Table4_The combination of Chinese and Western Medicine in the management of rheumatoid arthritis: A real-world cohort study across China.DOCX

Objective: To investigate the efficacy of Integrative medicine (IM), compare with Western medicine (WM), in the treatment of rheumatoid arthritis (RA) in a cohort study.
Methods: This is a cohort study with recruitment of RA patients from 10 hospitals in China. The primary outcome was change in disease activity score 28 (DAS28) during 4 follow-up visits. Generalized estimating equation (GEE) models that controlled for variables were used to investigate a time trend and assess group differences in the primary outcome and secondary outcomes after propensity score matching (PSM).
Results: A total of 3195 patients with RA received IM (n = 1379, 43.2%) or WM (n = 1816, 56.8%). Following 1:1 propensity score matching, 1,331 eligible patients prescribed IM were compared to 1,331 matched patients prescribed WM. The GEE analysis with PSM showed that the IM was more beneficial to significantly decrease the levels of VAS, PGA and PhGA (VAS: odds ratio (OR), 0.76; 95% CI, 0.63–0.92; p = 0.004; PGA: OR, 0.76; 95% CI, 0.64–0.92; p = 0.007; and PhGA: OR, 0.77; 95% CI, 0.64, 0.93; p = 0.004), and reduce DAS28 (OR, 0.84; 95% CI, 0.73–0.98; p = 0.030) in the per-protocol population.
Conclusion: This study suggests that compare to WM, IM has advantages in improving RA-related outcomes. However, the statistical significance might not reveal significant clinical difference. Further studies should be focused on specific treatment strategies and/or disease stages.

研究目的：本队列研究旨在探讨整合医学（Integrative medicine, IM）相较于西医（Western medicine, WM）治疗类风湿关节炎（rheumatoid arthritis, RA）的疗效。
研究方法：本研究为队列研究，招募了来自中国10家医院的类风湿关节炎患者。主要结局指标为4次随访期间的疾病活动度评分28（disease activity score 28, DAS28）变化。采用校正混杂变量的广义估计方程（generalized estimating equation, GEE）模型，在倾向得分匹配（propensity score matching, PSM）后分析时间趋势，并评估主要及次要结局指标的组间差异。
研究结果：共计3195名类风湿关节炎患者接受整合医学治疗（n=1379，占比43.2%）或西医治疗（n=1816，占比56.8%）。经1:1倾向得分匹配后，纳入1331名接受整合医学治疗的合格患者与1331名匹配的西医治疗患者进行对照。经倾向得分匹配后的广义估计方程分析显示，在符合方案人群中，整合医学可显著降低视觉模拟评分（Visual Analogue Scale, VAS）、医生整体评估（Physician Global Assessment, PGA）及患者整体评估（Patient Global Assessment, PhGA）水平（VAS：比值比（odds ratio, OR）=0.76，95%置信区间（confidence interval, CI）：0.63~0.92，p=0.004；PGA：OR=0.76，95%CI：0.64~0.92，p=0.007；PhGA：OR=0.77，95%CI：0.64~0.93，p=0.004），同时可降低疾病活动度评分28（OR=0.84，95%CI：0.73~0.98，p=0.030）。
研究结论：本研究表明，相较于西医治疗，整合医学在改善类风湿关节炎相关结局方面具有优势。但该统计学显著性差异未必能体现显著的临床价值，未来研究应聚焦于特定治疗策略及/或疾病分期。