Kết hợp Đông – Tây y trong điều trị bệnh gout và viêm khớp dạng thấp: tổng quan bằng chứng

Gout and rheumatoid arthritis (RA) are prevalent inflammatory arthritides, each with distinct pathophysiological mechanisms. While Western medicine offers standardized treatments targeting inflammation and disease control, many patients seek complementary therapies like acupuncture and herbal medicines to alleviate pain, improve function, and mitigate adverse effects. The integration of Eastern and Western medical approaches presents a promising avenue for comprehensive patient care, yet its evidence base regarding efficacy and safety remains a critical area for investigation. This review aims to synthesize contemporary evidence on the benefits and risks of combining traditional East Asian medicine, such as acupuncture, classical herbal formulas (e.g., Simiao Decoction) and Tripterygium wilfordii extracts, with standard Western therapies for the management of gout and rheumatoid arthritis. This exploration is crucial for guiding clinical practice and informing patient-centered care.

Y bác sĩ, nhà nghiên cứu trong lĩnh vực thấp khớp học, y học nội khoa tổng quát và y học bổ sung/tích hợp, quan tâm đến các liệu pháp điều trị gout và viêm khớp dạng thấp.

This narrative review synthesizes evidence on combining Eastern and Western medicine for managing gout and rheumatoid arthritis (RA). The methodology involved reviewing major international guidelines and recent systematic reviews and randomized trials on acupuncture and herbal therapies for adult patients with gout or RA, comparing integrative regimens to Western care alone. Sources included PubMed/PMC and Cochrane databases, focusing on clinically relevant outcomes. Findings indicate that while Western guidelines emphasize urate-lowering therapy and DMARD strategies for gout and RA respectively, evidence for integrative approaches is mixed. Specifically, for RA, a randomized trial highlighted the superior efficacy of Tripterygium wilfordii extract over sulfasalazine in ACR responses, but underscored significant toxicity concerns necessitating careful risk-benefit assessment. Acupuncture for RA yielded inconsistent benefits across reviews, with some suggesting minimal impact and others reporting symptom and function improvements, reflecting heterogeneous methodologies. In gout, classical formulas like Simiao Decoction demonstrated anti-inflammatory and urate-lowering mechanisms in preclinical models and small clinical studies, with recent reviews noting potential adjunctive symptom relief and safety, though study quality varied. The review concludes that while integrative regimens can offer symptomatic relief for certain patients when integrated with guideline-based Western care, rigorous management of safety concerns, particularly with Tripterygium wilfordii and potential herb-drug interactions, is paramount. Current evidence advocates for shared decision-making and selective, closely monitored application rather than routine adoption. Future research should prioritize high-quality, sham-controlled, and add-on randomized trials with standardized outcomes to solidify the role of integrative medicine in these conditions. This approach ensures optimal patient outcomes, combining the strengths of both medical traditions.