Glucocorticoid Discontinuation in Patients with Rheumatoid Arthritis under Background of Chinese Medicine: Challenges and Potentials Coexist<sup>*</sup>

YAO Chuan-hui; ZHANG Chi; SONG Meng-ge; XIA Cong-min; CHANG Tian; MA Xie-li; LIU Wei-xiang; LIU Zi-xia; LIU Jia-meng; TANG Xiao-po; LIU Ying; LIU Jian; PENG Jiang-yun; HE Dong-yi; HUANG Qing-chun; GAO Ming-li; YU Jian-ping; LIU Wei; ZHANG Jian-yong; ZHU Yue-lan; HOU Xiu-juan; WANG Hai-dong; FANG Yong-fei; WANG Yue; SU Yin; TIAN Xin-ping; LYU Ai-ping; GONG Xun; GONG Xun; JIANG Quan

doi:10.1007/s11655-025-4212-3

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Glucocorticoid Discontinuation in Patients with Rheumatoid Arthritis under Background of Chinese Medicine: Challenges and Potentials Coexist^*

Original Article | Updated：2025-07-11

- Glucocorticoid Discontinuation in Patients with Rheumatoid Arthritis under Background of Chinese Medicine: Challenges and Potentials Coexist^*
- Chinese Journal of Integrative Medicine Vol. 31, Issue 7, Pages: 581-589(2025)
- Affiliations：
  
  1.Department of Rheumatology and Immunology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing (100053), China
  2.Department of Internal Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing (100007), China
  3.Department of Rheumatology and Immunology, the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan (250013), China
  4.Department of Rheumatology and Immunology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei (230031), China
  5.Department of Rheumatology and Immunology, the Affiliated Hospital of Yunnan University of Traditional Chinese Medicine, Kunming (650200), China
  6.Department of Rheumatology and Immunology, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai (200052), China
  7.Department of Rheumatology and Immunology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou (510120), China
  8.Department of Rheumatology and Immunology, the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang (110031), China
  9.Department of Rheumatology and Immunology, the Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang (330006), China
  10.Department of Rheumatology and Immunology, the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin (300193), China
  11.Department of Rheumatology and Immunology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, Guangdong Province (518033), China
  12.Department of Rheumatology and Immunology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing (100078), China
  13.Department of Rheumatology and Immunology, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou (730050), China
  14.Department of Rheumatology and Immunology, Affiliated Hospital of the Third Military Medical University of the Chinese People's Liberation Army, Chongqing (400038), China
  15.Department of Rheumatology and Immunology, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing (210029), China
  16.Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing (100044), China
  17.Department of Rheumatology and Immunology, Peking Union Medical College Hospital, Beijing (100730), China
  18.School of Chinese Medicine, Hong Kong Baptist University, Hong Kong (999077), China
- Author bio：
  
  Prof. GONG Xun, E-mail: gongxun8269@163.com, and
  Prof. JIANG Quan, E-mail: doctorjq1961@163.com
- Funds：
- DOI：10.1007/s11655-025-4212-3
  CLC：
- Accepted：14 October 2024，
  
  Published：2025-07
- Accepted：
Scan QR Code
YAO Chuan-hui, ZHANG Chi, SONG Meng-ge, et al. Glucocorticoid Discontinuation in Patients with Rheumatoid Arthritis under Background of Chinese Medicine: Challenges and Potentials Coexist^*[J]. Chinese journal of integrative medicine, 2025, 31(7): 581-589.
DOI：

YAO Chuan-hui, ZHANG Chi, SONG Meng-ge, et al. Glucocorticoid Discontinuation in Patients with Rheumatoid Arthritis under Background of Chinese Medicine: Challenges and Potentials Coexist^*[J]. Chinese journal of integrative medicine, 2025, 31(7): 581-589. DOI： 10.1007/s11655-025-4212-3.

