Integrating Chinese Herbal Medicine into Conventional Care Was Related to Lower Risk of Sarcopenia Among Rheumatid Arthritis Patients: A Retrospective, Population-Based Study

Figures & data

Figure 1 Flow chart for population inclusion criteria.

Table 1 Patient Demographic Data and Comorbidities

	Total Patients	Non-CHM Users	CHM Users	Standardized Difference
		n = 2746 (%)	n = 2746 (%)
Age (years)	51.09(11.6)	51.3(11.8)	50.9(11.4)	0.0007
Mean (SD)
Age				0.001
≤50 years	2440(44.4)	1194(43.5)	1246(45.4)
>50 years	3052(55.6)	1552(56.5)	1500(54.6)
Gender				0.001
Male	1446(76.3)	731(26.6)	715(26.0)
Female	4046(73.7)	2015(73.4)	2031(74.0)
Monthly income (in USD)				0.0007
≤623	2277(41.5)	1126(41.0)	1151(41.9)
624–1394	2984(54.3)	1503(54.7)	1481(53.9)
≥1395	231(4.2)	117(4.3)	114(4.2)
Residential area				0.0007
Urban	3182(57.9)	1585(57.7)	1597(58.2)
Suburban	839(15.3)	434(15.8)	405(14.7)
Rural	1471(26.8)	727(26.5)	744(27.1)
CCI				0.0008
Mean (SD)	5.1(7.2)	4.9(7.3)	5.1(7.2)

Abbreviations: CCI, Charlson-Deyo Comorbidity Index; CHM, Chinese herbal medicine; NTD, New Taiwan Dollar; SD, standard deviation.

Table 2 Sarcopenia Incidence (per 1000 PY) and Risk in RA Patients with and without CHM Use

Patient Group	Case	PYs	Incidence	Crude HR (95% CI)	Adjusted HR* (95% CI)
Non-CHM users	220	22,396.80	9.83	1	1
CHM users	175	22,746.06	7.69	0.78 (0.64–0.95)	0.78(0.65–0.94)
CHM use for 31–730 days	162	20,243.21	8.00	0.81 (0.66–0.98)	0.81(0.66–0.97)
CHM use for >730 days	13	2503.85	5.19	0.53 (0.30–0.90)	0.53(0.30–0.92)

Notes: *Model adjusted for age, gender, urbanization level, monthly income and CCI score.

Abbreviations: RA, rheumatoid arthritis; CHM, Chinese herbal medicine; PYs, person-years; HR, hazard ratio; CI, confidence interval.

Table 3 Sarcopenia Incidence (per 1000 PY) and Risk in RA Patients with and without CHM Use, Stratified by Sex and Age

Age (Years)	Non- CHM Users			CHM Users			Crude HR (95% CI)	Adjusted HR (95% CI)
	Case	PYs	Incidence	Case	PYs	Incidence
Gender
Male	37	6303.10	5.87	41	6040.32	6.79	1.17 (0.75–1.71)	1.14^† (0.74–1.77)
Female	186	16,429.08	11.32	131	16,371.35	8.00	0.70 (0.56–0.86)	0.69^† (0.57–0.88)
Age
≤50	92	9978.59	9.22	69	10,364.38	6.66	0.71 (0.52–0.96)	0.70* (0.51–0.95)
>50	131	12,753.59	10.27	103	12,047.29	8.55	0.84 (0.65–1.08)	0.83* (0.65–1.09)

Notes: *Model adjusted for urbanization level, gender, monthly income, and CCI score. ^†Model adjusted for age, urbanization level, monthly income, and CCI score.

Abbreviations: RA, rheumatoid arthritis; CHM, Chinese herbal medicine; PYs, person-years; HR, hazard ratio; CI, confidence interval.

Table 4 Herbs Contained in the Most-Used Single-Herb and Multi-Herb Products Among Study Participants

