Objective:

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To summarize the evidence from systematic reviews (SRs) on the benefits and safety of Tripterygium glycosides (TG) and total glucosides of paeony (TGP)

commonly used to treat rheumatoid arthritis (RA) in China

for patients with RA.

Methods:

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SRs of randomized controlled trials (RCTs) on TG or TGP in treating RA were included

by searching 8 databases from their inception until December 2017. Two authors extracted data independently. We assessed the quality of SRs using AMSTAR and graded the quality of evidence according to the GRADE approach.

Results:

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Eleven SRs containing an average of 7.6 RCTs

involving a total of 7

012 participants were included in this overview. On the basis of included SRs

TG and TGP could improve the following indexes for RA patients: American College of Rheumatology (ACR) 20 response rate

ACR50 response rate and ACR70 response rate

swollen joint count

tender joint count

erythrocyte sedimentation rate and C-reactive protein. Moreover

TGP could reduce incidence of hepatotoxicity. The most common adverse effects of TG were gastrointestinal discomfort and gonad toxicity

while for TGP was mild to moderate diarrhea. The overall quality of evidence for these findings ranged from "low" to "moderate".

Conclusions:

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TG and TGP might be 2 potentially effective complementary and alternative drugs for patients with RA. Nevertheless

due to gonad toxicity

TG should only be considered in elderly patients or patients without reproductive needs. More evidence from high quality RCTs and SRs is warranted to support the use of TG and TGP for RA patients.