| Objective:Rheumatoid arthritis(RA)is a chronic disease with high incidence and high morbidity rate.It greatly affects the patients’ quality of life.The study designed a based on the idea of evidence-based medicine,and aimed to use meta-analysis to evaluated effects of different treatments by traditional Chinese medicine(TCM)or western medicine in RA.Through preliminary objective and systematic evaluation,the efficacy of TCM and the methodology of the randomized controlled trials(RCTs)of the TCM treatment were evaluated.The efficacy of standardized western medicine treatment and classical prescription including Guizhi Shaoyao Zhimu decoction,Baihu Guizhi decoction,Wutou decoction,and Huangqi Guizhi Wuwu decoction were compared to provide a reliable data of TCM treatment,in order to provide a standardized clinical protocols for RA diagnosis and treatment.It was designed to improve the level of RA treatment by TCM comprehensively,which provides a practical reference value for therapeutic treatment.Study Design:This study has 2 parts.In the first part of the study,meta-analysis was conducted on RCTs journals by TCM and Western medicine for RA treatment through searching the Chinese and overseas electronic databases from January 2008 to December 2017.28 articles of Guizhi Shaoyao Zhimu decoction,three articles of Baihu Guizhi decoction,5 articles of Huangqi Guizhi Wuwu decoction and 11 articles of Wutou decoction were included.After quality evaluation and heterogeneity tests,meta-analysis was conducted to compare the differences in efficacy between TCM and Western medicine in the treatment of RA.In the second part,clinical cases of my doctoral degree teacher professor Wang Yue was shared and his valuable experience and theories in treating RA was discussed.Results:(1)28 RCTs articles of Guizhi Shaoyao Zhimu decoction was included,with 2440 cases in total,1236 cases in TCM group,and 1204 cases in western medicine group.The clinical therapeutic effect of Guizhi Shaoyao Zhimu decoction was 94.3%,while western medicine was 81.3%.RR=1.16,95%CI(1.09,1.23).After statistical analysis,the clinical efficacy of the two groups was p<0.00001.In terms of ESR,the result is(MD =-8.43,95%CI[-13.27,-3.29]),p =0.001,CRP(MD =-4.24,95%CI[-6.38,-2.11]),p<0.0001,morning stiffness(MD =-22.17,95%CI[-31.33,-13.05]),p<0.00001,all the primary indicators were significantly better than western medicine group.For Guizhi Shaoyao Zhimu decoction combined with western medicine group,the clinical efficacy was 93.0%,while western medicine group was 78.8%,RR=1.18,95%CI(1.03,1.24),by statistical analysis,the two groups of clinical efficacy p<0.00001.In terms of ESR,the result is(MD =-9.09,95%CI[-14.26,-3.91]),p = 0.0006,and CRP(MD =-7.41,95%CI[-11.41,-3.40]),p = 0.0003;morning stiffness(MD=-13.69,95%CI[-17.51,-9.28]),p<0.00001,RF(SMD =-1.30,95%CI[-1.92,-0.68]),p<0.0001).All the primary indicators were significantly better than western medicine group.(2)Three RCT articles of Baihu Guizhi decoction were included,with 252 cases in total,127 cases in TCM group and 125 cases in western medicine group.The clinical efficacy of Baihu Guizhi decoction combined with western medicine group was 90.2%,and that of western medicine group was 76.4%,RR=1.19,95%CI(1.03,1.36).After statistical analysis,the clinical efficacy of the two groups was compared with p=0.02.In terms of ESR,the result is(MD =-8.92,95%CI[-15.16,-2.69]),p=0.005,CRP(MD=-5.41,95%CI[-7.74,-3.07]),p<0.00001,morning stiffness(MD =-15.65,95%CI[-18.98,-12.32]),p<0.00001,all the primary indicators were significantly better than western medicine group.(3)Five RCT articles of Huangqi Guizhi Wuwu decoction was included,with 359 cases in total,189 cases in TCM group and 170 cases in western medicine group.The clinical efficacy of Huangqi Guizhi Wuwu decoction combined with western medicine group was 91.9%,while western medicine group was 76.4%,RR=1.18,95%CI(1.05,1.32),p=0.005.In terms of ESR,the result is(MD=-5.90,95%CI[-23.51,11.72]),p=0.51,CRP(MD=-4.23,95%CI[-10.86,-2.40]),p=0.21,morning stiffness(MD =-21.22,95%Cl[-42.9,10.46]),p =0.06,RF(MD =-3.79,95%Cl[-7.15,-0.42]),p=0.03.Huangqi Guizhi Wuwu decoction combined with western medicine group in the performed significantly better in RF and was significantly better than the western medicine group,but there were no significant statistical difference in the improvement of CRP,ESR and morning stiffnes.