## 3 Results  
### Literature Search and Selection Process  
A comprehensive search across various electronic databases yielded 2212 records. After eliminating duplicate and irrelevant studies by scrutinizing the titles and abstracts, 13 full-text articles were assessed for eligibility. Finally, five studies with six RCTs comprising a total of 329 participants were included in this meta-analysis (Figure 1).  
\begin{table}
\begin{tabular}{c c c c c c} \hline \hline
**Study** & **Formulation** & **Source** & **Species, Concentration** & **Quality Control** & **Chemical Analysis** \\  & & & & **Reported?** (Y/N) & **Reported?** (Y/N) \\ \hline  & Instaflex(tm) contains: & & & & \\  & glucosamine sulfate (1500 mg) & & & & \\  & methylsulfonyl-methane (MSM) (500 mg) & & & & \\  & white willlow bark extract (standardized to & & & \\  & 15% silica) (520 mg) & & & white willow bark, 15\% & \\ DC Nieman 2013 [35] & Singer not concentrate (50 mg) & Direct Digital, Charlotte, & & & \\  & Boweils serata extract (standardized to & United State, North Carolina, & & \\  & 65\% boswellic acid) (125 mg) & & & \\  & turmeter root extract (50 mg) & & & \\  & cyzenet 40 mH (1.60 mg) & & & \\  & hyaluronic acid (4.0 mg) & & & \\ \hline  & Pain Bico-Routhins (per capsule): & & & \\  & Vitamin DS (as chokcal  
\begin{table}
\begin{tabular}{c c c c c c c c c c} \hline \hline \multirow{2}{*}{**Outcome**} & **Number of Studies** & **Number of Participants** & **Risk of Bias** & **Imprecision** & **Inconsistency** & **Indirectness** & **Publication Bias** & **Relative Effect (95\%** & **Confidence** & **Confidence** **in Effect Estimate Interval**) & **Confidence** **(Grade)** \\ \hline Pain & 4 & 229 & Serious & Serious & Moderate & Not serious & Serious & \(-0.31\) (\(-0.53\), & Very low \\  & & & & & & & & \(-0.08\) (\(-1.08\), & Very low \\ \hline WOMAC & 4 & 276 & Serious & Serious & Serious & Not serious & Serious & \(-0.80\) (\(-1.08\), & Very low \\  & & & & & & & & \(-0.53\)) & Very low \\ \hline Adverse & 5 & 329 & Serious & Serious & Not serious & Not serious & Serious & \(1.37\) (\(0.79\), \(2.37\)) & Very low \\  & & & & & & & & & \\ \hline \hline \end{tabular}
\end{table}
Table 4: GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) criteria for assessing the quality of evidence.  
\begin{table}
\begin{tabular}{c c c c c} \hline \hline \multirow{2}{*}{**Study**} & **Compound,** & \multirow{2}{*}{**Source**} & **Purity (\%)** & **Quality Control** \\  & **Concentration** & & **(and Grade, If** & **Reported?** \\  & & & & **Applicable)** & **(Y/N)** \\ \hline [PERSON] 2001 [34] & Salicin, 17.6\% & _Salix purpurea \(\times\)daphonoides_ & N & N \\ \hline [PERSON] 2004 [37] & Salicin, 15\% & _Salix daphonoides_ & N & N \\ \hline  & & & White willow, wild yam, bogbean, & & \\  & & & meadowsweet, black cohosh, & & \\ [PERSON] 2008 & & & ginger, dandelion root, celery seed, & & \\
[38] & Nil & & licorice, devil’s claw, turmeric (did & N & N \\  & & & not report the concentration of & & \\  & & & every herb) & & \\ \hline \hline \end{tabular}
\end{table}
Table 3: Isolated chemical compounds from the included studies.  
Figure 2: ROB2, risk of bias assessment of the included studies, and the summary of domains. The study conducted by [PERSON] et al. comprised two distinct trials. The first trial focused on osteoarthritis and was designated as “C Biegert 2004”. The second trial, which centered on rheumatoid arthritis, was labeled “C Biegert 2004”. See refs. [34; 35; 36; 37; 38].