Canter P H, Wider B, Ernst E
Department of Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, 25 Victoria Park Road, Exeter EX2 4NT, UK.
Rheumatology (Oxford). 2007 Aug;46(8):1223-33. doi: 10.1093/rheumatology/kem116. Epub 2007 May 23.
To systematically review the evidence from randomized clinical trials (RCTs) for the effectiveness of the antioxidant vitamins A, C, E or selenium or their combination in the treatment of arthritis. METHODSL: A systematic search of computerized databases from inception to September 2006 for relevant RCTs, application of pre-defined inclusion/exclusion criteria and independent data extraction by two authors. Methodological quality was assessed using the Jadad scale.
The searches identified 20 unique RCTs meeting the inclusion criteria: 11 in inflammatory arthritis and 9 in osteoarthritis (OA). The studies included are generally of poor quality. They fall into three main clusters: selenium for rheumatoid arthritis (n = 5); vitamin E for inflammatory arthritis (n = 5) and vitamin E for OA (n = 7). One RCT suggests superiority of vitamin E over placebo and three RCTs suggest equivalence between vitamin E and diclofenac in the treatment of inflammatory arthritis. In OA, four RCTs compared vitamin E with placebo. Two shorter-term studies were positive and two longer-term studies were negative. Two further RCTs suggest equivalence between vitamin E and diclofenac in the treatment of OA. Findings for selenium, vitamin A and a combination product in inflammatory arthritis and for vitamin A, and a combination product in OA were negative. An isolated positive result for vitamin C in OA is of doubtful clinical significance.
Clinical trials testing the efficacy of vitamin E in the treatment of OA and inflammatory arthritis have been methodologically weak and have produced contradictory findings. There is presently no convincing evidence that selenium, vitamin A, vitamin C or the combination product selenium ACE is effective in the treatment of any type of arthritis.
系统评价随机临床试验（RCT）中抗氧化维生素A、C、E或硒及其组合治疗关节炎有效性的证据。方法：对截至2006年9月的计算机化数据库进行系统检索以查找相关RCT，应用预先定义的纳入/排除标准，并由两位作者独立提取数据。使用Jadad量表评估方法学质量。
检索确定了20项符合纳入标准的独特RCT：11项针对炎性关节炎，9项针对骨关节炎（OA）。纳入的研究质量普遍较差。它们主要分为三类：用于类风湿关节炎的硒（n = 5）；用于炎性关节炎的维生素E（n = 5）和用于OA的维生素E（n = 7）。一项RCT表明维生素E优于安慰剂，三项RCT表明在治疗炎性关节炎时维生素E与双氯芬酸等效。在OA中，四项RCT将维生素E与安慰剂进行了比较。两项短期研究结果为阳性，两项长期研究结果为阴性。另外两项RCT表明在治疗OA时维生素E与双氯芬酸等效。在炎性关节炎中，关于硒、维生素A及其组合产品以及在OA中关于维生素A及其组合产品的研究结果均为阴性。OA中维生素C的一项孤立的阳性结果临床意义存疑。
测试维生素E治疗OA和炎性关节炎疗效的临床试验方法学存在缺陷，且结果相互矛盾。目前没有令人信服的证据表明硒、维生素A、维生素C或硒ACE组合产品对任何类型的关节炎有效。
