Traditional Chinese Medicine For Treating Rheumatoid Arthritis: A Systematic Review

Background: Rheumatoid arthritis (RA) is a kind of systemic autoimmune disease,which may lead to be deformed and disability.That is one of the main reasons lead to disable in our countty.The pathogenesis isn't clear.So far,the effectiveness of western medicine is not satisfactive and adverse reaction is serious, though NSAIDs and GC could control the symptom temporarily. Traditional Chinese medicine have superiority against RA. The curative effect have be admitted by patients and doctors.Objectives: To assess the effectiveness and safety of traditional Chinese medicine therapies in the treatment of rheumatoid arthritis.Search Strategy: We developed a search strategy using terms to include all forms of arthritis combined with traditional Chinese medicine. We have searched the following electronic databases: CNKI, Wanfang Data, Vip Information , CBMdisc, CMCC, CBMweb and the Chinese medicine document database. This was supplemented by searching the reference lists from retrieved trials.Selection criteria: All randomized trials of traditional Chinese medicine interventions in rheumatoid arthritis, compared to placebo or western medicine or no intervention. There were two reviewers independently read and select each potential study according to the criteria.Exclusion criteria:Except the studies of follow interventions: traditional Chinese medicine fumigate,iontophoresis,intermediate frequency,electromagnetic therapy and so on. The intervention of trial group and control group is unreasonable.Not parallel control study.Data collection and analysis: Data were extracted independently by two reviewers and an assessment of methodological quality were conducted.Main results:1. 110 trials were included.The general methodological quality of all the trials wererelatively poor. 5 trials had high quality as assessed with Jadad scales.The otherswere poor. 2. Eight of the trials were included into Meta analysis about the effective rate,including 2 studies with the intervention of Total Glucosides of Paeony +Methotrexate VS Methotrexate,2 studies of Tripterygium wilfordii VS Methotrexate,2 Studies of Bi Su Qing composition VS Indomethacin,2 Studies of Feng Shi Xian Dan VS Indomethacin .The results of meta-analysis: Total Glucosides of Paeony + Methotrexate VS Methotrexate show no significant differences between them, RR_total=1.05, 95%CI [0.92, 1.20], the curative effect of the former was not better than the latter; Tripterygium wilfordii VS Methotrexate show significant differences between them, RR_total=1.15, 95%CI [1.01, 1.30]; Feng Shi Xian Dan VS Indomethacin show significant differences between them, RR_total=1.21, 95%CI [1.04, 1.41], the former was more effective than the latter;Bi Su Qing composition VS Indomethacin show significant differences between them, RR_total=1.35, 95%CI [1.05, 1.73], the former was more effective than the latter. 29 of 50 studies(Chinese traditional medicine integrated western medicine VS western medicine) show Chinese traditional medicine were not better than western medicine;the left 21 studies were opposite. 27 of 52 studies(Chinese traditional medicine VS western medicine) show Chinese traditional medicine were not better than western medicine; the left 25 studies were opposite.Because of the multiformity of the intervention, including Chinese formulated products, extractive, medicinal broth and so on, there were significant heterogeneity, so we cann't pool more data.3. 51 of 110 studies reported the adverse effect detailly. Four of the trials were included into Meta analysis about the adverse effect rate,including 2 studies with the intervention of Total Glucosides of Paeony +Methotrexate VS Methotrexate,2 studies of Tripterygium wilfordii VS Methotrexate .The results of meta-analysis: Total Glucosides of Paeony + Methotrexate VS Methotrexate show no significant differences between them, RR_total=0.80, 95%CI [0.49, 1.31], the adverse effect rate of the former was not lower than the latter; Tripterygium wilfordii VS Methotrexate show no significant differences between them, RR_total=0.81, 95%CI[0.48, 1.38], the adverse effect rate of the former was not lower than the latter; 13 of 23 studies(Chinese traditional medicine integrated western medicine VS western medicine) show the adverse effect rate of Chinese traditional medicine were not lower than western medicine;the left 10 studies were opposite. 12 of 24 studies(Chinese traditional medicine VS western medicine) show the adverse effect rate of Chinese traditional medicine were not lower than western medicine; the left 12 studies were opposite.4. 5 trials with high quality as assessed with Jadad scales reported effective rate:2 of them show Chinese traditional medicine integrated western medicine were better than western medicine.The left 3 trials were opposite.4 of them reported the adverse effect rate:1 trails show the adverse effect rate of Chinese traditional medicine integrated western medicine were lower than western medicine.The other 3 trials were opposite.Author's conclusions: The clinical effect of traditional Chinese medicine or integrated western medicine against RA didn't be confirmed yet.The quality of the RCTs'reports of traditional Chinese medicine against RA was low.Analysis results of questionnaires to researchers indicated that research of RCTs was a process of low quality too.