Objective  To evaluate efficacy and safety of 5 different Chinese herbal decoctions in the treatment of rheumatoid arthritis (RA) by network Meta-analysis.

Methods  PubMed, Embase, Cochrane Library and Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) of 5 kinds of traditional Chinese medicine decoctions (Juanbi decoction, Wutou decoction, Baihu plus Guizhi decoction, Guizhi Shaoyao Zhimu decoction and Duhuo Jisheng decoction) combined with conventional treatment such as methotrexate and meloxicam from inception to January 1, 2024. Two reviewers independently screened literature, extracted data and assessed risk bias of included studies. The network Meta-analysis was then performed using Stata 17 software.

Results  A total of 35 RCTs involving 3 316 patients were included. The results of the network Meta-analysis found that compared with conventional treatment, 5 kinds of traditional Chinese medicine decoction+conventional treatment significantly increased total clinical effective rate (P<0.05); Juanbi decoction+conventional treatment, Guizhi Shaoyao Zhimu decoction+conventional treatment, Duhuo Jisheng decoction+ conventional treatment significantly reduced RF level (P<0.05); Juanbi decoction+conventional treatment, Wutou decoction+conventional treatment, Guizhi Shaoyao Zhimu decoction+conventional treatment, Duhuo Jisheng decoction+conventional treatment significantly reduced CRP level and ESR level (P<0.05); Guizhi Shaoyao Zhimu decoction+conventional treatment, Duhuo Jisheng decoction+conventional treatment significantly reduced incidence of adverse reactions (P<0.05). The cumulative probability ranking results showed that Guizhi Shaoyao Zhimu decoction+conventional treatment had the best effect in improving the total clinical effective rate and reducing RF level and incidence of adverse reactions; Wutou decoction+conventional treatment had the best effect in reducing CRP level; Juanbi decoction+conventional treatment had the best effect in reducing ESR level.

Conclusion  Traditional Chinese medicine decoction combined with conventional treatment can improve the overall efficacy of RA. In terms of improving indexes, Guizhi Shaoyao Zhimu Decoction or Juanbi decoction combined with conventional treatment can be selected for clinical treatment of RA. Guizhi Shaoyao Zhimu decoction or Duhuo Jisheng decoction combined with conventional therapy can be selected to improve safety. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.

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