Non-pharmacological interventions in the treatment of rheumatoid arthritis: A systematic review and meta-analysis

Matthew A Turk; Yideng Liu; Janet E Pope

doi:10.1016/j.autrev.2023.103323

Non-pharmacological interventions in the treatment of rheumatoid arthritis: A systematic review and meta-analysis

Autoimmun Rev. 2023 Jun;22(6):103323. doi: 10.1016/j.autrev.2023.103323. Epub 2023 Mar 20.

Authors

Matthew A Turk¹, Yideng Liu², Janet E Pope³

Affiliations

¹ University College Dublin School of medicine, Belfield, Dublin 4, Ireland.
² Schulich School of Medicine, University of Western Ontario, St. Joseph's Health Care, London, Ontario, Canada.
³ Schulich School of Medicine, University of Western Ontario, St. Joseph's Health Care, London, Ontario, Canada. Electronic address: janet.pope@sjhc.london.on.ca.

PMID: 36940841
DOI: 10.1016/j.autrev.2023.103323

Abstract

Purpose: To investigate the role of non-pharmaceutical therapies on disease activity in rheumatoid arthritis through systematic review and meta-analysis.

Methods: A review of Pubmed, EMBASE, Web of Science, and the Cochrane Library was performed from inception until March 26, 2019. Only randomized controlled trials which assessed oral, non-pharmacological interventions (e.g. diets, vitamins, oils, herbal remedies, fatty acids, supplements, etc.) in adult patients with rheumatoid arthritis, that presented clinically-relevant outcomes (defined as pain, fatigue, disability, joint counts, and/or disease indices) were included in our meta-analysis. Data were analyzed as mean differences between active and placebo and forest plots were performed. Heterogeneity was evaluated using I-squared statistics while funnel plots and Cochrane's risk of bias assessment evaluated bias.

Results: 8170 articles were identified in the search and 51 were RCTs were included. The mean difference in DAS28 was significantly improved in experimental group treated with diet (-0.46 [-0.91, -0.02], p = 0.04), zinc sulfate, copper sulphate, selenium, potassium, lipoic acid, turmeric, pomegranate extract, chamomile, and cranberry extract supplements (-0.77 [-1.17, -0.38], p < 0.001), A, B6, C, D, E, and K vitamins (-0.52 [-0.74, -0.29], p < 0.001), and fatty acids (-0.19 [-0.36, -0.01], p = 0.03). Other clinical metrics such as SJC, TJC, HAQ, SDAI, ACR20, and self-reported pain were decreased in the treatment groups. There was significant reporting bias in the studies.

Conclusion: Some non-pharmacological therapies may modestly improve some clinical outcomes in patients with rheumatoid arthritis. Many identified studies lacked full reporting. Further clinical trials that are well-designed, adequately powered, and sufficiently report ACR improvement criteria or EULAR response criteria outcomes are needed to confirm the efficacy of these therapies.

Keywords: Non-pharmacological treatment; Rheumatoid arthritis; Systematic literature review; meta-analysis.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Adult
Arthritis, Rheumatoid* / drug therapy
Dietary Supplements
Fatty Acids / therapeutic use
Humans
Pain
Vitamins / therapeutic use

Substances

Vitamins
Fatty Acids