Talk:Rheumatoid arthritis

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EGCG vs GTE[edit]

Per my undo (of the deletion), the reviews provided specifically refer to EGCG (not just Green Tea Extracts) and even name it as such in their titles. Here's another separate review on EGCG for RA again that can be added too: [1]. I'm fine for the text to be modified to "Green tea extract and EGCG" if preferred, since EGCG is one of the components of green tea extracts. There's no point in just deleting it, since there's a vast number of studies and reviews all showing the same thing. Just update the wording if it's so concerning. The vast majority of other non-EGCG specific studies of GTEs contain EGCG as well anyway, having most of the same effect (although higher EGC to EGCG ratios result in a bit lower EGCG absorption/bioavailability). Anyway, here's also example of long-term (10 year), repeatedly NIH-funded research programs, where the grants started off on green tea polyphenols and then moved to EGCG specifically for some years (searched by one of the principle investigators in the field as example). If the U.S. NIH alone has spent at least 10 years renewing funding to RA research programs (apart from all the international work), then it's notable enough for an "RA Research" section: [2]. 14.200.91.233 (talk) 09:58, 1 October 2017 (UTC)

Update: I updated the wording to read "green tea extracts and [..]". 14.200.91.233 (talk) 10:02, 1 October 2017 (UTC)
It's been deleted as WP:Crystal, without any explanation of how, even after this Talk section was set up. Please follow WP process and discuss changes before arbitrary opinion edits, especially when a Talk section has explicitly been created. Calling it WP:Crystal is non-sense. There's >17 years of research into EGCG and RA with extensive positive research findings. The results are highly relevant both to understanding of RA processes and identification of treatments. Note, the Zefr and Jytdog cabal have been working in tag-team on the EGCG page too, so no surprise they're burying content as a pack here also. I know the golden age of Encyclopedia Britannica was a few decades ago, but really WP can still creep a little bit into the current century. 120.17.210.246 (talk) 14:02, 1 October 2017 (UTC)
Still waiting on an answer User:Jytdog who deleted and User:Zefr who redeleted. Again, please stop ignoring Talk sections (this Talk existed before your tagteam redeleted it Zefr). Also, stop claiming that they're created against other users (e.g. Cathry), when you know that it regarded your own deletions without explanations. 120.17.83.90 (talk) 03:41, 4 October 2017 (UTC)

I'm re-adding this as after several days, nobody has substantiated their claims, or made any argument here for why it shouldn't be in Wikipedia.

− Multiple reviews of green tea extract and epigallocatechin gallate pre-clinical and animal studies have concluded that it has promising potential for inflammation and rheumatoid arthritis treatment[3][4][5], with one noting the lack of human clinical studies "despite promising pre-clinical findings and the thorough mechanistic insights", as "surprising"[6].

120.17.218.156 (talk) 21:11, 4 October 2017 (UTC)

Posting this here and in the next section, too. I am familiar with all of those references. The first (Ahmed 2010) states: "The efficacy of EGCG or GTE in human RA or OA using the phase-controlled trials is yet to be tested." Wu (2012) likewise "Data for human studies are essentially absent." Reigsecker's 2013 review describes no clinical trials. Granja's 2017 article cited only in vitro literature. A search at clinicaltrial.gov found no clinical trials in progress. Until there are multiple clinical trials published in peer-reviewed journals, properly reviewed as a published article, it is premature to incorporate the EGCG research into this article. David notMD (talk) 13:27, 27 October 2017 (UTC)
Granja's 2017 review, cited literature that included in vivo results including "a rat model of adjuvant-induced arthritis (AIA)" (Singh et.al. 2016), not just in vitro. Granja's review states: "For this reason, new therapies are needed and EGCG may be a promising compound. In fact, EGCG has a high antioxidant activity and also capacity to decrease the inflammation response in the body [116–118]". Results of one cited paper: "Administration of EGCG (50 mg/kg/day) for 10 days ameliorated AIA in rats by reducing TAK1 phosphorylation and K48-linked polyubiquitination", conclusion "findings provide a rationale for targeting TAK1 for the treatment of RA with EGCG.". 120.21.5.180 (talk) 13:46, 2 November 2017 (UTC)
Morinobu et.al., Lee et.al. and several other studies cited in Granja's review show the same EGCG effectiveness in animal models of RA. There's far more than just in vitro theory. 120.21.5.180 (talk) 13:54, 2 November 2017 (UTC)
If there where multiple human clinical trials, it'd just be "Treatment" and specific health claims made, not noted under "Research". Clinical trials aren't necessary to say it's being investigated by an NIH funded program and other teams. 120.17.72.185 (talk) 14:41, 2 November 2017 (UTC)

