中醫治療對高齡多關節骨關節炎急性醫療事件之保護效果：一項真實世界證據研究

Traditional Chinese Medicine as a Protective Factor Against Acute Healthcare Events in Geriatric Multi-joint Osteoarthritis: A Real-World Evidence

目的：探討中西醫結合治療對老年多關節骨關節炎（MJOA）患者急診與住院風險之影響及中藥效益。方法：回溯性世代研究，納入2016至2022年≥65歲MJOA患者（平均年齡73.6歲），分為純西醫組（WM, 7848人）與中西醫合併組（CWM, 2306人）。採28天地標分析（Landmark analysis）以消除不死時間偏誤（immortal time bias, ITB)，以傾向分數配對（PSM）平衡基線。用單變量Cox模型評估風險比（HR），並對龜鹿二仙膠（GEJ）進行亞組分析。結果：校正ITB後，與WM組比較，CWM組顯著降低住院風險（HR=0.873；95% CI：0.812 to 0.939；p<0.001），急診風險無顯著差異。GEJ亞組亦顯著降低住院風險（HR=0.861；95% CI：0.794 to 0.933；p <0.001），而急診風險下降趨勢未達顯著（p=0.088）。中醫藥介入時間分析顯示：即時（0天）或早期（≤3個月）介入可顯著降低住院風險，延遲（>3個月）則無益處。結論：中西醫結合與高齡MJOA患者住院風險的顯著降低相關。核心處方GEJ可能透過緩解關節退化與骨肉減少症展現保護力。本研究支持中醫藥作為老年MJOA的輔助療法，更強調及早中醫藥介入對於高齡MJOA患者降低急性醫療負擔的價值。

Objective: To investigate the impact of integrative traditional Chinese and Western medicine (CWM) on the risks of emergency department (ED) visits and hospitalizations in older patients with multi-joint osteoarthritis (MJOA), and to evaluate the clinical benefits of Chinese herbal medicines. Methods: This retrospective cohort study included MJOA patients aged≥65 years (mean age: 73.6 years) diagnosed between 2016 and 2022. Patients were categorized into a Western medicine group (WM; n=7,848) and an integrative CWM group (n=2,306). A 28-day landmark analysis was used to mitigate immortal time bias (ITB), and propensity score matching (PSM) was applied to balance baseline characteristics. Univariate Cox proportional hazards models were used to estimate hazard ratios (HRs). Furthermore, a subgroup analysis was conducted for users of the formula Gui-Lu-Er-Xian-Jiao (GEJ). Results: After ITB adjustment, the CWM group showed a significantly lower risk of hospitalization compared to the WM group (HR=0.873; 95% CI: 0.812 to 0.939; p<0.001), while the risk of ED visits showed no significant difference. The GEJ subgroup also demonstrated a significantly reduced hospitalization risk (HR=0.861; 95% CI: 0.794 to 0.933; p<0.001); however, the trend toward a reduced ED risk did not reach statistical significance ( p=0.088). Additionally, timing analyses revealed that immediate (day 0) or early (≤3 months) intervention significantly reduced the hospitalization risk, whereas delayed intervention (>3 months) yielded no protective benefits. Conclusion: Integrative CWM was associated with a lower risk of hospitalization in older MJOA patients. As a core formula, GEJ exerts protective effects, likely by helping mitigate the dual burden of joint degeneration and osteosarcopenia. These findings support traditional Chinese medicine as a valuable adjunctive therapy for MJOA and highlight the critical importance of early intervention in mitigating the acute healthcare burden in aging populations.