League table of pain in network meta-analysis.

ObjectiveHand osteoarthritis poses a significant health challenge globally due to its increasing prevalence and the substantial burden on individuals and the society. In current clinical practice, treatment options for hand osteoarthritis encompass a range of approaches, including biological agents, antimetabolic drugs, neuromuscular blockers, anti-inflammatory drugs, hormone medications, pain relievers, new synergistic drugs, and other medications. Despite the diverse array of treatments, determining the optimal regimen remains elusive. This study seeks to conduct a network meta-analysis to assess the effectiveness and safety of various drug intervention measures in the treatment of hand osteoarthritis. The findings aim to provide evidence-based support for the clinical management of hand osteoarthritis.MethodsWe performed a comprehensive search across PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials was conducted until September 15th, 2022, to identify relevant randomized controlled trials. After meticulous screening and data extraction, the Cochrane Handbook’s risk of bias assessment tool was applied to evaluate study quality. Data synthesis was carried out using Stata 15.1 software.Results21 studies with data for 3965 patients were meta-analyzed, involving 20 distinct Western medicine agents. GCSB-5, a specific herbal complex that mainly regulate pain in hand osteoarthritis, showed the greatest reduction in pain [WMD = -13.00, 95% CI (-26.69, 0.69)]. CRx-102, s specific medication characterized by its significant effect for relieving joint stiffness symptoms, remarkably mitigated stiffness [WMD = -7.50, 95% CI (-8.90, -6.10)]. Chondroitin sulfate displayed the highest incidence of adverse events [RR = 0.26, 95% CI (0.06, 1.22)]. No substantial variation in functional index for hand osteoarthritis score improvement was identified between distinct agents and placebo.ConclusionsIn summary, GCSB-5 and CRx-102 exhibit efficacy in alleviating pain and stiffness in HOA, respectively. However, cautious interpretation of the results is advised. Tailored treatment decisions based on individual contexts are imperative.

手骨关节炎（Hand Osteoarthritis, HOA）因其患病率持续攀升，给个体与社会带来沉重负担，已成为全球范围内亟待应对的重大健康挑战。在当前临床实践中，手骨关节炎的治疗手段涵盖多种方案，包括生物制剂、抗代谢药物、神经肌肉阻滞剂、抗炎药物、激素类药物、镇痛剂、新型协同药物及其他各类药物。尽管治疗手段种类繁多，但遴选最优治疗方案仍颇具难度。本研究旨在开展一项网状meta分析（network meta-analysis），以评估各类药物干预措施用于手骨关节炎治疗的有效性与安全性，研究结果旨在为手骨关节炎的临床管理提供循证依据。
方法 本研究于2022年9月15日前，在PubMed、Embase、Web of Science及Cochrane对照试验中心注册库（Cochrane Central Register of Controlled Trials）中进行全面检索，以筛选相关随机对照试验。经严格筛选与数据提取后，采用Cochrane手册偏倚风险评估工具对研究质量进行评价。数据分析采用Stata 15.1软件完成。
结果 本研究共纳入21项研究，涉及3965例患者，涵盖20种不同的西医药物。其中，GCSB-5作为一种主要用于缓解手骨关节炎疼痛的特异性复方中草药，在减轻疼痛方面效果最为显著[加权均数差（weighted mean difference, WMD）=-13.00，95%置信区间（confidence interval, CI）(-26.69, 0.69)]。CRx-102作为一种以显著缓解关节僵硬症状为特点的特异性药物，可有效改善关节僵硬情况[WMD=-7.50，95%CI(-8.90, -6.10)]。硫酸软骨素的不良事件发生率最高[相对风险（relative risk, RR）=0.26，95%CI(0.06, 1.22)]。不同药物与安慰剂相比，在手骨关节炎功能指数评分改善方面未出现显著差异。
结论 综上，GCSB-5与CRx-102分别在缓解手骨关节炎疼痛与僵硬症状方面展现出疗效，但对本研究结果的解读需持谨慎态度，临床应结合患者个体情况制定个体化治疗方案。