A Bibliometric Analysis Of Osteoporosis Secondary To Rheumatoid Arthritis And A Meta-analysis Of Traditional Chinese Medicine Treatment

Purpose and significanceRheumatoid arthritis is a common rheumatism with high disability rate.Osteoporosis is a common complication.At present,there is no systematic summary and evidence-based medical research on secondary osteoporosis of rheumatoid arthritis,and no unified treatment scheme has been formed,which greatly affects the curative effect of the disease.Therefore,this study is the first time to conduct bibliometric analysis of osteoporosis secondary to rheumatoid arthritis,and to conduct meta-analysis on the randomized controlled study of traditional Chinese medicine for the treatment of secondary osteoporosis of rheumatoid arthritis for the first time,to evaluate the therapeutic effect of traditional Chinese medicine,and provide evidence for the improvement and optimization of the treatment plan of traditional Chinese medicine.Research method1.Bibliometric analysis of osteoporosis secondary to rheumatoid arthritis(1)Based on the CNKI and Web of Science database,the domestic and foreign literature retrieval is carried out according to the set retrieval strategy,and then the documents are screened and eliminated manually,and finally the qualified documents are obtained.(2)Use the document analysis function of CNKI and WOS to count the publishing time of all documents,calculate the number of papers issued every year and draw,and count the countries where the documents are published.(3)Export the documents in conformity with the requirements to the CiteSpace software,set the title,summary,keywords and identifiers as the subject source,set the time to 2001-2020,select "1" for the time slice,and select Top50%of the threshold value.The system defaults for the selection of association strength.The author,organization and keyword are used as nodes to analyze co occurrence,and cluster analysis,time evolution analysis and emergent word analysis are carried out for keywords,and visualization map is drawn and analyzed at length.2.Meta-analysis of Chinese medicine treatment for osteoporosis secondary to rheumatoid arthritis(1)Domestic literature:Using Chinese keywords "rheumatoid arthritis","rheumatoid arthritis","rheumatoid","arthritis","osteoporosis","osteoporosis","osteoporosis fracture","fracture","bone density","traditional Chinese medicine","Chinese herbal medicine",searching the CNKI,China biomedical literature database(CBM),Wanfang(Wangfang data),VIP database.Search methods:subject=("rheumatoid arthritis" OR "rheumatoid arthritis"OR "arthritis")AND("osteoporosis" OR "osteoporosis" OR "fracture" OR "bone density")AND("traditional Chinese medicine" OR "Chinese herbal medicine").The retrieval time is from the date of establishment to October 2020.(2)Foreign Literature:the database of EMBASE,PubMed,WOS and Cochrane library is retrieved by using English keywords "rheumatoid arthritis","osteoporosis","bone loss","osteoporotic fracture","fracture","bone mineral density","traditional Chinese medical","traditional Chinese medicine".Retrieval method:subject=("rheumatoid arthritis")AND("osteoporosis" OR "bone loss" OR "osteoporotic fracture" OR "fracture" OR "bone mineral density")AND("traditional Chinese medical" OR "traditional Chinese medicine").The retrieval time is from the date of establishment to October 2020.(3)After retrieval according to the above methods,the Noteexpress document management software is used to remove weight,and then it is selected manually according to the inclusion and exclusion criteria,and finally 29 documents are included.(4)The data extraction of the included documents was carried out by using the basic information extraction table provided by the international Cochrane cooperation network.The basic contents primarily include the first author,publication time,intervention measures,follow-up time,sample size,efficacy index,etc.(5)The "bias risk assessment" in Cochrane evaluation manual 5.1.0 is used for evaluation,and the bias risk assessment chart is drawn by revman5.3 software.(6)The data in the basic information extraction table are entered into revman5.3 software,and the indexes of bone density,bone metabolism,disease activity and symptom score are analyzed and forest map is drawn.Research findings1.Bibliometric analysis of osteoporosis secondary to rheumatoid arthritis(1)518 documents were obtained from CNKI database retrieval,433 were included after manual screening;560 documents were obtained by wos database retrieval,and 431 were finally included after manual screening.The number of papers in 2001-2020 is increasing gradually.(2)The authors ranking the top in the number of CNKI database posts are XuShengqian,XuJianhua,Liu Wen,etc.;the authors with the highest ranking of the center of the distribution mainly include XuShengqian,XuJianhua and Gongxun.The authors of the number of papers published in the wo database are G HAUGEBERG?GUNTER WOLF?GLENN HAUGEBERG,etc.(3)The organizations ranking the top in the number of CNKI database papers are rheumatism and immunity department,the First Affiliated Hospital of Anhui Medical UniversityL;the joint surgery center of the whole military Orthopedic Center of Lanzhou Military General Hospital;and rheumatology department,the First Affiliated Hospital of Anhui Medical University,etc.The organizations that ranked the top in the number of documents issued by the wo database are Sorlandet Hosp,Diakonhjemmet Hosp,Univ Jena,Hanyang Univ,etc.(4)The countries with the top 10 posts in the web database are USA,JAPAN,GERMANY,ENGLAND,PEOPLES R CHINA,SOUTH KOREA,NETHERLANDS,NORWAY,SWEDEN,ITALY.