Abstract
Objective To compare the efficacy and safety of kidney-tonifying and blood-activating medicinal herbs (KTBAMs) and nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of knee osteoarthritis (KOA). Methods Randomized controlled trials (RCTs) from online databases that compared the efficacy of KTBAMs and NSAIDs in the treatment of KOA were retrieved. The main outcomes included the evaluation of functional outcomes, pain, and adverse effects. The Cochrane risk-of-bias (ROB) tool was used to assess methodological quality. Results A total of 38 RCTs (3994 participants) were included in our meta-analysis. We found that KTBAMs had a significantly higher total effective rate (P < 0.00001, risk ratio (RR) = 1.08, confidence interval (CI) = 1.05 to 1.11, I2 = 4%) and a lower gastrointestinal adverse reaction rate (P < 0.00001, RR = 0.36, CI = 0.24 to 0.53, I2 = 33%) than NSAIDs. KTBAMs showed greater improvements in the Knee Society Scale (KSS) scores (mean difference (MD) = 7.17, 95% CI 0.71 to 13.64, P=0.03). Regarding the visual analog scale (VAS) scores, WOMAC scores, and Lequence scores, there were no significant differences between the KTBAM group and the NSAID group. The GRADE quality level of this systematic review indicated that the very low-quality evidence showed that KTBAMs had a higher total effective rate, while the moderate-quality evidence showed that the adverse reactions of KTBAMs were lower and the KSS scores were higher. Low-quality evidence showed no significant differences in improving VAS scores, WOMAC scores, or Lequence scores. Conclusion KTBAMs were superior to NSAIDs in terms of a higher total effective rate, a lower adverse reaction rate, and a higher KSS score. There were no significant differences between KTBAMs and NSAIDs in improving VAS scores, WOMAC scores, and Lequence scores of patients with KOA. Therefore, KTBAMs may be an alternative effective method for treating KOA. However, high-quality, well-designed RCTs with long-term follow-up are still required.
Highlights
Knee osteoarthritis (KOA) is one of the most common chronic muscular diseases in old people [1]. e main manifestations of KOA are pain and dysfunction in the knees, which affect quality of life and lead to a high rate of disability in elderly individuals. e approximate prevalence of KOA in the general population throughout the world is 12%–35% [2]
Previous studies have demonstrated the efficacy of herbal medicines, such as Duhuo Jisheng decoction (DJD)
kidney tonifying and blood-activating medicinal (KTBAM) appear to be as effective as NSAIDs and seem to have an add-on effect to NSAIDs for the treatment of KOA
Summary
Knee osteoarthritis (KOA) is one of the most common chronic muscular diseases in old people [1]. e main manifestations of KOA are pain and dysfunction in the knees, which affect quality of life and lead to a high rate of disability in elderly individuals. e approximate prevalence of KOA in the general population throughout the world is 12%–35% [2]. E main manifestations of KOA are pain and dysfunction in the knees, which affect quality of life and lead to a high rate of disability in elderly individuals. E main objectives in the management of KOA have been to alleviate pain, educate patients about their disease, restore function, slow down the progression of disease, and maintain a health-related quality of life [4]. Conservative approaches address early stages of the disease, such as oral NSAIDs, hyaluronic injection, and self-management, but the clinical results may not satisfy patients. In light of this situation, alternative treatments such as herbal preparations [5], acupuncture [6], moxibustion [7], massage [8], and tai-chi [9] have been investigated for their efficacy in randomized controlled trials (RCTs) and have drawn attention
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