Heliyon (Nov 2024)
Efficacy and safety of integrated traditional Chinese and Western medicine for rheumatoid arthritis-interstitial lung disease: A systematic review and meta-analysis
Abstract
Objective: To systematically evaluate the efficacy and safety of integrated traditional Chinese and Western medicine(TCM-WM) for the treatment of rheumatoid arthritis-associated interstitial lung disease (RA-ILD). Materials and methods: An independent search of electronic databases (PubMed, Excerpta Medica Database, Cochrane Central Register of Controlled Trials, OVID Medline, China National Knowledge Infrastructure, WanFang Data, VIP Data databases, and China Biology Medicine disc) from inception to June 25, 2024 was performed to identify studies treating RA-ILD that used combined Chinese and Western medicine treatment compared to Western medicine. Two researchers independently audited each article, and the quality was assessed using the Cochrane Risk of Bias Assessment Tool 2 and the modified Jadad. Meta-analyses were performed using Review Manager 5.4 and Stata 16.0 software to analyze data. Sample certainty and conclusiveness of evidence were assessed using the Grading of Recommendations Assessment, Development, and Evaluation Profiler (GRADEPRO) and trial sequential analysis(TSA) 0.9.5.10 beta. Results: Eighteen randomised controlled trials (RCT), including 1353 patients, were abstracted. Integrated traditional Chinese and Western medicine was significantly more effective than Western medicine in improving lung function in patients with rheumatoid arthritis-associated interstitial lung disease, including forced vital capacity (FVC) (Standardized Mean Difference (SMD) = 1.44, 95 % CI 0.93 to 1.95, P < 0.00001), diffusion capacity for carbon monoxide of the lung (DLCO) (SMD = 1.20, 95 % CI: 0.57 to 1.84, P = 0.0002), and total lung capacity (TLC) (SMD = 1.29, 95 % CI: 0.81 to 1.76, P < 0.00001). There were significant differences between the two groups in the reduced high-resolution Computed Tomography scores (Mean Difference(MD) = −1.92, 95 % CI: 2.73 to −1.10, P < 0.00001). Significantly reduced inflammatory markers, combined Chinese and Western medical treatments for RA-ILD were substantially better than Western treatments, including erythrocyte sedimentation rate(ESR) (MD = −7.89, 95 % CI: 12.40 to −3.39, P < 0.00001), C-reactive protein(CRP) (MD = −4.75, 95 % CI: 8.61 to −1.34, P = 0.006), rheumatoid factor(RF) (MD = −41.76, 95 % CI: 66.95 to −16.56, P = 0.001). Combination therapy improved clinical effectiveness (odds ratio (OR) = 3.69, 95 % CI: 2.68 to 5.07, P < 0.00001). Simultaneously, trial sequential analysis indicated that the results demonstrating the superiority of integrated traditional Chinese and Western medicine over Western medicine alone in the treatment of rheumatoid arthritis-associated interstitial lung disease are robust. Conclusion: Current evidence shows that combined traditional Chinese medicine is effective and safe for rheumatoid arthritis-associated interstitial lung disease compared with Western medicine alone. The sample size for inclusion concerns may require the inclusion of more randomised trials in the future to validate our results.
