Efficacy and safety of traditional Chinese medicine decoctions as an adjuvant treatment for rheumatoid arthritis: A systematic review and meta-analysis

BACKGROUND: To assess the effectiveness and safety of traditional Chinese medicine (TCM) decoctions as an additional therapy for rheumatoid arthritis (RA) via a systematic review and meta-analysis. METHODS: Databases including PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure, and Wanfang were searched up to June 2024. Randomized controlled trials (RCTs) on TCM decoctions as adjunctive RA treatment were included. Primary outcomes were efficacy and safety. Effect sizes were measured using standardized mean difference, risk ratio, and 95% confidence intervals. Sensitivity and subgroup analyses were conducted to test result robustness and identify heterogeneity sources. Data were analyzed using RevMan 5.4 and Stata 15. In addition, the quality of evidence was assessed using grading of recommendations assessment, development and evaluation grading. RESULTS: Thirty-six RCTs with 6934 participants showed that TCM decoctions significantly improved overall efficacy versus control (risk ratio = 1.25, 95% confidence interval [1.21-1.29], P < .00001). They also reduced erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, swollen joint count, Disease Activity Score, and morning stiffness duration compared to placebo. Subgroup analysis suggested treatment duration, disease duration, and age may affect efficacy. Among them, the quality of evidence was high for Visual Analog Scale, and moderate for overall efficacy, C-reactive protein, Disease Activity Score, Traditional Chinese Medicine Symptom Score, and interleukin-1. CONCLUSION: TCM decoctions as adjunctive RA treatment significantly enhance efficacy. However, due to study limitations, further large-scale, multicenter RCTs are needed to confirm these findings.