Chinese herbal medicines versus disease modifying antirheumatic drugs for management of rheumatoid arthritis: A systematic review

Background: Chinese herbal medicines (CHMs) have been used for a long time to treat rheumatoid arthritis (RA), and many controlled trials have been done. This review aims to assess the beneficial and harmful effects of CHMs versus disease-modifying antirheumatic drugs (DMARDs) in patients with RA. 

Methods: Databases including The Cochrane Library, MEDLINE, EMBASE, The Chinese Biomedical Database, CNKI and Wanfang Data were searched to identify randomized controlled trials published before May 2011 that compared CHMs with DMARDs. The Cochrane Collaboration's tool for assessing risk of bias was employed to address the quality of the included trials.

Results: Twenty trials involving 1849 participants met the inclusion criteria. The trials had high risk of bias. Methodological quality was generally low. Seventeen different herbal medicines were tested. Most of the included trials had positive results on the response rate and demonstrated CHM specificity. The trials report adverse events related both to CHM and DMARD treatment, 115 in the CHM groups versus 258 in the DMARD groups.

Conclusion: Despite some favorable results in clinical trials, these findings should be carefully interpreted due to the low methodological quality. Further clinical trials with optimal CHM treatment protocols, rigorous and well-controlled randomized design are warranted.