(4)Eleven RCT articles of Wutou decoction were included,with a total of 913 cases,478 cases of TCM group,and 435 cases of western medicine group.The clinical efficacy of Wutou decoction was 88.2%,while western medicine group was 69.3%,RR = 5.09,95%CI(2.50,10.34),p<0.00001,there were significant statistically differences.There were no statistically difference in the WuTou decoction group in the improvement of RF(MD=3.75,95%CI[-166.14,173.64]),p=0.97.The clinical efficacy of Wutou decoction combined with western medicine group was 89.8%,while western medicine group was 69.2%,RR=3.93,95%CI(2.46,6.28),p<0.00001.Wutou decoction combined with western medicine group performed in ESR was(MD =-8.5,95%CI[-12.05,-4.94]),p<0.00001;CRP(MD =-5.40,95%CI[-6.60,-4.21]),p<0.00001;morning stiffness(MD =-19.93,95%CI[-36.59,-3.27]),p = 0.02;RF(MD =-21.47,95%CI[-51.87,8.92]),p =0.17,It indicates that all the classical prescription or its combination with western medicine in treating RA had a higher efficacy than western medicine.The Guizhi Shaoyao Zhimu decoction has shown significantly improved joint swelling,joint tenderness,joint pain index,joint tenderness index,joint swelling index,joint function improvement when compared with the western medicine group with statistical difference,p<0.05,.The improvement of joint dysfunction,p>0.05,had no statistical difference.Guizhi Shaoyao Zhimu decoction combined with western medicine group has shown on TCM syndrome efficacy,ACR improvement rate,joint swelling,joint tension,two-hand grip,joint swelling,TCM syndromes,VAS,HAQ,DAS28,TNF-a significantly better than the western medicine group with statistical difference,p<0.05.There was no statistical difference in the improvement of rest pain.Baihu Guizhi decoction combined with western medicine group has shown significantly improvement of IL-1,TNF-a,and arterial tenderness than western medicine group with statistical difference,p<0.05.Huangqi Guizhi Wuwu decoction combined with western medicine group has shown significantly improvement on joint pain index,joint swelling index and joint tenderness index than that of western medicine group with statistical difference,p<0.05.The improvement of IL-1β in Wutou decoction group has shown significant improvement than that in western medicine group with statistical difference,p<0.05.Wutou decoction combined with western medicine group has not shown significant improvement on anti-CCP antibody was p>0.05.Conclusions:① Meta-analysis indicated that the total clinical efficacy of treating RA by classical prescription combined with western medicine can significantly improve the total therapeutic rate,and improve the measures of laboratory testing indicators,including ESR,CRP,and RF,when western medicine was used as a control.Clinical measures in the improvement of joint function showed a higher efficacy than western medicine in general.There were fewer adverse reactions than conventional western medicine.② Meta-analysis indicated that the classical prescription showed a higher efficacy than western medicine in gerenal.But as the quality and quantity of included RCT were low,the reliability of the results were affected.③JADAD scale were used and indicated that only 2 out of 47 included RCT were in high quality,the others are in low quality.Though meta-anaylsis indicatd that clinical prescription had therapeutic advantages in treating RA,but their efficacy required more high quality RCT to provide the evidence.④Professor Wang Yue used classical prescription in treating RA with great therapeutic effects,which would provide valuable clinical experience in the clinical application of TCM in the future. |
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