Silymarin & RA

Results of a randomized and controlled clinical trial were recently published in Medicina (Kaunas), evaluating the use of silymarin in combination with conventional disease-modifying antirheumatic drugs (DMARDs) among people with active rheumatoid arthritis (RA). Over an 8-week trial period, 122 participants (85% women) diagnosed with RA and who were receiving conventional treatment (e.g., methotrexate, leflunomide, sulfasalazine, hydroxychloroquine, or azathioprine, either as monotherapy or multi-drug therapy) were assigned to either a control group or to a group supplemented daily with a 375mg standardized milk thistle extract providing 300mg of silymarin, to be taken in conjunction with DMARDs therapy.

After 8 weeks, all indicators of disease activity were significantly improved from baseline values in the group receiving silymarin, while the control group experienced a worsening in all but one of these markers. This included TJC28 and SJC28 (tender joint count and swollen joint count in 28 joints), morning stiffness, pain intensity, PtGA and PhGA (patient’s and physician’s global assessment of disease activity). Only the PhGA did not significantly worsen in the control group. No significant differences/changes were observed in the inflammatory markers, ESR and CRP between baseline or between groups.

Silymarin supplementation was also associated with significant improvements in disability indices and EULAR responses, as well as fatigue, depression, and anxiety (which correlated with disease severity/activity). For example, participants receiving silymarin had significant improvements in the HAQ-DI (health assessment questionnaire-disability index) while the control group reported a worsening in scores. At baseline, only 6.8% and 3.6% of people reported only mild to moderate disability in the silymarin and control groups respectively, but this increased to 44.1% with silymarin by the 8th week, compared to 1.7% in the control group. Similarly, the percentage of participants with severe to very severe disability dropped from 44% to just under 2% with silymarin, indicating a substantial shift in severity.