Acupuncture for ankylosing spondylitis: An updated systematic review and meta-analysis

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Background: Existing evidence is insufficient to support that acupuncture is effective in treating ankylosing spondylitis (AS) due to the constraints of acupuncture site and manipulation, and relatively straightforward study treatments and indicators. Objective: By incorporating high-quality original literature, this study aims to evaluate the effectiveness of acupuncture for AS and to demonstrate acupuncture as a non-drug supplementary and alternative means for treating AS. Methods: We searched seven databases from their inception to March 31, 2023. Only randomized controlled trials (RCTs) with PEDro score ≥ 6 that compared traditional acupuncture alone or in combination with non-acupuncture therapy on diagnostic AS were considered. The PEDro, ROB2, and STATA tools were used for quality evaluation and statistical analysis. Results: A total of 21 RCTs covering 1884 patients were included. Meta-analysis showed that acupuncture had positive effects on Western medicine effective rate (RR = 1.223, 95%CI: 1.150, 1.301, P < 0.001), traditional Chinese medicine effective rate (RR = 1.175, 95%CI: 1.111, 1.243, P < 0.001), pain score (visual analogue scale, SMD = −0.666, 95%CI: −0.801, −0.531, P < 0.001), spinal function including bath ankylosing spondylitis function index score (SMD = −0.827, 95%CI: −0.945, −0.708, P < 0.001), bath ankylosing spondylitis disease activity index score (SMD = −1.069, 95%CI: −1.190, −0.949, P < 0.001), and bath ankylosing spondylitis metrology index score (SMD = −0.699, 95%CI: −0.887, −0.511, P < 0.001), ankylosing spondylitis quality of life score(SMD = −0.619, 95%CI: −0.917, −0.322, P < 0.001), C-reactive protein levels (SMD = −0.980, 95%CI: −1.092, −0.868, P < 0.001) and erythrocyte sedimentation rate value (SMD = −0.701, 95%CI: −0.810, −0.591, P < 0.001). Conclusion: Though with a high risk of bias, the high-quality studies indicate that acupuncture is a beneficial complementary and alternative therapy for AS patients, as it can reduce pain intensity and improve effective rate, spinal function, and anti-inflammatory response.