References

  1. ^ https://arthritis-research.biomedcentral.com/articles/10.1186/ar2982
  2. ^ http://grantome.com/search?q=@author%20%20Ahmed%20Salah-Uddin
  3. ^ Granja, Andreia; Frias, Iúri; Neves, Ana Rute; Pinheiro, Marina; Reis, Salette (2017). "Therapeutic Potential of Epigallocatechin Gallate Nanodelivery Systems". BioMed Research International. 2017: 1–15. doi:10.1155/2017/5813793. ISSN 2314-6133. 
  4. ^ Wu, Dayong; Wang, Junpeng; Pae, Munkyong; Meydani, Simin Nikbin (2012). "Green tea EGCG, T cells, and T cell-mediated autoimmune diseases". Molecular Aspects of Medicine. 33 (1): 107–118. doi:10.1016/j.mam.2011.10.001. ISSN 0098-2997. 
  5. ^ Riegsecker, Sharayah; Wiczynski, Dustin; Kaplan, Mariana J.; Ahmed, Salahuddin (2013). "Potential benefits of green tea polyphenol EGCG in the prevention and treatment of vascular inflammation in rheumatoid arthritis". Life Sciences. 93 (8): 307–312. PMC 3768132Freely accessible. PMID 23871988. 
  6. ^ Fürst, Robert; Zündorf, Ilse (May 2014). "Plant-derived anti-inflammatory compounds: hopes and disappointments regarding the translation of preclinical knowledge into clinical progress". Mediators of Inflammation. 2014: 1–9. doi:10.1155/2014/146832. PMC 4060065Freely accessible. PMID 24987194. 146832. 
Research is a continuous process, often grounded on in vitro and epidemiology, progressing to animal models, then if a drug, Phases I, II, III, then FDA review and approval. In the U.S., dietary supplement ingredients do not require FDA approval, and are often brought to market based on one, two or multiple clinical trials. Often industry funded rather than government grants (U.S. NIH or other). Wikipedia has its own criteria for inclusion in Research - ideally more than one clinical trial, consistent results, and at least one review that can be used as a citation. Your position is that if there is any research (those references), then it is appropriate to describe the work under "Research." This does not jibe with Wikipedia's definition of "Research." Basically, TOO SOON. See the content on fatty acids for an example of sufficient research, and even there, the reviews concluded that the evidence is not sufficiently consistent to recommend as a treatment. David notMD (talk) 15:28, 2 November 2017 (UTC)
The research cited is not industry funded, so not sure why that's raised in this context. One of the leading teams has in fact been funded repeatedly by U.S. NIH for 10+ years, specifically on GTE, then EGCG for RA. Could you please reference the requirement for (multiple) human clinical trials as prerequisite for inclusion with a Research section. Note, it's not a medical claim and WP:MEDRS has different applications in different contexts. You say 'ideally', but it's also not a requirement if that prevents improving Wikipedia, using otherwise reasonably verifiable information. The primary concern, should be whether there's likelihood for misstatements causing serious detrimental risk to readers. Which should be balanced against positive risk, that it may (and in this case is likely to) have positive outcomes, both due to efficacy in animal models and established safety profile. Importantly, the level of research is made entirely clear to readers, where they can ask their own GP and rheumatologist about it. As for my own (a top professor teaching rheumatology at the largest medical school in my country), he was very comfortable with me increasing green tea and fish oil consumption and giving a hydroxychloroquine prescription, for use in case symptoms persisted. They didn't. Anecdata isn't evidence, but the treatment plan was reasonable when patient informed and was based on available evidence and relative risk analysis (against alternative options). 120.17.50.29 (talk) 04:24, 10 November 2017 (UTC)

Research section[edit]

Removed vague preliminary content and sources below per WP:PRIMARY and WP:CRYSTAL. "theory" and "is thought" reflect conjecture = unencyclopedic content. --Zefr (talk) 14:03, 1 October 2017 (UTC)

There was an open discussion immediately above about EGCG content. Your multiples removals, in cabal with Jytdog, without any community discussion, even when active talk sections have been created, is completely inappropriate behaviour. Your citing "CRYSTAL", without any explanation why is unconstructive. 120.17.210.246 (talk) 15:16, 1 October 2017 (UTC)
You tell users like User:Cathry to use Talk (which she already does), while you continually don't show that courtesy to anyone else.
You cite WP:BRD, while you're intentionally initiating edit waring and clearly provocative behaviour at every opportunity. Deny others the "cycle" that BRD requires and use BRD as excuse and front to regularly trash page content en-mass. Then have the audacity to report Cathry for what YOU have been starting, onto an Admins page? Appalling. 120.17.210.246 (talk) 15:36, 1 October 2017 (UTC)

