Effects of Vitamin C and Vitamin E in rheumatoid arthritis - A randomized, open label, and comparative study in a tertiary care hospital

ABSTRACT

Background: Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease of autoimmune origin. It affects many organs and joints symmetrically. The involvement of reactive oxygen species (ROS) in the pathogenesis of RA is significant. Oxidative stress occurs when there is excess production of pro oxidants (ROS) and decrease in the level of antioxidants causing oxidative damage to tissues. Anti-oxidants such as Vitamins C and E are very effective in controlling free-radical induced inflammation. Apart from providing symptomatic relief they also modify the disease. Aims and Objectives: The aim of the study was to study the efficacy of Antioxidants Vitamins C and E as an add-on therapy to standard treatment in the management of RA compared to standard treatment alone. Materials and Methods: This was an open label randomized comparative study. In this study, 96 patients were screened and 60 patients were included. They were randomly divided into 30 each in study and control group. Control group received T. Hydroxy chloroquine 400 mg OD and T. Indomethacin 25 mg BD (standard treatment), study group received standard treatment plus T. Vitamin C 500 mg, and Vitamin E 400 mg for 8 s. They were followed for 4 weeks. Improvement of patients was monitored by, pain by visual analog scale, tender joint score, swollen joint score, disease activity score 28, inflammatory markers (ESR, CRP), and every 4 weeks till 12 weeks. Results: All the 60 patients included in this study completed the study. After 8 weeks of treatment in the study group there is statistically significant improvement in pain score, tender joint score, swollen joint score and DAS score. Similarly, statistically significant reduction in inflammatory markers includes ESR and CRP. In the follow-up period, the improvement in study group was sustained. Conclusion: Adding Vitamins C and E over and above the standard treatment can be a new approach in the treatment of RA.