Session Information
Date: Sunday, November 5, 2017
Title: Rheumatoid Arthritis – Clinical Aspects Poster I: Treatment Patterns and Response
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Medical bugs, a term used to describe insects and arthropods for medical treatment, have been widely used in the past centuries for pain relief. The treatment is believed to include biologically active substances that induce anti-inflammatory effects. Previous trials have shown that medical bugs may reduce the need for analgesic intake of people with rheumatoid arthritis (RA). However, few studies have been conducted to evaluate the effect of medical bugs on musculoskeletal disease. The aim of this systematic review was to evaluate the pain relief of commonly used medical bugs in RA patients to better understand its benefits and inform clinical practice.
Methods: A comprehensive search on PubMed and Chinese databases (CNKI, Wan Fang and VIP) and the Cochrane Library was conducted through May 1, 2017. Only randomized controlled trials (RCTs) using medical bug (including ant, centipedes, scorpions and others) therapy for adult RA patients who met diagnostic by the 1995 ACR criteria or 2002 Traditional Chinese Medicine criteria were included. The effects of medical bugs were evaluated with a tender joint count and pain score of joints. The differences between treatment groups were reported as mean difference (P-value) across the studies. The methodologic quality of the studies was assessed with the Jadad instrument. The heterogeneity of the studies, including varying comparison methods, and methodologic limitations, precluded a formal meta-analysis.
Results: Ten RCTs with a total of 1,176 RA patients (age range = 38-62 years, 59% female, disease duration range = 1 month-30 years) met the eligibility criteria. Studies were conducted between 2002 and 2015 in China. Outcomes included the Chinese pain score and Visual Analogue Scale (VAS). Medical bugs were either used singly or in combination with other Chinese herbs. The overall quality of trials was modest (mean Jadad score = 2). Table 1 summarizes the information from the included studies. All 10 studies utilizing medical bugs either alone or in combination with other Chinese herbs showed efficacy in pain relief for RA. No adverse events were reported in either treatment or control groups.
Conclusion: Medical bug therapy appears to relieve pain in patients with RA. These studies did not evaluate disease modifying effects, and the use of combination treatments makes it difficult to ascertain which ingredient may induce the effect. Still, the potential of medical bug treatment and its non-pharmacologic properties may have value and deserve further study. Rigorously designed and well-controlled multicenter RCTs of biological active compounds of medical bugs for RA symptom relief need to be conducted in future studies.
Table 1. Randomized Clinical Trials Evaluating Medical Bugs for Joint Pain in Rheumatoid Arthritis
|
Author Year |
N a (Ageb) |
Diagnostic Criteria |
Medical bugs |
Control |
Duration (Weeks) |
Effect on Tender Joint Count or Joint Pain Score (mean changes)c |
|
Yang 2002 |
280 (ND) |
Chinese criteria 2002 |
20 herbs including centipede and scorpion, 9g/day |
Tripod, 2tablets*twice/day |
12 |
#2.40 e (P< 0.05) |
|
Huang 2005 |
76 (38y) |
ACR 1995 and Chinese criteria 2002 |
18 herbs including centipede 1g and Steleophaga 5g, once/day; Methotrexate, 10mg/week; Penicillamine, 250mg*twice/day |
Glucosidorum Tripterygll Totorum, 1mg/kg/day |
8 |
#1.79 e (P< 0.05) |
|
Shen 2004 |
85 (39y) |
ACR 1995 |
16 herbs including centipede 2g and scorpion 3g, 250ml*twice/day |
Tripterygium polyglycoside tablets, 20mg*3 times/day |
24 |
#1.80 d (P< 0.01) |
|
Huang 2014 |
82 (39y) |
Chinese criteria 2002
|
14 herbs including centipede 0.35g, 6 Tablets*3times/day; Diclofenac Sodium Sustained Release Tablets, 75mg*twice/day |
Diclofenac Sodium Sustained Release Tablets, 75mg*twice/day |
8 |
#7.18 e (P< 0.05) |
|
Liu 2003 |
120 (ND) |
ACR 1995 |
Prednisone adequate dose for 4 weeks; 14 herbs including scorpion 10g, 250ml*twice/day |
Methotrexate, 10mg*once/week; Indometacin Tablets, 150mg/day; Prednisone, 30mg/day |
14 |
#0.40 e (P< 0.05) |
|
Cheng 2003 |
79 (38y) |
ACR 1995 |
10 herbs including scorpion, 2-3 times/day |
Fenbid, 600mg *twice/day |
8 |
#0.81 e (P< 0.05) |
|
Liu 2009 |
66 (49y) |
ACR 1995 |
12 herbs including scorpion 3g, 250ml*twice/day; Methotrexate, 10mg/week; Meloxicam, 7.5mg*twice/day |
Methotrexate, 10mg/week; Meloxicam, 7.5mg*twice/day |
12 |
#1.10 d (P< 0.05) |
|
Liu 2011 |
80 (49y) |
ACR 1995 |
3 herbs including scorpion 5g, 150 ml*3 times/day |
2 herbs not including scorpion, 150ml*3 times/day |
12 |
^0.25 (P< 0.05) |
|
Feng 2015 |
100 (62y) |
Chinese criteria 2002 |
14 Herb including 1 centipede and 1 scorpions, 200g*twice/day; 6 herbs hot pack for 30-50 min, once or twice/day |
Methotrexate, 5mg*3 times/day |
3 |
#1.20 e (P< 0.05) |
|
Dai 2007 |
208 (39y) |
ACR 1995 |
15 herbs including ant 30g, 150ml*twice/day |
Ibuprofen, 300mg*3 times/day |
5 |
#2.59 d (P< 0.01) |
|
a N= number of patients included; b Age reported in years as a mean; c Mean difference was calculated between groups; d Severity of joint pain was scored 0, 1, 2, 3, respectively measured by physicians; e Chinese pain score: lower score = better outcome. Chinese criteria: Guiding Principles of Clinical Research on Traditional Chinese Medicine, including main symptoms: joint swelling and pain and four of the following secondary symptoms: joint tenderness, limited flexion and extension, morning stiffness, joint cold, aggravated pain in nights, hand and foot cold, fatigue, aggravated pain in rainy days, pale tongue, heavy and soft pulse. #: indicate decrease, ^: indicate increase. |
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To cite this abstract in AMA style:
Zhang R, Yuan P, Li J, Dong B, Kang W, Hyon S, Bannuru RR, Harvey WF, Wang C. Medical Bugs for Pain Relief in Patients with Rheumatoid Arthritis, a Systematic Review [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/medical-bugs-for-pain-relief-in-patients-with-rheumatoid-arthritis-a-systematic-review/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/medical-bugs-for-pain-relief-in-patients-with-rheumatoid-arthritis-a-systematic-review/