[Objective] This study focuses on evaluating the actual efficacy of DMARDs (drugs used for anti-rheumatic therapy) in the treatment of osteoarthritis. [Method] The research team conducted a comprehensive literature search in multiple authoritative databases, including PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Database, and CBM, through computer retrieval. The search scope is limited to randomized controlled trials (RCTs) studying the application of DMARDs in the treatment of osteoarthritis, with a time span from the creation of each database to December 2024. Two researchers independently conducted literature screening and data extraction based on pre-set inclusion and exclusion criteria. The research quality was evaluated using the Cochrane bias risk assessment tool and statistical analysis was conducted using RevMan 5.4 software. [Result] After screening, a total of 15 randomized controlled trials were included in this analysis, which involved 8 different DMARDs drugs, including methotrexate, hydroxychloroquine, Iguatemo, adalimumab, etanercept, tocilizumab, Orthokin, and Anakin. In terms of participants, the experimental group had a total of 771 people, while the control group had 784 people. The meta-analysis results showed that DMARDs exhibited significant efficacy in relieving pain in patients with osteoarthritis, with an overall standardized mean difference of [SMD=-0.44, 95% CI (-0.78, -0.10), P=0.01]. Further analysis revealed that conventional synthesized DMARDs had a more prominent effect [SMD=-0.71, 95% CI (-1.23, -0.20), P=0.007], while biosynthetic DMARDs had a relatively weaker effect [SDM=-0.04, 95% confidence interval (-0.20, 0.12), P=0.62]. In terms of specific drugs, methotrexate showed significant efficacy in relieving pain [SD=-0.71, 95% confidence interval (-1.32, -0.11), P=0.02], while hydroxychloroquine [SD=-0.19, 95% confidence interval (-0.53, -0.15), P=0.28] and TNF – α inhibitors [SD=-0.09, 95% confidence interval (-0.37, 0.18), P=0.50] did not show significant efficacy. Similarly, interleukin receptor antagonists did not show significant effects [SMD=-0.01, 95% CI (-0.22, 0.19), P=0.91]. In terms of pain relief for specific types of osteoarthritis, DMARDs have limited relief for osteoarthritis [SMD=-0.12, 95% CI (-0.26, 0.02), P=0.10], while their relief for knee osteoarthritis is more significant [SMD=-0.88, 95% CI (-1.65, -0.11), P=0.02]. In addition, methotrexate, hydroxychloroquine, and interleukin-1 receptor antagonists showed significant effects in improving joint function [SMD=-0.90, 95% CI (-1.73, -0.08), P=0.03]. [Conclusion] There are differences in the effectiveness of DMARDs in relieving pain in osteoarthritis. Methotrexate has been proven to be an effective choice for treating patients with moderate to severe osteoarthritis or severe osteoarthritis accompanied by obvious synovitis, especially in the treatment of knee osteoarthritis. On the contrary, hydroxychloroquine, adalimumab, etanercept, tocilizumab, Orthokin, and Anakinra did not show significant pain relief effects in the treatment of osteoarthritis. Meanwhile, methotrexate, hydroxychloroquine, and IL-1 receptor antagonists did not show significant effects in improving overall joint function.
