbal formula or compound Chinese medicine, may provide an efficient treatment option for RA in terms of the bone-protecting efficiency. Thus, Chinese medicine may also function as a type of DMARD, which could be used as an alternative or add-on treatment for patients with rheumatic diseases. However, more high quality studies are urgently needed to apprehend the full potential of traditional medicines for the use in the treatment of rheumatic diseases, especially the studies addressing mechanism of traditional medicinal effects.
In this Research Topic, we intend to publish high-quality evidence-based Research articles as well as Reviews providing an overview of recent advances in the field of the use of traditional medicines in rheumatology. While submissions may inevitably reference concepts unique to Chinese medicine such as qi balancing, the molecular processes underpinning proposed modes of action should be especially emphasized. More specifically, the biological or -omic (microRNA, lncRNA, gut microbiota, etc.) mechanisms of traditional medicinal effects in treating rheumatic diseases are welcomed, but Clinical Trials would not be accepted. In addition, submissions on meta-analysis, the discovery of biologically active compounds, biomarkers for traditional medicinal effects, and well-designed experiments testing the potential efficacy of traditional therapies for rheumatic diseases are welcomed.
We would like to acknowledge and thank Zhihua Yang, Xuan Tang, Huasheng Liang, Kaixin Gao and Maojie Wang
for their support on the collection's Editorial article.