Efficacy of Qingpeng ointment (a Tibetan medicine) for acute gouty arthritis: a multi-center, randomized, double-blind, placebo-controlled trial.

The short version

This multicenter randomized, double-blind, placebo-controlled trial with 203 adults tested Qingpeng ointment, a Tibetan medicine formula applied directly to the skin, for acute gouty arthritis. Gout is an inflammatory arthritis in which uric acid crystals (monosodium urate) deposit in joints, producing sudden severe pain, swelling, redness and stiffness. Standard attack treatments such as colchicine, corticosteroids and NSAIDs (non-steroidal anti-inflammatory drugs) can cause digestive, kidney and cardiovascular side effects, so the researchers examined an externally applied option. Tibetan medicine is a traditional healing system practiced for over 2,000 years, and the ointment combines nine ingredients, including Oxytropis herb, rhubarb-type root, aconite-type root, chebulic and belleric myrobalan fruits, emblic fruit and benzoin resin. Participants were adults aged 18-65 at three hospitals in China, all within one week of the start of a gout flare and rating joint pain at 3 or more on a 0-10 scale. Half received the ointment and half a look-alike placebo made of glycerin and paraffin. Everyone spread a thin layer over the painful joint twice a day for seven days and massaged it in. Both groups also received diclofenac tablets to take only if pain climbed to 7 or higher. Pain and swelling were self-rated on visual analog scales, and swelling was also measured with calipers. After seven days, pain scores were lower with the ointment (median 1.75 vs 2.00; P = 0.038, a difference of 0.25 points on a 10-point scale), and 26.5% of that group reported complete pain resolution compared with 15.8% with placebo (P = 0.046). Swelling scores were also lower (1.00 vs 2.00; P = 0.032), and swelling disappeared in 33.3% vs 21.8% (P = 0.046). Joint mobility improved more with the ointment (P = 0.004). Several measures did not differ: redness, C-reactive protein (an inflammation marker), serum uric acid, the amount of rescue medication left over, and most caliper measurements; calipers showed a difference only in a small subgroup of other joints (8 vs 9 participants). Adverse events occurred in 4 ointment users and 1 placebo user, mostly mild skin itching or rash, and all resolved. The authors report that the formula relieved pain, swelling and stiffness without serious side effects, and suggest topical products may suit people who cannot tolerate oral drugs. Limitations include outcomes reported by patients themselves, a seven-day follow-up, 15 withdrawals, uneven adherence (nine participants applied it fewer than ten of the 14 scheduled times), imputation of missing values with the last observation carried forward, which can introduce bias, and a mostly male sample. Because all nine ingredients were tested together, the study cannot show which one is responsible for the effects.

Key findings

• In a seven-day, double-blind trial of 203 adults having an acute gout attack, a Tibetan herbal ointment (Qingpeng ointment) lowered self-rated joint pain more than a matching placebo ointment (median 1.75 vs 2.00 on a 0-10 scale, P = 0.038), and complete pain resolution was more common (26.5% vs 15.8%).
• Swelling scores were also lower with the ointment (1.00 vs 2.00, P = 0.032) and joint mobility improved more (P = 0.004), but redness, CRP (a blood marker of inflammation) and serum uric acid did not differ between groups.
• Adverse events were few and mild, mainly skin itching or rash (4 of 102 ointment users, 1 of 101 placebo users), and all resolved after reducing or stopping use.
• The differences were modest, outcomes were self-reported, follow-up was only seven days, and the nine-ingredient formula was tested as a whole, so the effect cannot be linked to any single herb.

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