Expert consensus on the treatment of rheumatoid arthritis with chinese patent medicines

Background: Chinese patent medicines (CPMs) are widely used for the treatment of rheumatoid arthritis (RA) in China and especially by Western biomedical doctors who are not well trained in TCM. Thus, it is important to create a guideline or an expert consensus so that the CPMs are used correctly. Methods: The Delphi technique was used to generate the expert consensus. Twenty-eight (28) integrative medicine rheumatologists joined the consensus. A questionnaire regarding the general therapeutic principles, the categories, and the indications for the specific CPMs used for RA treatment was devised for this study. Results: More than 80% of the experts agreed on the following therapeutic principles: CPM could be used to treat all patients with RA (82.10%), CPM should be used under the guidance of Traditional Chinese Medicine (TCM) (100%), and CPM could be used for active RA treatment in combination with Western medicine (WM) (85.71%), but could be used alone (92.86%) for the treatment of inactive RA. In addition, CPM and WM should be taken separately (82.14%), although the CPM could reduce the side-effects of the WMs if used in combination with CPM (96.43%). For the treatment of active RA, the CPMs were recommended by more than 50% of the experts included the Leigongteng Duogan tablets (85.7%), Zhengqing Dengtongning tablets (64.3%), and Simiao pills (53.6%). Alternatively, for the treatment of inactive RA, Duhuo Jisheng mixture (71.4%), Yishen Juanbi pills (53.6%), and Wangbi electuary (50.0%) were recommended. Total paeonia glucoside capsules were recommended for the active (50.0%) and inactive RA (64.3%) treatment. The indications of each CPM were specified according to the symptoms related to the TCM pattern classification. Conclusions: This expert consensus regarding the treatment of RA with various CPMs was formed to aid WM doctors in the correct use of CPMs.