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The effectiveness of treatments for Kashin–Beck disease: a systematic review and network meta-analysis

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Clinical Rheumatology Aims and scope Submit manuscript



This study aims to evaluate the efficacy of treatments for Kashin–Beck disease (KBD).


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.


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.


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.

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KZ conceptualised and designed the study. KZ and JLH screened the literature and selected the study. KZ extracted data and accessed the quality of trials, conducted the analysis and wrote the draft of the manuscript. QZ wrote part of the discussion. WZ and BD advised on the analysis and the representation of the results. All authors contributed to the intellectual interpretation of the findings and approved the final manuscript.


QZ was supported by the Innovation Research Grant from the University of Electronic Science and Technology, Chengdu, China.

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Correspondence to Weiya Zhang.

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Zou, K., Hu, J., Zhou, Q. et al. The effectiveness of treatments for Kashin–Beck disease: a systematic review and network meta-analysis. Clin Rheumatol 38, 3595–3607 (2019).

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