Ann Rheum Dis doi:10.1136/annrheumdis-2014-205971
  • Correspondence

Comparison of Tripterygium wilfordii Hook F with methotrexate in the treatment of rheumatoid arthritis

  1. Donald M Marcus
  1. Correspondence to Dr Donald M Marcus, Department of Medicine, MS 285, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA; dmarcus{at}
  • Received 21 May 2014
  • Accepted 22 May 2014
  • Published Online First 17 June 2014

The study by Qian-wen Lv et al1 found the efficacy of the herb Tripterygium wilfordii Hook F (TwHF) for treatment of rheumatoid arthritis to be non-inferior to that of methotrexate. The duration of that trial was 24 weeks, but rheumatoid arthritis is a chronic disease that requires years of therapy. The authors did not consider adequately the full range of the herb's potential adverse effects, especially for long-term treatment.

TwHF has direct effects on the male and female reproductive tracts of humans and laboratory animals.2–4 It causes irregular menses and amenorrhoea, which may be reversible, increased levels of follicle-stimulating and luteinising …

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