One theory is that infections may provoke the autoimmune response characteristic of rheumatoid arthritis. One example of this theory is that unique bacterial species associated with periodontitis may initiate an autoimmune response in genetically susceptible individuals by citrullinating self-proteins, thus leading to the production of ACPAs. PMID 25534621 PMID 22274780 Porphyromonas gingivalis expresses a bacterial PAD that is thought to citrullinate alpha-enolase. PMID 20820197 The bacterial virulence factor leukotoxin A from Aggregatibacter actinomycetemcomitans was shown to induce hypercitrullination in neutrophils, and exposure to leukotoxin A is associated with ACPA and mediates the genetic risk conferred by HLA-DRB1 shared epitope alleles. PMID 28292977

It is not reason to delete info. There are plenty articles about theories themself at Wikipedia. If causes of illness not installed - theory is all you can know about it. Your deletion is against consensus, you mast revert it. Cathry (talk) 14:52, 1 October 2017 (UTC)
The removed content is just guessing; please read WP:CRYSTAL. --Zefr (talk) 14:57, 1 October 2017 (UTC)
WP:CRYSTAL is not relevant here at all. Cathry (talk) 15:00, 1 October 2017 (UTC)
I agree with Cathry, the edit should be reverted. EGCG and RA links have been investigated and proven for nearly two decades. Please cease bulk disruptive editing. 120.17.210.246 (talk) 15:24, 1 October 2017 (UTC)
The edit was fine. Jytdog (talk) 15:27, 1 October 2017 (UTC)
Calling something conjecture because it used the word "theory" and therefore irrelevant to Wikipedia, is just ridiculous (especially a research section). Gravity and evolution are 'just theory', but do you propose to delete those too? Your 'edit' also deleted other content on EGCG and you (Jytdog/Zefr, which I assume to be the same user), still haven't answered. There is no WP:CRYSTAL regarding the EGCG research. It's confirmed by multiple reviews and investigators. The very definition of research includes building theorems and theories. 120.18.15.25 (talk) 11:33, 5 October 2017 (UTC)
I am familiar with all of those references. The first (Ahmed 2010) states: "The efficacy of EGCG or GTE in human RA or OA using the phase-controlled trials is yet to be tested." Wu (2012) likewise "Data for human studies are essentially absent." Reigsecker's 2013 review describes no clinical trials. Granja's 2017 article cited only in vitro literature. A search at clinicaltrial.gov found no clinical trials in progress. Until there are multiple clinical trials published in peer-reviewed journals, properly reviewed as a published article, it is premature to incorporate the EGCG research into this article. David notMD (talk) 13:27, 27 October 2017 (UTC)
Thread continued from dupe in #EGCG vs GTE above. 120.21.5.180 (talk) 13:57, 2 November 2017 (UTC)

Omega-3 - newer references[edit]

I am not editing the article on this aspect because I have a COI (consultant to clients that sell fish oil dietary supplements) but want to offer for consideration meta-analyses that are more recent than what is currently cited in the article (Ruggiero 2009 and Miles 2012). David notMD (talk) 15:19, 27 October 2017 (UTC)

