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Modified Si-Miao Pill for Rheumatoid Arthritis: A Systematic Review and Meta-Analysis
Objective:
The aim of this review and meta-analysis was to assess the effects and safety of modified Si-Miao pill (mSMP) in treatment of rheumatoid arthritis.
Design:
A systematic literature search was carried out in eight databases from their available dates of inception to April 2020. After screening, fifteen randomized, controlled trials (RCTs) comparing the effects and safety of mSMP in combination with western medicine (including disease-modifying antirheumatic drugs (DMARDs) and nonsteroidal anti-inflammatory drugs (NSAIDs)) in treating rheumatoid arthritis patients were included after screening.
Results:
In comparison with DMARDs, or coadministration of DMARDs and NSAIDs, mSMP in combination with western medicine significantly lowered erythrocyte sedimentation rate (mean difference (MD) = -10.61, 95% confidence interval (CI) [-12.19, -9.03]), C-reactive protein (MD = -6.50, 95% CI [-8.43, -4.56]), rheumatoid factors (MD = -17.31, 95% CI [-24.34, -10.27]), swollen joint count (MD = -1.63, 95% CI [-2.29, -0.97]), tender joint count (MD = -1.98, 95% CI [-2.34, -1.62]), and morning stiffness time (MD = -24.37, 95% CI [-29.41, 19.33]) and ameliorated the condition of patients (odds ratio (OR) = 3.69, 95% CI [2.64, 5.14]). Additionally, mSMP in combination with western medicine seemed safer (OR = 0.49, 95% CI [0.30, 0.81]).
Conclusion:
The results of the meta-analysis study have shown that mSMP in combination with western medicine therapies appears to be more effective and safer than western medicine alone in the treatment of rheumatoid arthritis including reducing inflammatory markers and adverse events and improving symptoms. Howbeit, more high-grade, large-scale RCTs of mSMP in various countries and regions are still needed.
Insights
Modified Si-Miao pill (mSMP) combined with western medicine shows improved efficacy and safety for rheumatoid arthritis treatment. This approach effectively reduces inflammatory markers and adverse events compared to western medicine alone.
Area of Science:
- Integrative Medicine
- Rheumatology
- Pharmacology
Background:
- Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by joint inflammation and damage.
- Current treatments for RA include disease-modifying antirheumatic drugs (DMARDs) and nonsteroidal anti-inflammatory drugs (NSAIDs), which can have side effects.
- Modified Si-Miao pill (mSMP) is a traditional Chinese medicine formulation explored for its potential therapeutic benefits in RA.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy and safety of mSMP in combination with conventional western medicine for treating rheumatoid arthritis.
- To compare the outcomes of mSMP plus western medicine versus western medicine alone in RA patients.
Main Methods:
- A systematic literature search was conducted across eight databases up to April 2020.
- Fifteen randomized controlled trials (RCTs) involving RA patients treated with mSMP combined with DMARDs and/or NSAIDs were included.
- Data on inflammatory markers, clinical symptoms, and adverse events were extracted and analyzed.
Main Results:
- Combination therapy significantly reduced erythrocyte sedimentation rate, C-reactive protein, rheumatoid factors, swollen and tender joint counts, and morning stiffness duration.
- Overall patient condition and symptom amelioration were significantly improved in the mSMP combination group.
- The combination therapy demonstrated a potentially safer profile with fewer adverse events compared to western medicine alone.
Conclusions:
- The meta-analysis suggests that mSMP in conjunction with western medicine therapies is more effective and safer than western medicine monotherapy for rheumatoid arthritis.
- This combined approach effectively reduces inflammatory markers, improves RA symptoms, and lowers the incidence of adverse events.
- Further high-quality, large-scale, multi-regional RCTs are warranted to confirm these findings and establish broader clinical applicability.
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