Appraisal of clinical practice guidelines for the management of rheumatoid arthritis in traditional Chinese medicine using the AGREE II instrument: A systematic review

Introduction: An increasing number of clinical practice guidelines (CPGs) in traditional Chinese medicine (TCM) for rheumatoid arthritis (RA) have been issued, and all have been developed in China but their quality is unclear. This study aimed to systematically review the quality and consistency of recommendations on the TCM CPGs for RA in China using the AGREE II instrument. Methods: TCM CPGs identified from five electronic databases and hand searches through related handbooks published between January 1990 and December 2012. The CPG were categorized into Evidence Based (EB) guideline, Consensus Based with no explicit consideration of Evidence Based (CB-EB) guideline and Consensus Based (CB) guideline according to the method reported previously. Four reviewers independently appraised the CPGs based on the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument, and compared the recommendation on TCM pattern (Zheng) classification and treatment. Results: Five TCM CPGs satisfied the inclusion criteria. The quality score of EB guideline was higher than CB-EB and CB guidelines. Five TCM patterns in the CPGs were recommended in the EB CPG. The herbal preparations including Tripterygium wilfordii recommended in the EB CPG were mostly recommended for RA treatment. The recommendations on non-drug management in the CPGs were fairly consistent, and the recommendations are different based on the different TCM patterns accordingly. Conclusions: EB CPG for RA treatment in TCM show higher quality with measurement of AGREE II instrument, and it suggested that TCM CPG could be better developed with clinical evidence.