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Background Osteoarthritis (OA) is the most common form of arthritis, causing by multiple factors. It has long been a belief that arthritis pain is influenced by the weather. However, scientific studies have documented inconsistent results. To date, neither systematic review nor meta-analysis of existing findings has comprehensively considered their relations. The present study will critically appraise and synthesize the existing evidence from observational studies that examined the relationship between certain climate conditions and OA. Methods and design: This protocol will be conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. There are no restrictions on the study date or publication status for searches in the Cochrane Library, EMBASE, Web of Science, PubMed, and other relative databases. All eligible observational studies will be included, with weather conditions as effect factors and OA symptom or imaging abnormality as outcomes. Two reviewers will be responsible for data extraction and analysis. Risk of bias and quality appraisal will be performed for the included studies using Newcastle-Ottawa Scale (NOS). Meta-analysis will be conducted using Rev Man V.5.3 with the associations between weather conditions and OA presented by odds ratios (ORs), relative risks (RRs), hazard ratios (HRs) and the 95% confidence intervals (CIs). Results This systematic review and meta-analysis will present the overall association between weather conditions and OA. The association of climate factors influencing OA incidence or progression would be further illustrated in subgroup analysis depending on whether that has been extensively described in the literature. Discussion This study will provide the analysis evidence on the effect of meteorological factors on OA. In an approach of dealing with weather conditions, the results will benefit the daily management of OA.

Objective. The aim of this study is to systematically evaluate the evidence whether traditional Chinese herbal patches (TCHPs) for osteoarthritis (OA) are effective and safe and analyze their medication patterns. Methods. A systematic literature search was performed using all the possible Medical Subject Headings (MeSH) and keywords from January 1979 to July 2013. Both randomized controlled trials (RCTs) and observational studies were included. Estimated effects were analyzed using mean difference (MD) or relative risk (RR) with 95% confidence intervals (CI) and meta-analysis. Results. 86 kinds of TCHPs were identified. RCTs and controlled clinical trials (CCTs) which were mostly of low quality favored TCHPs for local pain and dysfunction relief. TCHPs, compared with diclofenac ointment, had significant effects on global effectiveness rate (RR = 0.50; 95% CI (0.29, 0.87)). Components of formulae were mainly based on the compounds “Xiao Huo Luo Dan” (Minor collateral-freeing pill) and “Du Huo Ji Sheng Tang” (Angelicae Pubescentis and Loranthi decoction). Ten kinds of adverse events (AEs), mainly consisting of itching and/or local skin rashes, were identified after 3-4 weeks of follow-up. Conclusions. TCHPs have certain evidence in improving global effectiveness rate for OA; however, more rigorous studies are warranted to support their use.

Background Knee osteoarthritis (OA) is considered a major public health issue causing chronic disability worldwide with the increasing number of aging people. In China and increasingly worldwide, many sufferers with knee OA are using complementary and alternative medicine including herbal drug, herbal patch, acupuncture and Tuina etc., to alleviate their symptoms. However, evidence gathered from systematic reviews or randomized controlled trials (RCT) has only validated acupuncture for the management of osteoarthritic pain. Moreover, such Traditional Chinese Medicine (TCM) methods above are commonly used in an integrative way. This trial is aimed to compare the efficacy of an individually integrated TCM approach in the management of knee OA with other single treatments as parallel randomized controls. Methods/design Five teaching hospitals will participate in this randomized controlled trial. 500 participants, 100 in each hospital, will be randomly assigned to receive oral administration of a Chinese herbal drug (counter osteophytes capsule), topical use of a Chinese herbal patch (Fufnag Zijin patch), acupuncture, Tuina and the individually integrated TCM approach. The individually integrated TCM approach consists of basic treatment of oral counter osteophytes capsule, variable use of Tuina, acupuncture and a herbal patch based on the severity of the patient's symptoms. The interventions are given for a period of 4 weeks. The primary outcome measure is the self-reported total score using the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcome measures include patient and investigator global assessment of response to treatment, patient and investigator global assessment of OA condition, WOMAC pain, stiffness, and physical function subscales, short-form 36 (SF-36) and TCM assessment of OA condition measured by syndromes questionnaire. Mixed models and sensitivity analysis will be used for the statistical analysis. Discussion The trial is designed to test the hypothesis that an individually integrated TCM approach is more effective than four treatment modalities used separately. The major limitation of this study is lack of placebo control and of double blinding. Trial Registration Chinese Cochrane Center ChiCTR-TRC-00000176