complementary medicine

1. Chinese Herbal Remedy Shows Promise for Treating Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disease that causes painful and debilitating swelling of the joints. Physicians often prescribe antiinflammatory drugs such as sulfasalazine for the initial treatment of rheumatoid arthritis. Despite the clinical efficacy of these types of drugs, many patients discontinue treatment due to lack of improvement or adverse events. The Chinese herbal remedy Tripterygium wilfordii Hook F (TwHF) (also known as “lei gong teng” or “thunder god vine”) has shown promise in treating autoimmune and inflammatory conditions. Researchers randomly assigned 121 patients to take either TwHF root extract 60mg three times per day or sulfasalazine 1g two times per day for 24 weeks. The researchers used a standard measure of joint involvement to determine treatment outcomes. Many patients in both groups discontinued treatment. However, among those who continued treatment for 24 weeks, improvement was greater with TwHF (67%) than with sulfasalazine (36%) and adverse event rates were similar. The resulst were similar in analyses that adjusted for patient dropout. Researchers conclude that the rapid improvement in joint symptoms may make TwHF extract an attractive and affordable alternative to antiinflammatory drugs.

2. Elective Induction of Labor May Reduce Cesareans, Improve Fetal Outcomes

Elective induction of labor, or labor that is induced without medical necessity, is rapidly increasing in the United States. Pregnant women who are at term and their physicians may consider labor induction for several reasons including physical discomfort, scheduling issues, or concerns about maternal or fetal complications. However, many experts discourage the practice because of the widely held belief that it increases the risk for cesarean delivery and other complications. Researchers conducted a systematic review of 11 randomized trials and 25 observational studies to compare the benefits and harms of elective induction of labor and expectant management of pregnancy. The researchers found that elective induction of labor at 41 weeks of gestation and beyond was associated with an approximately 20 percent reduction in the rate of cesarean delivery and a 50 percent reduction in the presence of meconium in the amniotic fluid. These results suggest that outcomes may be better with elective induction of labor. More research should be conducted before elective induction of labor is routinely adopted.

3. Chinas National Free Antiretroviral Program Has Limited Success, Shows Need for Improvement

In 2002, China began the National Free Antiretroviral Program to provide highly active antiretroviral therapy (HAART) to eligible patients with HIV. To determine the longterm outcomes of the program, researchers collected information on patient deaths and CD4 cell counts for the 48,785 program participants over five years. They found that mortality was highest within the first three months after HAART initiation. After about six months of treatment, death rates decreased to levels similar to those seen in HIVinfected patients who receive HAART in other developing countries. The lower death rates remained stable through year five. However, about half of the patients in the program had CD4 cell counts that suggested treatment failure after five years. The researchers believe that treatment failure may be due to the limited number of drug choices available to these patients. Once resistance developed, patients had few options for other drugs they could take.

Source
Angela Collom

Hereditary angioedema (HAE) is an autosomal dominant disease affecting approximately 10,000 people in the United States. HAE causes recurrent attacks of intense localized edema involving the skin, airway, and visceral organs. While chronic therapy with attenuated androgens or plasmin inhibitors has been the mainstay of HAE therapy, many new therapies for prophylaxis and acute treatment are on the horizon. It is important for physicians to understand the signs and symptoms of patients who present with HAE and to be familiar with the conventional and emerging therapies available to treat them.

To address the need for current education on HAE, Robert Michael Educational Institute LLC (RMEI) and Postgraduate Institute for Medicine (PIM) are jointly sponsoring a complimentary continuing medical education selfstudy audio activity titled Changing Paradigms in Hereditary Angioedema A Focus on Timely Diagnosis and New Therapies. This activity is supported by an educational grant from ViroPharma Incorporated.

Faculty for this continuing medical education activity include the following experts in allergy and immunology Allen P. Kaplan, MD, from Medical University of South Carolina in Charleston, South Carolina; Bruce L. Zuraw, MD, from the University of California School of Medicine in San Diego, California; and Paula J. Busse, MD, from the Mount Sinai School of Medicine in New York.

“Quality continuing medical education is vital to developing and increasing knowledge and skills and enhancing patient care,” says Robert Michael Educational Institute LLC President and CEO, Robert M. Colleluori.

RMEI is a medical education company that specializes in independent, certified and noncertified education. The goal of all certified RMEI educational offerings is to promote a spirit of lifelong learning and continuous professional development. RMEI works closely with medical experts to design activities that improve diagnosis and treatment leading to better outcomes for patients. These activities include national and international symposia, teleconferences, live meetings, enduring print materials, and interactive Internet programs.

Chinese herbal medicine (CHM) may relieve symptoms in the treatment of endometriosis. A systematic review by Cochrane Researchers found some evidence that women had comparable benefits following laparoscopic surgery and suffered fewer adverse effects if they were given Chinese herbs compared with conventional drug treatments.

Endometriosis is a gynaecological disorder affecting as many as one in six women of reproductive age. It can cause pelvic pain, irregular and painful periods, and infertility. Surgical treatments do not always lead to longterm improvement in symptoms and drug treatments can have unpleasant side effects such as hot flushes, acne and weight gain.

The researchers conducted the first English language systematic review of CHM for treatment of endometriosis. Two trials, which together focused on a total of 158 women, were included in the review. In one trial, CHM provided symptomatic relief comparable to that provided by the hormonal drug gestrinone, but with fewer side effects. In the other trial, CHM was more effective than the hormonal drug danazol, and also resulted in fewer side effects.

“These findings suggest that Chinese herbs may be just as effective as certain conventional drug treatments for women suffering from endometriosis, but at present we dont have enough evidence to generalize the results,” says lead researcher Andrew Flower of the Complementary Medicine Research Unit at the University of Southampton in the UK.

110 studies were originally considered for review but most were of poor methodological quality and had to be excluded. The researchers stress the need for Chinese researchers to adopt more rigorous methods in carrying out trials and reporting them. “Poor quality reporting has the potential to confuse and undermine research in Chinese herbal medicine,” says Flower.

Source
Jennifer Beal
WileyBlackwell