  • Senftleber NK, Nielsen SM, Andersen JR, Bliddal H, Tarp S, Lauritzen L, Furst DE, Suarez-Almazor ME, Lyddiatt A, Christensen R. Marine Oil Supplements for Arthritis Pain: A Systematic Review and Meta-Analysis of Randomized Trials. Nutrients. 2017 Jan 6;9(1). pii: E42. doi: 10.3390/nu9010042. Review. PubMed PMID: 28067815; PubMed Central PMCID: PMC5295086.
  • Jiang J, Li K, Wang F, Yang B, Fu Y, Zheng J, Li D. Effect of Marine-Derived n-3 Polyunsaturated Fatty Acids on Major Eicosanoids: A Systematic Review and Meta-Analysis from 18 Randomized Controlled Trials. PLoS One. 2016 Jan 25;11(1):e0147351. doi: 10.1371/journal.pone.0147351. eCollection 2016. Review. PubMed PMID: 26808318; PubMed Central PMCID: PMC4726565.
  • Di Giuseppe D, Crippa A, Orsini N, Wolk A. Fish consumption and risk of rheumatoid arthritis: a dose-response meta-analysis. Arthritis Res Ther. 2014 Sep 30;16(5):446. doi: 10.1186/s13075-014-0446-8. PubMed PMID: 25267142; PubMed Central PMCID: PMC4201724.
  • Lee YH, Bae SC, Song GG. Omega-3 polyunsaturated fatty acids and the treatment of rheumatoid arthritis: a meta-analysis. Arch Med Res. 2012 Jul;43(5):356-62. doi: 10.1016/j.arcmed.2012.06.011. Epub 2012 Jul 24. PubMed PMID: 22835600.
What would you like to propose as a summary? Doc James (talk · contribs · email) 20:40, 27 October 2017 (UTC)
I did not look at the lit on gamma-linolenic acid, so would leave that with the existing ref. For omega-3, remove the two existing refs and add the four I listed above. The end result is that the updated evidence for omega-3 is a bit weaker than previously stated. Proposed text and refs to replace what is there now. David notMD (talk) 13:18, 28 October 2017 (UTC)
Fatty acids
Gamma-linolenic acid, an omega-6 fatty acid, may reduce pain, tender joint count and stiffness, is generally safe.[1] For omega-3 polyunsaturated fatty acids (found in fish oil), a meta-analysis on pain reported a favorable effect, although confidence in the effect was considered moderate. The same review reported less inflammation but no difference in joint function.[2] A review examined the effect of marine oil omega-3 fatty acids on pro-inflammatory eicosanoid concentrations; leukotriene4 (LTB4) was lowered in people with rheumatoid arthritis but not in those with non-autoimmune chronic diseases. (LTB4) increases vascular permeabiltity and stimulates other inflammatory substances.[3] A third meta-analysis looked at fish consumption. The result was a weak, non-statistically significant inverse association between fish consumption and RA.[4] A fourth review limited inclusion to trials that had consumption ≥2.7 g/day and duration greater than three months. Use of pain relief medication was significantly decreased, but improvements in tender or swollen joints, morning stiffness and physical function were not significant.[5] Collectively, the current evidence is not strong enough to determine that supplementation with omega-3 fatty acids or regular consumption of fish are effective treatments for rheumatoid arthritis.[2][3][4][5]

References

  1. ^ Soeken, K L; Miller, S A; Ernst, E (2003). "Herbal medicines for the treatment of rheumatoid arthritis: a systematic review". Centre for Reviews and Dissemination. National Institute for Health Research. Archived from the original on January 16, 2014. Retrieved March 23, 2013. 
  2. ^ a b Senftleber NK, Nielsen SM, Andersen JR, Bliddal H, Tarp S, Lauritzen L, Furst DE, Suarez-Almazor ME, Lyddiatt A, Christensen R (2017). "Marine Oil Supplements for Arthritis Pain: A Systematic Review and Meta-Analysis of Randomized Trials". Nutrients. 9 (1). doi:10.3390/nu9010042. PMC 5295086Freely accessible. PMID 28067815. 
  3. ^ a b Jiang J, Li K, Wang F, Yang B, Fu Y, Zheng J, Li D (2016). "Effect of Marine-Derived n-3 Polyunsaturated Fatty Acids on Major Eicosanoids: A Systematic Review and Meta-Analysis from 18 Randomized Controlled Trials". PLoS ONE. 11 (1): e0147351. doi:10.1371/journal.pone.0147351. PMC 4726565Freely accessible. PMID 26808318. 
  4. ^ a b Di Giuseppe D, Crippa A, Orsini N, Wolk A (2014). "Fish consumption and risk of rheumatoid arthritis: a dose-response meta-analysis". Arthritis Res. Ther. 16 (5): 446. doi:10.1186/s13075-014-0446-8. PMC 4201724Freely accessible. PMID 25267142. 
  5. ^ a b Lee YH, Bae SC, Song GG (2012). "Omega-3 polyunsaturated fatty acids and the treatment of rheumatoid arthritis: a meta-analysis". Arch. Med. Res. 43 (5): 356–62. doi:10.1016/j.arcmed.2012.06.011. PMID 22835600. 
Simplified a few things Doc James (talk · contribs · email) 20:19, 28 October 2017 (UTC)
All good with me. I went ahead with this. David notMD (talk) 18:27, 30 October 2017 (UTC)

Lifestyle changes as treatment or Research[edit]

Perhaps add to Research rather than Lifestyle, given modest nature of the evidence for fasting and vegetarian diet. The existing citations in Lifestyle are all Cochrane Reviews. David notMD (talk) 22:55, 4 November 2017 (UTC)

This is common recommendations so IMO it is fine were it is.
Research is more for stuff that is being studied but not really done yet. Doc James (talk · contribs · email) 07:53, 10 November 2017 (UTC)