# A retrospective cohort study in China: association between Tripterygium glycosides and reduced serum albumin levels in elderly rheumatoid arthritis patients

## TL;DR

This study found that Tripterygium glycosides, used to treat rheumatoid arthritis, can lower serum albumin levels, especially in elderly patients.

## Contribution

The study identifies a novel association between Tripterygium glycosides and hypoalbuminemia in elderly rheumatoid arthritis patients.

## Key findings

- TGs and TGs+MTX groups showed significant decreases in serum albumin after treatment.
- Advanced age was independently associated with the development of hypoalbuminemia.
- MTX alone did not significantly affect serum albumin levels.

## Abstract

Tripterygium glycosides (TGs) are widely used in rheumatoid arthritis (RA) treatment, but their potential impact on serum proteins, particularly albumin, warrants investigation. This study evaluates the effect of TGs on serum albumin levels in RA patients compared to methotrexate (MTX) or combination therapy (TGs + MTX) and identifies associated risk factors for hypoalbuminemia.

We conducted a retrospective study of 146 RA patients on TGs, 62 on MTX, and 54 on TGs + MTX. Serum albumin was measured before and after treatment. Logistic regression analysis was used to identify factors associated with post-treatment hypoalbuminemia.

Serum albumin levels did not differ significantly among the TGs, MTX, and TGs + MTX groups at baseline. Following treatment, the TGs and TGs + MTX groups exhibited significant decreases in mean serum albumin. In contrast, the MTX group showed stable albumin levels. Consequently, the incidence of hypoalbuminemia increased significantly after treatment with TGs (from 3.4 to 26.0%, p < 0.001) and TGs + MTX (from 0 to 18.5%, p < 0.001), but not with MTX alone (from 1.6 to 4.8%, p = 0.311). The mean changes in these serum proteins were significantly different among the three groups. Multivariable logistic regression analysis identified advanced age as a significant factor independently associated with the development of hypoalbuminemia.

Treatment with TGs, either alone or in combination with MTX, was associated with the development of hypoalbuminemia in patients with RA. This effect was significantly associated with advanced age, suggesting a need for closer monitoring in this vulnerable population.