(5)The key words in CNKI database are osteoporosis,rheumatoid arthritis,bone density,arthritis,etc;the key words ranking top mainly include rheumatoid arthritis,osteoporosis,bone density,arthritis,rheumatoid arthritis,etc.The cluster analysis of key words can be used to get five types of osteoporosis,bone density,arthritis,clinical efficacy and risk factors.The keywords that appear in the WOS database are mainly rheumatoid arthritis,osteoporosis,bone minimum density,release activity,women,etc;the key words ranking top in the center are mainly osteoporosis,follow up,information,minimum density,release,etc.(6)The key words of CNKI database included in the literature were analyzed,and eight words were obtained,which were osteoporosis,rheumatoid arthritis,bone density,arthritis,rheumatoid,fracture,osteoporosis fracture and bone metabolism.The paper analyzes the keywords of WOS database into the literature,and obtains 12 words,namely ma?densitometry?x ray radiogrammetry?glucocorticoid induced osteoporosis?necrosis factor alpha?absorptiometry?follow up?methotrexate?x ray absorptiometry?bisphosphonate?denosumab?management.2.Meta-analysis of Chinese medicine treatment for osteoporosis secondary to rheumatoid arthritis(1)Document screening process:349 literatures were retrieved according to the above research methods,and the rest 207 were re weighed by NoteExpress document management software,and then manually screened,and finally included in 29 documents.(2)Main characteristics of the study:because each document contains 1 original study,this study has been included in 29 original studies.Intervention measures:there are 2 studies on traditional vs western medicine,27 of them are traditional Chinese medicine plus western medicine.Included sample size:the total sample size of patients was 2506,of which 1253 in the test group and 1253 in the control group.Each original study:the sample size was between 48 and 160 cases,and the course of treatment was 1.5-12 months.(3)29 studies were evaluated according to the bias risk evaluation criteria:?random distribution method:13 studies were judged to be correctly randomly assigned;the other 16 were described as random distribution but could not be inferred whether the correct random method was adopted.?Allocation scheme hiding:29 studies did not mention random distribution scheme hiding,and it was not clear.?Blind method:29 studies were not clearly evaluated in subjects,researchers and outcome evaluators.?Results data integrity:29 studies did not report missing data,so they were rated as low risk.?Results of selective report:29 studies are none selective reports.?Other bias:no other sources of bias were included in the 29 studies.(4)Results of meta-analysis:?the meta-analysis of osteocalcin,CTX,25(OH)D and DAS28 showed that the heterogeneity was small,and the results were statistically significant(P<0.05).It suggested that traditional Chinese medicine could improve the scores of osteocalcin,CTX,25(OH)D and DAS28 in RA secondary OP patients,and the curative effect was better than that of western medicine,and the results were knot The results are highly reliable.?The results of the study were statistically significant(P<0.05),but meta-analysis suggested that heterogeneity was significant,suggesting that although traditional Chinese medicine treatment could improve the lumbar bone mineral density,Ward's triangle bone mineral density,femoral neck bone mineral density,bone alkaline phosphatase,blood calcium,C-reactive protein,erythrocyte sedimentation rate,joint pain score,morning stiffness time The meta-analysis suggested that the heterogeneity was large,suggesting that although traditional Chinese medicine treatment could improve these score,the results were less reliable due to the heterogeneity.?Meta-analysis of greater trochanter bone mineral density and forearm bone mineral density suggested that there was a large heterogeneity,and the results were not statistically significant.It suggested that the effect of traditional Chinese medicine on improving the greater trochanter bone mineral density and forearm bone mineral density of the greater rotor in RA secondary OP patients was not significant.Conclusion1.This study first uses the method of bibliometric analysis to analyze the existing literature of RA secondary OP,and shows the research characteristics at home and abroad through visual map.In recent 20 years,researchers at home and abroad pay more attention to RA secondary OP,and mature research team in China has conducted in-depth research.Risk factors and clinical effects,osteoporosis fracture and bone metabolism are the research hotspot in the future.Randomized controlled study is a hot topic in the future2.This study is the first time to use meta-analysis to systematically analyze the randomized controlled trials of traditional Chinese medicine in the treatment of RA secondary OP,so as to scientifically and objectively evaluate the curative effect of traditional Chinese medicine from the perspective of evidence-based medicine.The treatment of tonify liver and kidney and relieve rheumatism has a significant effect in improving osteocalcin and CTX in patients with RA secondary OP,and the results of meta-analysis are highly reliable.TCM syndrome differentiation and treatment methods such as liver tonifying,spleen strengthening,kidney tonifying and blood stasis removing were used to improve 25(OH)D,and the results of meta-analysis are highly reliable.Modified Guizhi Fuzi decoction can reduce the DAS28 score of patients with RA secondary OP,control the disease activity of rheumatoid arthritis,and the results of meta-analysis are highly reliable.