Glucocorticoid Discontinuation in Patients with Rheumatoid Arthritis under Background of Chinese Medicine: Challenges and Potentials Coexist.

Chuan-Hui YAO; Chi ZHANG; Meng-Ge SONG; Cong-Min XIA; Tian CHANG; Xie-Li MA; Wei-Xiang LIU; Zi-Xia LIU; Jia-Meng LIU; Xiao-Po TANG; Ying LIU; Jian LIU; Jiang-Yun PENG; Dong-Yi HE; Qing-Chun HUANG; Ming-Li GAO; Jian-Ping YU; Wei LIU; Jian-Yong ZHANG; Yue-Lan ZHU; Xiu-Juan HOU; Hai-Dong WANG; Yong-Fei FANG; Yue WANG; Yin SU; Xin-Ping TIAN; Ai-Ping LYU; Xun GONG; Quan JIANG

Return

Glucocorticoid Discontinuation in Patients with Rheumatoid Arthritis under Background of Chinese Medicine: Challenges and Potentials Coexist.

Author: Chuan-Hui YAO ¹ ; Chi ZHANG ² ; Meng-Ge SONG ¹ ; Cong-Min XIA ¹ ; Tian CHANG ¹ ; Xie-Li MA ¹ ; Wei-Xiang LIU ¹ ; Zi-Xia LIU ¹ ; Jia-Meng LIU ¹ ; Xiao-Po TANG ¹ ; Ying LIU ³ ; Jian LIU ⁴ ; Jiang-Yun PENG ⁵ ; Dong-Yi HE ⁶ ; Qing-Chun HUANG ⁷ ; Ming-Li GAO ⁸ ; Jian-Ping YU ⁹ ; Wei LIU ¹⁰ ; Jian-Yong ZHANG ¹¹ ; Yue-Lan ZHU ¹² ; Xiu-Juan HOU ¹² ; Hai-Dong WANG ¹³ ; Yong-Fei FANG ¹⁴ ; Yue WANG ¹⁵ ; Yin SU ¹⁶ ; Xin-Ping TIAN ¹⁷ ; Ai-Ping LYU ¹⁸ ; Xun GONG ^{19
,

20} ; Quan JIANG ^{20
,

21}
Author Information

1. Department of Rheumatology and Immunology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China.
2. Department of Internal Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100007, China.
3. Department of Rheumatology and Immunology, the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250013, China.
4. Department of Rheumatology and Immunology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, 230031, China.
5. Department of Rheumatology and Immunology, the Affiliated Hospital of Yunnan University of Traditional Chinese Medicine, Kunming, 650200, China.
6. Department of Rheumatology and Immunology, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, 200052, China.
7. Department of Rheumatology and Immunology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, 510120, China.
8. Department of Rheumatology and Immunology, the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, 110031, China.
9. Department of Rheumatology and Immunology, the Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang, 330006, China.
10. Department of Rheumatology and Immunology, the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
11. Department of Rheumatology and Immunology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, Guangdong Province, 518033, China.
12. Department of Rheumatology and Immunology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, 100078, China.
13. Department of Rheumatology and Immunology, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, 730050, China.
14. Department of Rheumatology and Immunology, Affiliated Hospital of the Third Military Medical University of the Chinese People's Liberation Army, Chongqing, 400038, China.
15. Department of Rheumatology and Immunology, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, 210029, China.
16. Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, 100044, China.
17. Department of Rheumatology and Immunology, Peking Union Medical College Hospital, Beijing, 100730, China.
18. School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, 999077, China.
19. Department of Rheumatology and Immunology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China. gongxun8269@
20. com.
21. Department of Rheumatology and Immunology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China. doctorjq1961@
Publication Type:Observational Study
Keywords: Chinese medicine; discontinuation; glucocorticoid; integrative medicine; rheumatoid arthritis
MeSH: Adult; Aged; Female; Humans; Male; Middle Aged; Arthritis, Rheumatoid/drug therapy*; Glucocorticoids/therapeutic use*; Medicine, Chinese Traditional; Retrospective Studies
From: Chinese journal of integrative medicine 2025;31(7):581-589
CountryChina
Language:English
Abstract: OBJECTIVE:To evaluate the dynamic changes of glucocorticoid (GC) dose and the feasibility of GC discontinuation in rheumatoid arthritis (RA) patients under the background of Chinese medicine (CM).
METHODS:This multicenter retrospective cohort study included 1,196 RA patients enrolled in the China Rheumatoid Arthritis Registry of Patients with Chinese Medicine (CERTAIN) from September 1, 2019 to December 4, 2023, who initiated GC therapy. Participants were divided into the Western medicine (WM) and integrative medicine (IM, combination of CM and WM) groups based on medication regimen. Follow-up was performed at least every 3 months to assess dynamic changes in GC dose. Changes in GC dose were analyzed by generalized estimator equation, the probability of GC discontinuation was assessed using Kaplan-Meier curve, and predictors of GC discontinuation were analyzed by Cox regression. Patients with <12 months of follow-up were excluded for the sensitivity analysis.
RESULTS:Among 1,196 patients (85.4% female; median age 56.4 years), 880 (73.6%) received IM. Over a median 12-month follow-up, 34.3% (410 cases) discontinued GC, with significantly higher rates in the IM group (40.8% vs. 16.1% in WM; P<0.05). GC dose declined progressively, with IM patients demonstrating faster reductions (median 3.75 mg vs. 5.00 mg in WM at 12 months; P<0.05). Multivariate Cox analysis identified age <60 years [P<0.001, hazard ratios (HR)=2.142, 95% confidence interval (CI): 1.523-3.012], IM therapy (P=0.001, HR=2.175, 95% CI: 1.369-3.456), baseline GC dose ⩽7.5 mg (P=0.003, HR=1.637, 95% CI: 1.177-2.275), and absence of non-steroidal anti-inflammatory drugs use (P=0.001, HR=2.546, 95% CI: 1.432-4.527) as significant predictors of GC discontinuation. Sensitivity analysis (545 cases) confirmed these findings.
CONCLUSIONS:RA patients receiving CM face difficulties in following guideline-recommended GC discontinuation protocols. IM can promote GC discontinuation and is a promising strategy to reduce GC dependency in RA management. (Trial registration: ClinicalTrials.gov, No. NCT05219214).