摘要

目的

本研究旨在评估中医药背景下类风湿关节炎 (rheumatoid arthritis

RA) 患者糖皮质激素 (glucocorticoid

GC) 使用剂量的动态变化及停用的可行性.

方法

本研究为多中心回顾性队列研究

共纳入2019 年9月1日至2023年12月4日在中国中医风湿病登记处 (CERTAIN) 注册并开始GC治疗的1

196 名RA患者. 依据治疗方案

将患者分为西药组和中西医综合治疗组 (中药联合西药) . 所有患者每3个月至少进行一次随访

监测GC剂量的调整情况. 采用广义估计方程分析GC剂量的变化

使用Kaplan-Meier曲线评估GC停用的概率

并通过Cox回归分析影响GC停用的因素. 此外

对于随访时间>12个月的患者进行敏感性分析.

结果

196例患者中女性占85.4%

中位年龄为56.4岁

880例患者 (73.6%) 接受了中西医综合治疗. 在中位数为12个月的随访期内

GC剂量逐渐减量

中西医综合治疗组较西药组减量更多 (

0.05) . 共410例患者 (34.3%) 停用GC

中西医综合治疗组的停用比例明显高于西药组 (40.8% vs. 16.1%

0.05) . Cox回归分析显示

年龄

60岁 (HR=2.142

95%CI: 1.523-3.012

0.001) 、中西医综合治疗 (HR=2.175

95%CI: 1.369-3.456

P=0.001) 、基线GC剂量≤7.5 mg (HR=1.637

95%CI: 1.177-2.275

P=0.003) 和未服用非甾体抗炎药 (HR=2.546

95%CI: 1.432-4.527

P=0.001) 是停用GC的重要因素

敏感性分析结果相同.

结论

中医药背景下RA患者在遵循指南停用GC方面存在挑战

中西医综合治疗具有促进GC减停的潜在优势.

Abstract

Objective:

To evaluate the dynamic changes of glucocorticoid (GC) dose and the feasibility of GC discontinuation in rheumatoid arthritis (RA) patients under the background of Chinese medicine (CM).

Methods:

This multicenter retrospective cohort study included 1

196 RA patients enrolled in the China Rheumatoid Arthritis Registry of Patients with Chinese Medicine (CERTAIN) from September 1

2019 to December 4

2023

who initiated GC therapy. Participants were divided into the Western medicine (WM) and integrative medicine (IM

combination of CM and WM) groups based on medication regimen. Follow-up was performed at least every 3 months to assess dynamic changes in GC dose. Changes in GC dose were analyzed by generalized estimator equation

the probability of GC discontinuation was assessed using Kaplan-Meier curve

and predictors of GC discontinuation were analyzed by Cox regression. Patients with <12 months of follow-up were excluded for the sensitivity analysis.

Results:

Among 1

196 patients (85.4% female; median age 56.4 years)

880 (73.6%) received IM. Over a median 12-month follow-up

34.3% (410 cases) discontinued GC

with significantly higher rates in the IM group (40.8%

. 16.1% in WM;

0.05). GC dose declined progressively

with IM patients demonstrating f

aster reductions (median 3.75 mg

. 5.00 mg in WM at 12 months;

0.05). Multivariate Cox analysis identified age

60 years [

0.001

hazard ratios (HR)=2.142

95% confidence interval (CI): 1.523–3.012

]

IM therapy (

=0.001

HR=2.175

95% CI: 1.369–3.456)

baseline GC dose ≤7.5 mg (

=0.003

HR=1.637

95% CI: 1.177–2.275)

and absence of non-steroidal anti-inflammatory drugs use (

=0.001

HR=2.546

95% CI: 1.432–4.527) as significant predictors of GC discontinuation. Sensitivity analysis (545 cases) confirmed these findings.

Conclusions:

RA patients receiving CM face difficulties in following guideline-recommended GC discontinuation protocols. IM can promote GC discontinuation and is a promising strategy to reduce GC dependency in RA management. (Trial registration: ClinicalTrials.gov

No. NCT05219214)

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