Chinese herbal medicine beats western medicine in the treatment of osteoarthritis of the knee

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Purpose: This study aims to evaluate the effectiveness and safety of oral Chinese herbal medicine in the treatment of knee osteoarthritis.

Study design: Systematic review and meta-analysis of randomized controlled trials (RCTs).

Materials and methods: A computer was used to retrieve all RCTs of Chinese herbal medicine in the treatment of knee osteoarthritis from 7 databases (PubMed; Embase; Cochrane Central Register of Controlled Trials; China National Knowledge Infrastructure; Chinese VIP Information Database; Chinese Biomedical Database and Wanfang Med Database) from the establishment to August 2021. The literature was organized using NoteExpress, and literature screening and data extraction were conducted by two researchers independently by the inclusion and exclusion criteria. Quality evaluation was performed using GRADE, and the meta-analysis was performed using RevMan5.4.

Results: A total of 31 RCTs and 3115 cases are included. The following meta-analysis results are observed: (1) WOMAC: Chinese herbal medicine vs. placebo (SMD = -0.87, 95% CI: -1.27 to -0.47, P < 0.0001), Chinese herbal medicine vs. Western medicine (SMD = -1.64, 95% CI: -2.09 to -1.19, P < 0.00001), and Chinese herbal medicine + Western medicine vs. Western medicine (SMD = -2.17, 95% CI: -3.01 to -1.33, P < 0.00001); (2) VAS: Chinese herbal medicine vs. Western medicine (SMD = -1.02, 95% CI: -1.63 to -0.41, P < 0.00001) and Chinese herbal medicine + Western medicine vs. Western medicine (SMD = -2.68, 95% CI: -4.36 to -1.00, P < 0.00001); (3) Lequesne severity index: Chinese herbal medicine vs. Western medicine (SMD = -0.90, 95% CI: -1.40 to -0.39, P = 0.0005) and Chinese herbal medicine + Western medicine vs. Western medicine (SMD = -0.94, 95% CI: -1.36 to -0.52, P < 0.0001); (4) Lysholm knee joint function score: Chinese herbal medicine vs. Western medicine (MD = 9.10, 95% CI: 4.20 to 14.01, P = 0.0003), and Chinese herbal medicine + Western medicine vs. Western medicine in a single trial (MD = 21.15, 95% CI: 19.71 to 22.59, P < 0.00001); (5) SOD: in a single trial, Chinese herbal medicine vs. Western medicine (MD = 1.62, 95% CI: 0.9 to 2.30, P < 0.00001) and Chinese herbal medicine + Western medicine vs. Western medicine (MD = 17.08, 95% CI: 10.71 to 23.44, P < 0.00001); (6) TNF-α: Chinese herbal medicine vs. Western medicine (SMD = -1.90, 95% CI: -2.04 to -0.14, P = 0.02) and Chinese herbal medicine + Western medicine vs. Western medicine (SMD = -2.32, 95% CI: -4.33 to -0.30, P = 0.02); (7) IL-1β: Chinese herbal medicine vs. Western medicine (SMD = -1.60, 95% CI: -2.36 to -0.84, P < 0.0001); and (8) IL-6: in a single trial, Chinese herbal medicine vs. Western medicine (MD = -0.75, 95% CI: -1.20 to -0.30, P = 0.001) and Chinese herbal medicine + Western medicine vs. Western medicine (MD = -3.18, 95% CI: -6.24 to -0.12, P = 0.04).

Conclusion: The efficacy of Chinese herbal medicine in the treatment of knee osteoarthritis is superior to those of placebo and Western medicine. At the same time, the combination of Chinese herbal medicine + Western medicine is superior to Western medicine alone in the treatment of knee osteoarthritis. 

Reference: https://pubmed.ncbi.nlm.nih.gov/35316726/