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. 1. Introduction OA, which is manifested by joint pain, disability, stiffness, and/or swelling, is a common chronic disease in the elderly worldwide [1–3]. In Traditional Chinese Medicine (TCM), symptoms of OA are usually known as “Bi-arthralgia” or “flaccidity” [4]. Conventional therapies for the management of OA consist of exercises, weight loss, acetaminophen, and oral and topical nonsteroidal anti-inflammatory drugs (NSAIDs), as well as intra-articular injection and several other treatments [3]. Such treatments may prove ineffective in some OA patients, and NSAIDs often have gastrointestinal (GI) and cardiovascular adverse events (AEs) [3, 5], so patients are turning increasingly to complementary and alternative medicine (CAM) as treatment options for OA [5]. Some reviews provide evidence for the effectiveness of herbal medicines for OA [5–8]. At the same time, external medications for the treatment of mild or moderate OA pain have been advocated by both the Chinese Orthopedic Association (COA) and the American College of Rheumatology (ACR), because it is deemed to have relatively less AEs and is more convenient for use [3, 9]. In many topical herbal medications, the patch or plaster is most frequently prescribed
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