Therapeutic effects of traditional Chinese medicine fumigation plus Yang-He decoction for patients with ankylosing spondylitis: systematic review and network meta-analysis

To compare and rank the therapeutic effects of traditional Chinise medicine fumigating (TCMF) plus Yang-He decoction (YHD), TCMF plus acupuncture, TCMF, YHD, acupuncture, and Western medicine (WM) in patients with ankylosing spondylitis (AS). The PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang, and VIP electronic databases were searched for eligible randomized controlled trials (RCTs) from their inception until April 2023. The primary endpoint was the efficacy rate. Nineteen RCTs involving 1,432 AS patients were selected. The surface under the cumulative ranking (SUCRA) probabilities indicated TCMF plus acupuncture (SUCRA: 78%) and TCMF plus YHD (SUCRA: 71%) exhibited relatively better efficacy. TCMF plus WM versus WM yielded a lower Visual Analogue Scale (VAS) score (P=0.043), shorter morning stiffness time (MST) (P=0.002), and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) (P=0.003). Moreover, YHD plus WM versus WM was associated with a lower VAS score (P<0.001), finger-floor distance (P<0.001), pillow-wall distance (PWD) (P=0.001), Bath Ankylosing Spondylitis Functional Index (BASFI) (P=0.001), erythrocyte sedimentation rate (P<0.001), or C-reactive protein (CRP) (P<0.001), elevated Schober test (P<0.001), thoracic expansion (P<0.001), spinal column activity (SCA) (P<0.001), and shorter MST (P<0.001). TCMF plus YHD versus WM achieved a lower VAS score (P=0.002), BASDAI (P<0.001), BASFI (P<0.001) or CRP (P=0.038), and elevated SCA (P=0.002). TCMF plus acupuncture versus WM showed lower VAS score (P<0.001) and BASFI (P<0.001). Finally, TCMF plus acupuncture versus acupuncture showed lower PWD (P=0.004) and CRP (P=0.031). TCMF plus acupuncture and TCMF plus YHD provided better therapeutic effects in patients with AS.