Ten trials (n=1,185, range 29 to 303) were included: seven RCTs and three CCTs. Study duration ranged from one to six months. Two studies rated high quality and eight rated low quality.
For patients treated with sinomenine, the number of improved patients was significantly greater when compared with NSAIDs (OR 2.57, 95% CI 1.79 to 3.70; 10 studies) as was the number of rheumatoid-factor-disappeared patients (OR 1.93, 95% CI 1.19 to 3.13; four studies). There was no significant heterogeneity for these comparisons.
Compared with NSAIDs, sinomenine was more effective in amelioration of: morning stiffness (WMD -15.66, 95% CI -19.01 to -12.30; three studies); painful joints (WMD -1.40, 95% CI -2.69 to -0.11; three studies) and erythrocyte sedimentation rate (WMD -2.44, 95% CI -3.39 to -1.49; four studies). Significant heterogeneity was present for the painful joints comparison. No significant differences were observed for the treatment of swollen joints, grip strength and C-reactive protein.
Adverse events occurred less frequently in the digestive system during sinomenine treatment than during NSAID treatment (OR 0.04, 95% CI 0.01 to 0.23; three studies), but occurred more frequently in the dermatomucosal system with sinomenine treatment (OR 3.07, 95% CI 1.14 to 8.22; four studies). There was no significant heterogeneity for these comparisons. Adverse events of the nervous system were similar for both treatments.