Pattern differentiation in Traditional Chinese Medicine can help define specific indications for biomedical therapy in the treatment of rheumatoid arthritis.
The objective of this study is to explore the role of Traditional Chinese Medicine (TCM) pattern differentiation in identifying a subset of patients with rheumatoid arthritis (RA) who are more likely to respond to biomedical combination therapy. This study uses data from a previous multicenter randomized-controlled clinical trial. One hundred and ninety-four (194) patients were treated with biomedical combination therapy (diclofenac, methotrexate, and sulfasalazine). ACR20 response at 12 weeks and 24 weeks was used for evaluation of efficacy. Eight (8) symptoms, which are the most important for establishing TCM cold and hot patterns in patients with RA, were analyzed in this study. TCM patterns were obtained using factor analysis of the eight symptoms. Thirst, vexation, hot feeling in the joints, turbid yellow-colored urine, and fever were classified as factor 1. Cold feeling in the whole body, cold feeling in the limbs, and cold feeling in the joints were classified as factor 2. The classification into factor 1 and 2 is similar to TCM hot pattern and cold pattern differentiation, since the symptoms in factor 1 and 2 are the key symptoms in TCM hot and cold patterns, respectively. The effective rates in patients with different TCM patterns were analyzed with the chi(2) method. At 12 weeks, ACR20 response in patients treated with the biomedical combination therapy was 36.08%. At 24 weeks, ACR20 response was 69.59%. Based on the eight symptoms used in factor analysis, the effective rates in the patients with cold pattern and hot pattern were 51.67% and 29.09%, respectively, after 12 weeks of treatment; and 88.52% and 55.36%, respectively, after 24 weeks of treatment. TCM pattern differentiation based on symptoms can help identify a subset of patients with RA that will more likely respond to biomedical therapy, consisting of diclofenac, methotrexate, and sulfasalazine.