Kun Zou1, Jinliang Hu2, Qiao Zhou3, Jiang Su3, Birong Dong4, Weiya Zhang5. 1. West China Research Centre of Rural Health Development, Department of Health Policy and Management, West China School of Public Health, West China Forth Hospital, Sichuan University, Chengdu, China. 2. Institution of Health Policy and Hospital Management, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Affiliated Hospital of the University of Electronic Science and Technology, Chengdu, China. 3. Department of Rheumatology and Immunology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Affiliated Hospital of the University of Electronic Science and Technology, Chengdu, China. 4. Centre of Gerontology and Geriatrics, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China. 5. Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, Nottingham City Hospital, University of Nottingham, Room A18, Hucknall Road, Nottingham, NG5 1PB, UK. weiya.zhang@nottingham.ac.uk.
Abstract
OBJECTIVES: This study aims to evaluate the efficacy of treatments for Kashin-Beck disease (KBD). METHOD: We searched PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, SinoMed, Chinese National Knowledge Infrastructure, reference lists and published systematic reviews and registries of ongoing trials through May 2015 for randomised controlled trials (RCTs) of treatments for KBD. Outcomes of interest were pain, function, stiffness, overall clinical improvement, radiographic improvement (X-ray) and adverse events. Frequentist network meta-analyses were conducted using random-effects consistency model to assess the efficacy of treatments for KBD. RESULTS: Forty-four RCTs with 9815 participants were included in the review. In children or adolescents, selenium (risk ratio 1.88, 95% confidence interval (CI) 1.51-2.33), vitamin C (2.03, 1.40-2.95) and aspirin (2.14, 1.12-4.08) were effective for radiographic structure improvement. In adults, chondroitin plus glucosamine was the best for pain (standardised mean difference 1.46, 95% CI 1.07-1.85), followed by intra-articular injection of hyaluronic acid (IAH) (1.09, 0.70-1.48), chondroitin (0.84, 0.47-1.21), diclofenac (0.63, 1.18-1.08), naproxen (0.55, 0.12-0.98), meloxicam (0.52, 0.03-1.01) and glucosamine (0.40, 0.13-0.67) compared to placebo, with similar results for other clinical outcomes in adults. However, the strength of most evidence was limited by the small number of trials with low to moderate quality. CONCLUSIONS: Selenium supplement has demonstrated some benefits for structural improvement of the disease in children. Chondroitin, glucosamine, IAH and nonsteroid anti-inflammatory drugs are effective for symptom improvements of KBD in adults. Evidence of surgical and complementary treatments for symptoms and aspirin and vitamin C for structure has yet to be established.Key Points• There were 23 nutraceuticals, pharmaceuticals and surgical and complementary treatments assessed for Kashin-Beck disease (KBD) in randomised trials.• Among the 23 treatments, chondroitin, glucosamine, IAH and non-steroid anti-inflammatory drugs are more effective than placebo to relieve symptoms for adults with KBD.• Selenium supplement is more effective than placebo for radiographic improvement in children or adolescents.• The efficacy of surgeries, aspirin, vitamin C and complementary treatments for KBD has not been established yet.
OBJECTIVES: This study aims to evaluate the efficacy of treatments for Kashin-Beck disease (KBD). METHOD: We searched PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, SinoMed, Chinese National Knowledge Infrastructure, reference lists and published systematic reviews and registries of ongoing trials through May 2015 for randomised controlled trials (RCTs) of treatments for KBD. Outcomes of interest were pain, function, stiffness, overall clinical improvement, radiographic improvement (X-ray) and adverse events. Frequentist network meta-analyses were conducted using random-effects consistency model to assess the efficacy of treatments for KBD. RESULTS: Forty-four RCTs with 9815 participants were included in the review. In children or adolescents, selenium (risk ratio 1.88, 95% confidence interval (CI) 1.51-2.33), vitamin C (2.03, 1.40-2.95) and aspirin (2.14, 1.12-4.08) were effective for radiographic structure improvement. In adults, chondroitin plus glucosamine was the best for pain (standardised mean difference 1.46, 95% CI 1.07-1.85), followed by intra-articular injection of hyaluronic acid (IAH) (1.09, 0.70-1.48), chondroitin (0.84, 0.47-1.21), diclofenac (0.63, 1.18-1.08), naproxen (0.55, 0.12-0.98), meloxicam (0.52, 0.03-1.01) and glucosamine (0.40, 0.13-0.67) compared to placebo, with similar results for other clinical outcomes in adults. However, the strength of most evidence was limited by the small number of trials with low to moderate quality. CONCLUSIONS:Selenium supplement has demonstrated some benefits for structural improvement of the disease in children. Chondroitin, glucosamine, IAH and nonsteroid anti-inflammatory drugs are effective for symptom improvements of KBD in adults. Evidence of surgical and complementary treatments for symptoms and aspirin and vitamin C for structure has yet to be established.Key Points• There were 23 nutraceuticals, pharmaceuticals and surgical and complementary treatments assessed for Kashin-Beck disease (KBD) in randomised trials.• Among the 23 treatments, chondroitin, glucosamine, IAH and non-steroid anti-inflammatory drugs are more effective than placebo to relieve symptoms for adults with KBD.• Selenium supplement is more effective than placebo for radiographic improvement in children or adolescents.• The efficacy of surgeries, aspirin, vitamin C and complementary treatments for KBD has not been established yet.
Authors: C Suetens; R Moreno-Reyes; C Chasseur; F Mathieu; F Begaux; E Haubruge; M C Durand; J Nève; J Vanderpas Journal: Int Orthop Date: 2001 Impact factor: 3.075
Authors: Gordon Guyatt; Andrew D Oxman; Elie A Akl; Regina Kunz; Gunn Vist; Jan Brozek; Susan Norris; Yngve Falck-Ytter; Paul Glasziou; Hans DeBeer; Roman Jaeschke; David Rind; Joerg Meerpohl; Philipp Dahm; Holger J Schünemann Journal: J Clin Epidemiol Date: 2010-12-31 Impact factor: 6.437
Authors: T E Towheed; L Maxwell; T P Anastassiades; B Shea; J Houpt; V Robinson; M C Hochberg; G Wells Journal: Cochrane Database Syst Rev Date: 2005-04-18