Table of Contents
ISRN Rheumatology
Volume 2011, Article ID 580704, 6 pages
Research Article

Results of a Pilot Randomized Placebo-Controlled Trial in Primary and Secondary Raynaud's Phenomenon with St. John's Wort: Detecting Changes in Angiogenic Cytokines When RP Improves

1Department of Medicine, University of Western Ontario, London, ON, Canada N6A 5C1
2Screening Laboratory for Immune Disorders, Lawson Health Research Institute, London, ON, Canada N6A 4V2
3Department of Microbiology & Immunology, University of Western Ontario, London, ON, Canada N6A 5C1
4Rheumatology, St. Joseph's Health Care London, London, ON, Canada N6A 4V2
5Department of Mathematics and Statistics, McMaster University, Hamilton, ON, Canada L8S 4K1

Received 6 May 2011; Accepted 27 June 2011

Academic Editors: M. G. Danieli, B. A. Eberhard, C. G. Mackworth-Young, and C.-H. Suh

Copyright Β© 2011 DΓ©anne Malenfant et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objectives.To perform a 6-week double-blind RCT in Raynaud's phenomenon (RP) comparing the plant extract St. John's Wort (SJW) to placebo. Methods. RP patients having at least 7 attacks per week were stratified by primary and secondary RP and within secondary by systemic sclerosis or other connective tissue disease. Subjects completed a daily standardized diary recording all RP attacks (frequency, duration and severity). Serum levels of 18 inflammatory and angiogenic cytokines were measured pre- and post-treatment. Results. Eighteen patients completed the study; 8 received SJW and 10 placebo. The decrease in mean number of attacks per day was 0.75 with SJW and 1.01 with placebo, 𝑃 = 0 . 0 6 . Attack duration and severity were not different between groups. Cytokine analyses demonstrated no between-groups differences. Combining treatment groups, those with >50% improvement in frequency of attacks yielded a significant increase in E-selectin ( 𝑃 = 0 . 0 4 9 ), MMP-9 ( 𝑃 = 0 . 0 1 1 ), G-CSF ( 𝑃 = 0 . 0 2 ), and VEGF ( 𝑃 = 0 . 0 1 2 ) pre- versus post-treatment. A ≥50% improvement in severity of attacks corresponded to a significant increase in levels of sVCAM-1 ( 𝑃 = 0 . 0 0 3 ), sICAM-1 ( 𝑃 = 0 . 0 0 7 ), and MCP-1 ( 𝑃 = 0 . 0 0 4 ). Conclusions. There were no clinical or biomarker benefit of SJW versus placebo in RP. However, combining all patients, there were changes in some cytokines that may be further investigated.