The combination of Chinese and Western Medicine in the management of rheumatoid arthritis: A real-world cohort study across China

Abstract

Objective: To investigate the efficacy of Integrative medicine (IM), compare with Western medicine (WM), in the treatment of rheumatoid arthritis (RA) in a cohort study.Methods: This is a cohort study with recruitment of RA patients from 10 hospitals in China. The primary outcome was change in disease activity score 28 (DAS28) during 4 follow-up visits. Generalized estimating equation (GEE) models that controlled for variables were used to investigate a time trend and assess group differences in the primary outcome and secondary outcomes after propensity score matching (PSM).Results: A total of 3195 patients with RA received IM (n = 1379, 43.2%) or WM (n = 1816, 56.8%). Following 1:1 propensity score matching, 1,331 eligible patients prescribed IM were compared to 1,331 matched patients prescribed WM. The GEE analysis with PSM showed that the IM was more beneficial to significantly decrease the levels of VAS, PGA and PhGA (VAS: odds ratio (OR), 0.76; 95% CI, 0.63–0.92; p = 0.004; PGA: OR, 0.76; 95% CI, 0.64–0.92; p = 0.007; and PhGA: OR, 0.77; 95% CI, 0.64, 0.93; p = 0.004), and reduce DAS28 (OR, 0.84; 95% CI, 0.73–0.98; p = 0.030) in the per-protocol population.Conclusion: This study suggests that compare to WM, IM has advantages in improving RA-related outcomes. However, the statistical significance might not reveal significant clinical difference. Further studies should be focused on specific treatment strategies and/or disease stages.

Integrative medicine using East Asian herbal medicine for inflammatory pain in patients with rheumatoid arthritis: A protocol for systematic review and meta-analysis integrated with multiple data mining for core candidate discovery

“…First, several studies have demonstrated that IM is a more effective alternative to monotherapy for various diseases including RA. [21,40] However, since only the synthesis of evidence for a relatively limited range has been attempted thus far, there is a lack of confidence in the robustness of the conclusion due to the insufficient sample size. As this study will collect and systematically analyze subject-related studies to the maximum extent, it will be possible to derive more statistically robust decision-making grounds based on a sufficiently large sample size.…”

“…[32][33][34][35] Recently, a number of statistical evidence and real world data have been accumulated to support the potential usefulness of IM for inflammatory and immunological improvement in patients with RA. [21,[36][37][38][39][40] For example, in a population-based cohort study in 2020, it was observed that the application of IM could lower the risk of coronary artery disease in RA. Additionally, in a more recent meta-analysis, it was reported that IM could attenuate the adverse effects of DMARDs.…”