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Meta-Analysis
. 2021 Oct 7:2021:3302886.
doi: 10.1155/2021/3302886. eCollection 2021.

The Efficacy of Antioxidative Stress Therapy on Oxidative Stress Levels in Rheumatoid Arthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Liuting Zeng  1 , Ganpeng Yu  2 , Kailin Yang  3 , Jun Li  2 , Wensa Hao  4 , Hua Chen  1
Affiliations
Meta-Analysis

The Efficacy of Antioxidative Stress Therapy on Oxidative Stress Levels in Rheumatoid Arthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Liuting Zeng et al. Oxid Med Cell Longev. .

Abstract

Objective: To explore the efficacy of antioxidative stress therapy on oxidative stress levels in rheumatoid arthritis (RA) by a systematic review and meta-analysis of randomized controlled trials.

Methods: Chinese and English databases such as PubMed, Embase, China National Knowledge Infrastructure (CNKI), and China Biomedical Literature were searched, mainly searching for clinical randomized controlled trials of antioxidant therapy for rheumatoid arthritis. The search time is from the establishment of the database to July 2021. Two researchers independently carried out literature search, screening, and data extraction. The bias risk tool provided by the Cochrane Collaboration was used to evaluate the bias risk of all the included literature, and the RevMan 5.3 software was used for meta-analysis.

Results: A total of 24 RCTs (28 records) and 1277 participants were included. The time span of randomized controlled trials (RCTs) is from 1986 to 2020. These RCTs involve 14 types of antioxidants or antioxidant therapies, and these therapies have varying degrees of improvement on oxidative stress in RA patients. The summary results showed that the MDA in the experiment group is lower (SMD -0.82, 95% CI -1.35 to -0.28, P = 0.003). The difference of TAC, SOD, NO, GPx, CAT, and GSH between two groups was of no statistical significance (TAC (SMD 0.27, 95% CI -0.21 to 0.75, P = 0.27), SOD (SMD 0.12, 95% CI -0.16 to 0.40, P = 0.41), NO (SMD -2.03, 95% CI -4.22 to 0.16, P = 0.07), GPx (SMD 0.24, 95% CI -0.07 to 0.54, P = 0.13), CAT (SMD 2.95, 95% CI -2.6 to 8.51, P = 0.30), and GSH (SMD 2.46, 95% CI -0.06 to 4.98, P = 0.06)). For adverse events, the summary results showed that the difference was of no statistical significance (RR 1.16, 95% CI 0.79 to 1.71, P = 0.45). In addition, antioxidant therapy has also shown improvement in clinical efficacy indexes (number of tender joints, number of swollen joints, DAS28, VAS, and HAQ) and inflammation indexes (ESR, CRP, TNF-α, and IL6) for RA patients.

Conclusion: The existing evidence shows potential benefits, mainly in reducing MDA and increasing TAC and GSH in some subgroups. However, more large samples and higher quality RCTs are needed to provide high-quality evidence, so as to provide more clinical reference information for the antioxidant treatment of RA.

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Conflict of interest statement

We declare no competing interests.

Figures

Figure 1
Figure 1
Flow diagram.
Figure 2
Figure 2
Risk of bias graph.
Figure 3
Figure 3
Risk of bias summary.
Figure 4
Figure 4
MDA.
Figure 5
Figure 5
TAC.
Figure 6
Figure 6
SOD.
Figure 7
Figure 7
NO.
Figure 8
Figure 8
GPx.
Figure 9
Figure 9
CAT.
Figure 10
Figure 10
GSH.
Figure 11
Figure 11
Adverse events.
Figure 12
Figure 12
Number of swollen joints.
Figure 13
Figure 13
Number of tender joints.
Figure 14
Figure 14
DAS28.
Figure 15
Figure 15
VAS.
Figure 16
Figure 16
HAQ.
Figure 17
Figure 17
ESR.
Figure 18
Figure 18
CRP.
Figure 19
Figure 19
TNF-α.
Figure 20
Figure 20
IL6.
Figure 21
Figure 21
Publication bias of oxidative stress index: (a) MDA; (b) TAC.
Figure 22
Figure 22
Publication bias of clinical efficacy indexes: (a) number of tender joints; (b) number of swollen joints; (c) DAS28; (d) HAQ; (e) VAS.
Figure 23
Figure 23
Publication bias of inflammation indexes: (a) ESR; (b) CRP; (c) TNF-α.
See this image and copyright information in PMC

References

    1. Helmick C. G., Felson D. T., Lawrence R. C., et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part I. Arthritis & Rheumatism . 2008;58(1):15–25. doi: 10.1002/art.23177. - DOI - PubMed
    1. Myasoedova E., Crowson C. S., Kremers H. M., Therneau T. M., Gabriel S. E. Is the incidence of rheumatoid arthritis rising?: results from Olmsted County, Minnesota, 1955-2007. Arthritis and Rheumatism . 2010;62(6):1576–1582. doi: 10.1002/art.27425. - DOI - PMC - PubMed
    1. Yu C., Li M., Duan X., et al. Chinese registry of rheumatoid arthritis (CREDIT): I. Introduction and prevalence of remission in Chinese patients with rheumatoid arthritis. Clinical and experimental rheumatology . 2018;36(5):836–840. - PubMed
    1. CREDIT Co-authors, Jin S., Li M., et al. Chinese Registry of rheumatoid arthritis (CREDIT): II. Prevalence and risk factors of major comorbidities in Chinese patients with rheumatoid arthritis. Arthritis research & therapy . 2017;19(1):p. 251. doi: 10.1186/s13075-017-1457-z. - DOI - PMC - PubMed
    1. Dai Y., Wang W., Yu Y., Hu S. Rheumatoid arthritis-associated interstitial lung disease: an overview of epidemiology, pathogenesis and management. Clinical Rheumatology . 2021;40(4):1211–1220. doi: 10.1007/s10067-020-05320-z. - DOI - PubMed