Efficacy and safety of Chinese herbal compound in the treatment of acute gouty arthritis: A systematic review and meta-analysis of randomized controlled trials

Abstract

Objective: The present study aimed to comprehensively assess the efficacy and safety of Chinese herbal compounds in the management of acute gouty arthritis (AGA).

Materials and methods: A systematic search was performed across multiple databases, including PubMed, The Cochrane Library, Embase, Web of Science, CBM, CNKI, VIP, and Wanfang, from their inception until December 1, 2024, to identify relevant randomized controlled trials (RCTs) involving Chinese herbal compounds for AGA. Two independent researchers were responsible for the retrieved literature screening, data extraction, and quality evaluation. A meta-analysis of RCTs that fulfill the inclusion criteria will be executed utilizing Stata 14.0 software. The quality of the outcomes will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results: A total of 28 studies, encompassing 2100 participants, were included in the analysis. The meta-analysis showed that compared with conventional Western medicine, Chinese herbal compounds significantly enhance the overall efficacy of AGA treatment (RR = 1.11, 95 %CI (1.05, 1.16), P < 0.00001; Level of evidence: very low). It also demonstrated improvements in the Visual Analogue Scale (VAS) (SMD = -1.46, 95 %CI(-2.17, -0.75), P < 0.00001; Level of evidence: very low), serum uric acid levels (SMD = -0.67, 95 %CI (-1.00, -0.33), P < 0.00001; Level of evidence: very low), blood sedimentation levels (SMD = -0.71, 95 %CI (-1.08, -0.33), P < 0.00001; Level of evidence: very low), C-reactive protein (CRP) levels (SMD = 0.89, 95 %CI(-1.33, -0.45), P < 0.00001; Level of evidence: very low), and the traditional Chinese medicine syndrome score(SMD = -0.93, 95 %CI (-1.37, -0.49), P < 0.00001; Level of evidence: very low). Additionally, a reduced incidence of adverse effects was noted (RR = 0.26, 95 %CI (0.18, 0.39), P < 0.00001; Level of evidence: moderate). Subgroup analysis revealed that regardless of whether the treatment duration was less than or more than 1 week, Chinese herbal compounds were effective in improving the total effective rate of AGA treatment, VAS scores, serum uric acid levels, blood sedimentation levels, CRP levels, and Traditional Chinese medicine symptom scores, while simultaneously decreasing the occurrence of adverse reactions.

Conclusion: Chinese herbal compounds demonstrated superior efficacy and safety compared to conventional Western medicine in treating AGA. However, further validation through multicenter, high-quality RCTs is warranted to strengthen this conclusion.

Keywords: Acute gouty arthritis; Chinese herbal compounds; Meta-analysis; Randomized controlled trials; Systematic review.