Chinese Herbal Product	Ingredients or Generic Name	Function Classification
Multi-herb products
Shu-Jing-Huo-Xue-Tang	Ginger, White Peony Root, Rehmannia Root, Cang Zhu, Citrus (Peel) - CHEN PI, Prunus Persica, Dong Quai Root, Cyathula Root Clematis Root, Poria, Gentiana, Notopterygium, Siler, Sichuan Lovage Root, Stephania Root, Angelica Root, Licorice Root.	Treats chronic pain syndromes, including sciatic neuralgia.
Jia-Wei-Xiao-Yao-San	Bupleuri radix, Angelicae radix, Paeoniae radix alba, Atractylodis rhizome macrocephalae, Poria cocos, Zingiberis siccatum rhizome, Menthae haplocalycis, and Glycyrrhizae radix	Reduces depression and anxiety.
Duo-Huo-Ji-Sheng-Tang	Herba Taxilli, Radix Rehmanniae, Poria, Radix Angelicae Pubescentis, Radix Gentianae Macrophyllae, Radix Saposhnikoviae, Cortex Eucommiae, Radix Achyranthis Bidentatae, Radix Angelicae Sinensis, Radix Alba Paeoniae, Radix Ginseng, Rhizoma Chuanxiong, Cortex Cinnamomi, Radix Glycyrrhizae, Pericarpium Zanthoxyli.	Reduces inflammation severity and encourages the lymphatic function.
Shao-Yao-Gan-Cao-Tang	Paeoniae Radix, Glycyrrhizae Radix.	Antioxidative and antiaggregating effect
Ge-Gen-Tang	Kudzu Root, Hb. Ephedra, Saposhnikovia Root, Cinnamon Branch, White Peony Root, Fresh Ginger, Jujube Fruit, Licorice Root	Induces sweating to release the exterior symptoms and dispel Wind-Cold
Dan-Gui-Nian-Tong-Tang	Notopterygium, Licorice, Chinese Skullcap, Capillaris, Atractylodes. Alba, Alisma, Polyporus, Siler Root, Anemarrhena, Dong Quai Root, Ginseng, Sophora Flavescens, Cimicifuga Rhizome, Pueraria Root, Cang Zhu Rhizome	Treats arthritis of the limbs, beriberi, skin diseases of the lower limbs and groin area, gonorrhea
Chuan-Xiong-Cha-Tiao-San	Chuanxiong Rhizoma, Schizonepetae Herba, Angelicae Dahuricae Radix, Notopterygii Rhizoma et Radix, Glycyrrhizae Radix et Rhizoma, Asari Radix et Rhizoma, Saposhnikoviae Radix, Menthae Haplocalycis Herba	Scatters wind and relieves pain.
Xue-Fu-Zhu-Yu-Tang	Prunus Persica, Dong Quai Root, Rehmannia Root, Carthamus Tinctorius, Cyathula Root, Aurantium, Chinese Peony Root, Platycodon Root, Sichuan Lovage Root, Bupleurum Root, Licorice Root.	Invigorates blood, dissolves stasis, and moves Qi, unblocks the channels, relieves painful obstructions
Ping-Wei-San	Rhizoma Atractylodis, Cortex Magnoliae officinalis, Pericarpium Citri reticulatae, Radix Glycyrrhizae Praeparata cum Melle, Rhizoma Zingiberis recens, Fructus Jujubae	Balances digestion and eases abdominal pain and fullness
Gan-Lu-Yin	Artemisia Capillaris flower, Scutellaria root, Loquat leaf, Immature orange, Rehmannia root, Asparagus root, Ophiopogon root, Dendrobium, and Glycyrrhiza	Treats oral inflammations, such as periodontitis, stomatitis, and glossodynia
Single-herb products
Yan-Hu-Suo	Corydalis yanhusuo.	Used for pain relief, anticancer effects, and enhancement of vital energy.
Ge-Gen	Kudzu Root	Treats infectious respiratory diseases.
Bei-Mu	Fritillaria Thunbergii	Treats cough with thick and yellowish sputum, lung abscess, skin infection, subcutaneous nodule, scrofula, goiter.
Huang-Qin	Scutellariae Radix	Clearing heat, removes toxins, relieves diarrhea and pain.
Da-Huang	Rheum Palmatum	Breaks up heat, removes blood stagnation and reduces swelling, release through the bowels.
Suberect Spatholobus Stem	Spatholobi Caulis	Tonifies blood, activates blood circulation, and frees collateral vessels.
Ye-Jiao-Teng	Caulis Polygoni Multiflori	Nourishes the Heart, calms the spirit, unblocks channels, dispels wind-dampness, alleviates itching (topically as a wash), astringes sweat.
Hai-Piao-Xiao	Cuttlefish bone	Stops bleeding, secures the essence, dries dampness, reduces gastric acidity.
San-Qi	Roots of Panax notoginseng	Used for cardiovascular diseases.
Chuan-Niu-Xi	Radix Cyathulae	Activates blood, eliminates stasis, strengthens tendons and bones, promotes urination, treats dysuria.

Figure 2 Sarcopenia risk regarding uses of top ten most-used single-herb and multi-herb products among subjects.