Abstract
BackgroundThe refractory, repetitive, and disabling characteristic of rheumatoid arthritis (RA) has seriously influenced the patients’ quality of life, and makes it a major public health problem. As a classic complementary and alternative therapy, acupuncture is usually applied for RA combined with disease-modifying anti-rheumatic drugs (DMARDs). However, there are various types of acupuncture, and the curative effects are different in different acupuncture therapies. In this study, we evaluated the clinical efficacy of different acupuncture therapies combined with DMARDs in the treatment of RA.MethodsThe randomized controlled trials (RCTs) of acupuncture combined with DMARDs in the treatment of RA were searched in both English and Chinese database of PubMed, Cochrane Library, EMBASE, Web of Science, CNKI, VIP database, Wanfang, and SinoMED, up to October 2021. Literature screening, data extraction, and evaluation of the risk of bias were carried out independently by two researchers, and the data were analyzed by Stata14.2 and GeMTC 0.14.3 software.ResultsA total of 32 RCTs were included, including 2,115 RA patients. The results of network meta-analysis were as follows: in terms of improving DAS28 score, Electro-acupuncture + DMARDs has the best efficacy. In terms of improving VAS score, Fire Needle + DMARDs showed the best efficacy. In terms of improving morning stiffness time, acupuncture-related therapies combined with DMARDs were not better than DMARDs alone in improving morning stiffness time in RA patients. In terms of reducing CRP and ESR, Fire Needle + DMARDs showed the best efficacy. In terms of reducing RF, Moxibustion + DMARDs has the best efficacy.ConclusionsThe comprehensive comparison of the outcome indicators in 8 different treatments indicates that electro-acupuncture combined with DMARDs is the best combined therapy in improving DAS28 score, while in terms of improving pain and serological markers, fire needle combined with DMARDs and moxibustion combined with DMARDs were the best combined therapies. However, it is impossible to find out which is better between fire needle and moxibustion due to the limited studies. Clinically, appropriate treatment should be selected according to the actual situation.Systematic Review Registration https://www.crd.york.ac.uk/prospero/#recordDetails, CRD42021278233.
Highlights
Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic and erosive polyarthritis [1, 2]
In the included 32 studies [21–52], 12 articles reported moxibustion combined with disease-modifying anti-rheumatic drugs (DMARDs), eight articles reported conventional acupuncture combined with DMARDs, five articles reported electro-acupuncture combined with DMARDs, two articles reported acupoint embedding combined with DMARDs, two articles reported fire needle combined with DMARDs, five articles reported warm needle combined with DMARDs, one article reported auricular acupoints combined with DMARDs, and 30 articles reported DMARDs
The convergence evaluation results showed that the Potential Scale Reduction Factor (PSRF) value was close to 1, and the inconsistent fit model result was similar to the consistent fit model (p = 0.407 > 0.05), indicating fine stability and consistency of results, so the Markov Chain Monte Carlo (MCMC) fitting consistency model was used for analysis
Summary
Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic and erosive polyarthritis [1, 2]. RA seriously affects the quality of life in patients, and it brings a heavy burden to society and economy [5]. The prevalence of RA is about 0.3% to 1% [6], and it is closely related to a variety of chronic diseases to bring a huge care burden [7]. The refractory, repetitive, and disabling characteristic of rheumatoid arthritis (RA) has seriously influenced the patients’ quality of life, and makes it a major public health problem. As a classic complementary and alternative therapy, acupuncture is usually applied for RA combined with disease-modifying anti-rheumatic drugs (DMARDs).
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