Is Chinese herbal formula (nourishing Yin therapy) effective and well tolerated as an adjunct medication to hydroxychloroquine in the treatment of primary Sjögren's syndrome? A meta-analysis of randomised controlled trials.

BACKGROUND: Previously, data mining methodology was used to identify 71 patented prescriptions in Chinese patent databases, indicating that Yin-nourishing therapy (YNT) may be an adjunct medication to hydroxychloroquine in the treatment of primary Sjögren's syndrome (pSS). The purpose of this study was to investigate effects of the addition of YNT, which includes tonifying liver and kidney therapy (TLKT) and replenishing Qi and nourishing Yin therapy (RQNYT), in the treatment of pSS. METHODS: Fourteen databases (including Chinese, English, Japanese, Korean and Latin databases) were searched to identify randomised controlled trials (RCTs) of YNT plus hydroxychloroquine (YNTPH) versus hydroxychloroquine alone in patients with pSS. Relevant publications up to June 2021 were selected. A meta-analysis and trial sequential analysis (TSA) were performed using Review Manager 5.3, Stata 14.0 and TSA 0.9 software. The quality of identified studies was assessed based on the Cochrane risk of bias tool and GRADE (grading of recommendations, assessment, development and evaluation) criteria. RESULTS: We included five RCTs with a total of 345 participants. Pooled results indicated significant differences in short-term outcomes, which were assessed via European League Against Rheumatism (EULAR) Sjögren's Syndrome Patient Reported Index (ESSPRI), EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI), tear production, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and immunoglobulin G (IgG) results when YNTPH was compared with hydroxychloroquine use alone (p < 0.05). No significant difference in salivary flow rate was reported. The most common side effect reported for both groups was gastrointestinal reaction. Sensitivity analyses suggested that heterogeneity might be ascribed to clinical methodology. Subgroup analyses revealed heterogeneities regarding salivary flow rate were eliminated. TLKT appeared to be better than RQNYT for improving salivary flow rate. TSA only supported changes in ESSPRI, ESSDAI and ESR values. For all studies, the quality of evidence was low. CONCLUSION: YNTPH may be an effective complementary therapy. Current evidence, however, is insufficient for determining whether YNTPH is more effective than hydroxychloroquine alone. Well-designed RCTs are needed to determine the role of YNT in pSS treatment.

[Efficacy of fan-needle radiofrequency for knee osteoarthritis guided by meridians-muscles theory].

OBJECTIVE: To observe the efficacy difference between fan-needle radiofrequency guided by meridians-muscles theory and oral administration of medication for knee osteoarthritis (KOA). METHODS: One hundred patients with KOA were randomly divided into an acupuncture group and a medication group, 50 cases in each one. The patients in the acupuncture group were treated with fan-needle radiofrequency guided by meridians-muscles theory at tendon nodes around knee joints (ashi points), 4 points per treatment, once every two weeks and two treatments were given. The patients in the medication group were treated with oral administration of celecoxib capsules, 1 capsule every day for 4 weeks. The visual analogue scale (VAS) and Western Ontario and McMaster Universities (WOMAC) in the two groups were observed before treatment, after treatment and during 4-week follow-up visit. The clinical efficacy was evaluated. RESULTS: Compared before treatment, the VAS was reduced in the two groups after treatment and during 4-week follow-up visit (all P<0.05), and the VAS score in the acupuncture group was lower than that in the medication group (both P<0.05). Compared before treatment, the pain score, stiffness score, activity function score and total score of WOMAC were reduced in the two groups after treatment and during 4-week follow-up visit (all P<0.05), and the scores in the acupuncture group were lower than those in the medication group (all P<0.05). After treatment, the total effective rate was 80.0% (40/50) in the acupuncture group, which was superior to 56.0% (28/50) in the medication group (P<0.05). During 4-week follow-up visit, the total effective rate was 76.0% (38/50) in the acupuncture group, which was superior to 40.0% (20/50) in the medication group (P<0.05). CONCLUSION: The efficacy of fan-needle radiofrequency guided by meridians-muscles theory is superior to oral administration of celecoxib capsules for KOA, which could relieve joint pain and stiffness, improve joint mobility, and has long effective duration.

[Treatment of Knee Osteoarthritis by Tendons of Minimally Invasive Therapy Combined Drug Ther- apy: a Clinical Observation of Sixty Cases].

OBJECTIVE: To assess the efficacy of tendons of minimally invasive therapy (TMIT) combined drug therapy by comparing it with treatment by drug therapy alone on patients with knee osteoarthritis (KOA). METHODS: Totally 60 KOA patients were assigned to the treatment group and the control group according to random digit table, 30 in each group. Patients in the control group took Hydrochloric Acid Glucosamine Capsule and Celecoxib Capsule. Patients in the treatment group additionally received TMIT. The treatment course for all was 4 weeks. Scores for visual analogue scale (VAS) and the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index were observed and recorded at week 1 and 4 after treatment by acupotomology mirror. RESULTS: Compared with before treatment, improvement was shown in VAS score, pain and stiffness degrees, activities and functions, and WOMAC scores at week 1 and 4 after treatment in all patients with statistical difference (P < 0.05). Besides, better effect was shown in the treatment group (P < 0.05). CONCLUSIONS: TMIT combined drug therapy could relieve KOA patients' pain, stiffness and joint activities, elevate the overall efficacy. TMIT was easily operated with less injury.

Evaluating meridian-sinew release therapy for the treatment of knee osteoarthritis.

Objective. In recent years, public health experts have concluded that the impact of osteoarthritis is equal in magnitude to that of cardiovascular disease. Osteoarthritis of the knee is prevalent in the elderly population; however, there are currently no effective treatments for this condition. In this study, we investigated the efficacy of "meridian-sinew release," a newly developed technique which entails using a meridian-sinew scope and a meridian-sinew knife to treat osteoarthritis of the knee. Methods. Patients (N = 90) with knee osteoarthritis were prospectively randomized to meridian-sinew release therapy, acupuncture therapy, or drug therapy groups, respectively. Outcome evaluation included pain, stiffness, physiological function, total symptom score, and overall changes in the condition. Results. After 12 weeks, patients' general assessment (GA) and doctors' general assessment (GA) of the condition were not significantly different among the three groups. However, significant differences in primary endpoint pain, joint stiffness, and total symptom score were found between the meridian-sinew group and the acupuncture group and between the meridian-sinew group and the control group (P < 0.05). No adverse events occurred during the trial. Conclusion. Our study suggests that meridian-sinew release therapy can improve knee osteoarthritis, alleviate joint pain, and improve functional movement disorder. It is a safe and effective treatment for knee osteoarthritis.