Serum biomarkers in rheumatoid arthritis patients and effect of Unani herbal formulation Qurs-e-Hudar on these biomarkers suggesting the anti-IL-6 effect

Abstract

Introduction

One of the herbal formulations known as Qurs-e-Hudar used in the Unani medicine for the treatment of rheumatoid arthritis (RA), has no known mechanism of action. In this endeavour, the effect of Qurs-e-Hudar on serum biomarkers in RA patients was evaluated.

Methods

In an open-label, single-centric clinical study, 26 RA patients were assessed for 6-week treatment by Qurs-e-Hudar in a dose of 250 mg twice a day. The serum was evaluated quantitatively for biomarkers including rheumatoid factor (RF), anti–cyclic citrullinated peptide (anti-CCP), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), tumour necrosis factor receptor 1 (TNFR1), vascular cell adhesion molecule 1 (VCAM1), interleukin 6 (IL-6), and chemokine ligand 13 (CXCL13) before and after treatment in RA patients and 26 healthy participants at once.

Results

The ESR, CRP, TNFR1, IL-6 and CXCL13 values were significantly high (P < 0.05) in RA patients comparing healthy controls. There was a significant reduction in (P < 0.05) in ESR and IL-6 values after treatment in RA patients. Although non-significant, a reduction in TNFR1 and CXCL13 was also observed. The results for efficacy assessed by reduction in disease activity score-28 (DAS-28) and remission assessed by the ACR-EULAR classification show a significant decrease (P < 0.01) after treatment in RA patients.

Conclusion

The significant clinical efficacy response obtained here is likely to be related to a significant reduction of IL-6 and ESR suggesting the role of Qurs-e-Hudar through IL-6 pathway. Larger systematic and comparative trials are warranted for further evaluation.