Evaluating the effect of oral n-acetylcysteine as an adjuvant treatment on clinical outcomes of patients with rheumatoid arthritis: a randomized, double blind clinical trial

The number of previous studies conducted on N-acetylcysteine (NAC) which demonstrated analgesic effects. But none of them evaluated the effect of oral NAC on rheumatoid arthritis (RA). Therefore the present study indicates that oral administration of NAC improved the health status in RA patients and might be considered as an adjuvant therapy.

Overproduction of pro-inflammatory cytokines along with oxidative stress plays a considerable role in rheumatoid arthritis (RA) pathogenesis. Some of the studies explained significant analgesic effects of N-acetylcysteine (NAC). This study conducted to assess the impact of oral NAC as adjuvant treatment on the clinical symptoms among the active RA patients.

A total of 51 active RA patients categorised into two groups; the first group obtained 600 mg NAC twice a day for 12 weeks along with standard treatment of RA, and other group acquired placebo along with standard treatment of RA. The pain, RA activity, patients' disease activity and physical performance was assessed by using visual analogue scale (VAS), Disease activity score (DAS-28), global health (GH) parameter, and health assessment questionnaire (HAQ). All the patients assessed for erythrocyte sedimentation rate (ESR), number of tender and swollen joints. The evaluation of data was completed by SPSS version 16.0.

DAS-28 and ESR exhibited no significant difference between the groups after 12 weeks of intervention. Although, HAQ, VAS, and GH showed notable improvements in the NAC group than placebo group. 

Oral administration of NAC associated with the improved health status of RA patients and considered as an adjuvant treatment among these patients. More analyses with longer study duration, larger sample size, and high doses of NAC are required to validate the impacts of oral NAC among RA patients.