Disease-modifying antirheumatic drugs (DMARDs) are often as a first-line option to treat rheumatic conditions including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), ankylosing spondylitis (AS) and psoriatic arthritis (PsA). For RA patients, therapy with DMARDs needs to commence right after a diagnosis is made, and comedication of conventional synthetic DMARDs (csDMARDs) and biologic DMARDs (bDMARDs) are considered favorable options in case that failed to achieve the aims of the treatment. However, due to the high incidence of adverse events that have been reported with csDMARDs and due to high cost associated with bDMARDs, the interest in complementary and alternative medicinal systems has significantly increased over the years.
As a specific example, Chinese medicinal disease-modifying antirheumatic drugs (CM-DMARDs) refers to those Chinese medicine compounds (CMC) with exact DMARDs-like effects. CMC usually consist of several single herbs, with multi-component, multi-target, and multi-pathway effects against different diseases. A diversified chemical composition is the material basis for the efficacy and toxicity of Chinese medicine compound preparations. This is exemplified in the Chinese battle against COVID-19, where the several well-known CMCs, Qingfei Paidu Decoction, HuaShi BaiDu Formula and XuanFeiBaiDu Granule, were first introduced as treatment options [1-3]. In China, there is a long history and experienced use of CMCs as a viable therapy for patients with diverse rheumatic diseases CMC showed promising outcomes in these patients, including variety of pharmacological effects such as analgesia, anti-inflammatory property and immune suppression. Those drugs demonstrating the ability to have anti-rheumatism effect are being classified as a CM-DMARD. Notably, the role of CM-DMARDs has been extensively investigated and the complex mechanisms behind the action of Chinese medicine compound PSORI-CM02 were studied, and it was revealed that it alleviated IMQ-induced psoriatic dermatitis and inhibited cell proliferation of Th17 by targeting M-MDSCs-induced (monocytic myeloid-derived suppressor cells) arginase-1. It is important that we note that economic burden and safety issues are the main factors that drive patients to pursue different treatment options. Compared to csDMARDs, tsDMARDs and bDMARDs, CM-DMARDs have fewer side effects and more importantly, the associated costs are lower than with other medications. Consequently, CM-DMARDs are considered acceptable and welcomed as an alternative or complementary treatment option for patients with rheumatic diseases in China. However, as a relatively new concept that was only recently defined, the use and further investigation of CM-DMARDs need to be further explored, especially when it comes to the mechanisms and functions that different CMC can have in different diseases. Moreover, as the effects of CMC are exerted through multiple pathways, an increasing number of studies are warranted, and more efforts should be made to explore challenges and future perspectives in this area of interest.
With this Research Topic we welcome the submission of Original Research, Review, and Systematic Review articles dealing with the use of DMARDs as a form of therapy to treat rheumatic diseases, including but not limited to the following subtopics:
• Omics studies based on effect of DMARDs on rheumatic diseases.
• Meta-analysis looking at the comparison between different types of DMARDs.
• Analysis of the underlying mechanisms and efficacy in the treatment of rheumatic diseases with different types of DMARDS.
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All the manuscripts submitted to the collection will need to fully comply with the
Four Pillars of Best Practice in Ethnopharmacology (you can freely download the full version
here).