Abstract: Objective This study was to investigate clinical features of rheumatoid arthritis (RA) patients with complicated drug-induced liver injury (DILI) after administration of herbal medicine, tripterygium wilfordii preparation trerament. Methods Sixty patients with RA and DILI were encountered in our hospital between January 2019 and October 2023, all had received treatment regimen containing tripterygium wilfordii preparation, and DILI was diagnosed by the Roussel Uclaf Causality Assessment Method (RUCAM). Results Of the 60 patients with RA and DILI, older than 46 years accounted for 75.0%, and longer than 4 months of tripterygium wilfordii preparation administration accounted for 40.0%; percentage of greater than five points of RUCAM score accounted for 88.3%, hepatocyte injury type accounted for 66.7%, and 1/2 grade of liver injuries accounted for 50.0%; the regimen for RA treatment included tripterygium wilfordii preparation(group A),tripterygium wilfordii preparation and steroids (group B),tripterygium wilfordii preparation and nonsteroidal anti-inflammatory agents (group C) and tripterygium wilfordii preparation, steroids and nonsteroidal anti-inflammatory agent combination (group D) in 10 cases, 12 cases, 30 cases and 8 cases, blood biochemical parameters in group D were significantly higher than those in other three groups (P<0.05); 26 patients (43.3%) recovered, 30 patients (50.0%)improved, and 4 (6.7%)discharged without liver function test normal after (23.4±7.0)day liver-protecting treatment. Conclusion Patients with rheumatoid arthritis are susceptible to liver injury after treatment of regimens containing tripterygium wilfordii preparation, the liver injuries might be even severe when too many drug combination administered, and fortunately, the prognosis is good.

Key words: Drug-induced liver injury, Rheumatoid arthritis, Herbal medicine, tripterygium wilfordii preparation, Clinical features