Background:Gout is a joint disease that causes severe pain,which is associated with hyperuricemia resulting from disorders of purine metabolism and/or impaired urate production and excretion.In addition to the recomme...Background:Gout is a joint disease that causes severe pain,which is associated with hyperuricemia resulting from disorders of purine metabolism and/or impaired urate production and excretion.In addition to the recommended pharmacological treatments,complementary and alternative medicine(CAM)plays a key role in disease management of hyperuricemia and gout.It seems necessary to identify their comparative effectiveness.Objective:This study aims to determine the efficacy of CAM therapy and to identify their comparative effectiveness on pain reduction and urate-lowering in patients with hyperuricemia and gout by reviewing randomized controlled trial.Methods:A systematic search was conducted in three electronic databases from inception to March 1,2025 for studies investigating the efficacy of CAM on hyperuricemia and gout.Pairwise and network meta-analysis were sequentially performed to quantify the efficacy of each category of interventions and to compare the relative effectiveness,respectively.Meta-regression was performed to evaluate the potential influence of study design and participants'characteristics on the intervention effectiveness.Results:A total of 89 studies with 9293 participants were included.Interventions were categorized into acupuncture,dietary supplements,patient education,and Chinese herbal medicine.Pairwise meta-analysis revealed that acupuncture had a positive effect on urate-lowering(SMD=-0.61,95%CI[-0.82,-0.40],P<0.01).Dietary supplements also demonstrated a positive effect on urate-lowering(SMD=-0.95,95%CI[-1.29,-0.61],P<0.01).The results showed that the efficacy of patient education on urate-lowering was significant compared with the control group(SMD=-2.01,95%CI[-2.90,-1.11],P<0.01).Chinese herbal medicine had statistically significant effects on urate-lowering(SMD=-1.39,95%CI[-1.80,-0.99],P<0.01)and on reducing pain(SMD=-1.14,95%CI[-1.49,-0.78],P<0.01).Acupuncture,dietary supplements and Chinese herbal medicine significantly improved the pain condition.Subgroup analysis suggested that appropriate extension of the course of acupuncture and shortening the duration of dietary supplements are more effective in lowering uric acid levels.Network meta-analysis indicated that patient education and acupuncture are most effective when using urate-lowering or pain reduction as outcome measures,respectively.Meta-regression further demonstrated that intervention measures and the duration of treatment were factors that influenced therapeutic efficacy.Conclusion:This review outlines the efficacy of complementary and alternative medicine on urate-lowering and pain reduction in patients with hyperuricemia and gout,and highlights the significant advantage of patient education in the long-term treatment of reducing uric acid levels,while acupuncture shows superior effectiveness in short-term pain management.展开更多
基金supported by grants from National Key R&D Program of China(No.2022YFC3501204)Key R&D Program of Zhejiang(NO.2023C03040)。
文摘Background:Gout is a joint disease that causes severe pain,which is associated with hyperuricemia resulting from disorders of purine metabolism and/or impaired urate production and excretion.In addition to the recommended pharmacological treatments,complementary and alternative medicine(CAM)plays a key role in disease management of hyperuricemia and gout.It seems necessary to identify their comparative effectiveness.Objective:This study aims to determine the efficacy of CAM therapy and to identify their comparative effectiveness on pain reduction and urate-lowering in patients with hyperuricemia and gout by reviewing randomized controlled trial.Methods:A systematic search was conducted in three electronic databases from inception to March 1,2025 for studies investigating the efficacy of CAM on hyperuricemia and gout.Pairwise and network meta-analysis were sequentially performed to quantify the efficacy of each category of interventions and to compare the relative effectiveness,respectively.Meta-regression was performed to evaluate the potential influence of study design and participants'characteristics on the intervention effectiveness.Results:A total of 89 studies with 9293 participants were included.Interventions were categorized into acupuncture,dietary supplements,patient education,and Chinese herbal medicine.Pairwise meta-analysis revealed that acupuncture had a positive effect on urate-lowering(SMD=-0.61,95%CI[-0.82,-0.40],P<0.01).Dietary supplements also demonstrated a positive effect on urate-lowering(SMD=-0.95,95%CI[-1.29,-0.61],P<0.01).The results showed that the efficacy of patient education on urate-lowering was significant compared with the control group(SMD=-2.01,95%CI[-2.90,-1.11],P<0.01).Chinese herbal medicine had statistically significant effects on urate-lowering(SMD=-1.39,95%CI[-1.80,-0.99],P<0.01)and on reducing pain(SMD=-1.14,95%CI[-1.49,-0.78],P<0.01).Acupuncture,dietary supplements and Chinese herbal medicine significantly improved the pain condition.Subgroup analysis suggested that appropriate extension of the course of acupuncture and shortening the duration of dietary supplements are more effective in lowering uric acid levels.Network meta-analysis indicated that patient education and acupuncture are most effective when using urate-lowering or pain reduction as outcome measures,respectively.Meta-regression further demonstrated that intervention measures and the duration of treatment were factors that influenced therapeutic efficacy.Conclusion:This review outlines the efficacy of complementary and alternative medicine on urate-lowering and pain reduction in patients with hyperuricemia and gout,and highlights the significant advantage of patient education in the long-term treatment of reducing uric acid levels,while acupuncture shows superior effectiveness in short-term pain management.
