Thunder god vine

Immunomodulatory & anti-inflammatory actions. Key TwHF constituents (notably triptolide and celastrol) suppress NF-κB signaling and downstream pro-inflammatory cytokines, and modulate T- and B-cell activity—mechanisms aligned with RA pathophysiology. These mechanisms are repeatedly described in pharmacology reviews of TwHF. Frontiers

Clinical signal for symptom control. Randomized trials and meta-analyses (mostly from China) show TwHF extracts can reduce RA disease activity and, in some studies, perform similarly to methotrexate (MTX) or improve outcomes when added to MTX. (See “Clinical studies” below.) Major evidence summaries (Cochrane; NIH NCCIH) characterize the overall evidence as low-to-moderate quality but suggestive of benefit, emphasizing safety concerns and the need for standardized products. Cochrane

There is no globally approved, standardized TwHF medicine for RA. Trials used specific Chinese-manufactured standardized tablets; do not attempt to use raw plant parts or non-standardized extracts (risk of serious toxicity). Always involve your rheumatologist.

Formulations used in RA trials

• TwHF polyglycoside tablets (sometimes called “Tripterygium glycosides,” “T2,” or “GTW”). Doses most often:
• 20 mg three times daily (total 60 mg/day) in several RCTs, including the TRIFRA trial; some trials used 10 mg TID. BMJ Advances in Rheumatology

Example regimens studied

• Monotherapy: TwHF 20 mg TID vs. MTX 12.5 mg weekly for 24 weeks (non-inferiority signal). BMJ Advances in Rheumatology
• Combination therapy: TwHF 20 mg TID + MTX 12.5 mg weekly vs. MTX alone for 24 weeks (combination performed best on primary response). BMJ Advances in Rheumatology

Monitoring and co-management (what reputable sources advise)

• Because TwHF is immunosuppressive and potentially toxic, reputable bodies (NIH NCCIH; national regulators) recommend medical oversight, use of standardized products only, and lab monitoring similar to DMARDs: CBC, liver & kidney function, and pregnancy prevention/counseling. NCCIH

Who should not use it (or must use extreme caution)

• Pregnancy & breastfeeding (contraindicated); risk of birth defects and amenorrhea.
• Trying to conceive / men of reproductive age: documented antifertility effects in men; menstrual disturbances in women.
• Osteoporosis risk, liver/kidney disease, immunodeficiency, or those on other immunosuppressants or CYP-metabolized drugs (drug-interaction potential). NCCIH

Regulatory & guideline context (use with caution)

• The MHRA (UK) specifically warns against unlicensed TwHF products due to serious adverse effects (fertility, liver, kidney, immune, blood, heart). GOV.UK
• The American College of Rheumatology’s integrative-care guidance for RA emphasizes evidence-based modalities (exercise, rehab, diet) alongside conventional DMARDs; TwHF is not part of standard RA pharmacotherapy recommendations and, if considered, should be within shared decision-making and close monitoring. Contentstack

TRIFRA RCT (24 weeks, n=207):

• Arms: MTX 12.5 mg weekly vs. TwHF 20 mg TID vs. MTX+TwHF.
• Primary outcome: ACR50 at week 24. Combination > MTX, TwHF ≈ MTX; open-label design (risk of bias). BMJ Advances in Rheumatology

TRIFRA 2-year radiographic follow-up:

• Suggests TwHF (alone or with MTX) may slow radiographic progression similarly or better than MTX, but non-blinded design limits certainty. ResearchGate

Cochrane review (Herbal therapy for RA):

• Concludes TwHF may improve some RA symptoms; higher doses (≈180–350 mg/day of certain preparations) appeared more effective than lower doses in included studies; adverse events are a concern; overall study quality variable. Cochrane

Systematic reviews/meta-analyses (recent):

• Broadly report that TwHF + MTX > MTX alone for symptom reduction and inflammatory markers, but emphasize heterogeneity, risk of bias, and safety issues; call for rigorous, longer, blinded trials. Frontiers

Older RCT programs & registries:

• Trials comparing TwHF to sulfasalazine, and combination with biologics, generally show symptom benefit but are limited by design and standardization issues. ICHGCP