Association between use of Chinese herbal medicine and depression risk in patients with rheumatoid arthritis: A nationwide retrospective cohort study

Abstract

Aim: Depression is a common mental disorder in rheumatoid arthritis (RA) patients and may provoke the onset of poor clinical prognoses. In view of this, whether or not the use of Chinese herbal medicines (CHMs) can alleviate the risk of depression still remains unclear. We conducted a longitudinal cohort study to evaluate the association between CHMs us and depression risk among RA patients. Method:Using claims data from the National Health Insurance of Taiwan, we identified 6609 newly diagnosed RA patients aged 20 years or older between 1998 and 2010. From this sample, we recruited 3386 CHM users and randomly selected 3223 controls using propensity scores matching from the remaining cases as the non-CHMs users. They were followed until the end of 2012 to record depression incidence. A Cox proportional hazards regression model was used to compute the hazard ratio (HR) of depression with regard to the use of CHMs. Results:During the 15-year follow-up, 249 CHM users and 314 non-CHM users developed depression, representing an incidence rate of 9.33 and 14.98, respectively, per 1000 person-years. We found that use of CHMs was associated with lower risk of depression by 38% (95% confidence interval 0.54-0.76). The most predominant effect was observed in those receiving CHMs for over 2 years (adjusted HR 0.34).Seven commonly prescribed CHMs could lessen the risk of depression: Chuan-niu-xi, | 987 LI et aL.

A Comparison of the Risk of Fracture in Rheumatoid Arthritis Patients with and without Receiving Chinese Herbal Medicine

“…Second, we added to the analysis prescription of biological agents, taken for six months or longer, which is a common surrogate used for RA severity in the administrative claims data. 11,38 These sensitivity analyses revealed that disease severity was not likely to alter the veracity of our findings that adding CHMs to conventional therapy reduced the risk of fracture in RA patients. Fourth, due to the use of a cohort study design, rather than a randomized controlled trial, inferences regarding the beneficial effect of CHMs on reducing fracture risk are likely limited due to unmeasured or unknown confounders.…”

“…Despite the interest in CHMs, only a few studies have reported the characteristics of CHMs usage patterns in RA patients. 9 , 11 To the best of our knowledge, no previous studies have directly determined an association between CHMs use and osteo-protective influence among RA patients. This study, therefore, aimed to corroborate the association, over time, between CHMs use and incident osteoporotic fracture among RA patients, using a nationwide medical claims database representative of the Taiwanese population.…”

“…2,8 Over the past decade, Chinese herbal medicines (CHMs), as a time-honored medical science, have been regarded as a commonly used complementary therapy for patients with RA. [9][10][11] Previous studies have inferred that by abating the nuclear factor kappa beta (NF-κB) signaling, several Chinese herbs, including Bei-Mu and Da-Huang, may be beneficial in regulating pro-inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). 12 It is noteworthy that these inflammatory mediators have been shown to moderate the production of bone marrow, leading to hypo-development of the skeleton, as well as brittleness of bone, thereby increasing susceptibility to fracture after RA onset.…”

Use of Chinese Herbal Medicines Is Related to a Reduction in Depression Risk Among Patients With Insomnia: A Matched Cohort Study

“…We, therefore, used the frequency of visits to Chinese medicine physicians to verify the CHMs exposure of each insomniac patient. Those receiving CHMs to treat insomnia for more than 30 days were deemed CHMs users, whereas those treated for 30 days or less were considered non-CHMs users (12,13). Based on this procedure, 31,238 cases were designated as CHMs users.…”

Traditional Chinese Medicine in Patients With Primary Sjogren's Syndrome: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

“…The mechanism of Jia-Wei-Xiao-Yao-San (JWXYS) in autoimmune disease was observed to increase synaptic plasticity and decrease the levels of inflammatory markers by upregulating the expression of hippocampal brain-derived neurotrophic factor (BDNF) (5)(6)(7). Suan-Zao-Ren-Tang (SZRT) could regulate the gammaaminobutyric acid-ergic(GABA) system in plasma which is crucial in the etiology of psychiatric disorders (8). The results of studies conducted on animals have indicated that Gan-Lu-Yin (GLY) can influence vascular smooth muscle activity (9) and exert anti-inflammatory effect (10)(11)(12).…”