Moxibustion, an acupuncture-like intervention, is increasingly used in the management of rheumatic conditions. The aim of this review is to summarize and critically evaluate the trials testing effectiveness of moxibustion for major rheumatic conditions. Fourteen databases were searched from their inception through May 2010, without language restriction. Randomized clinical trials (RCTs) were included if moxibustion was used as the sole treatment or as a part of a combination therapy with conventional drugs for rheumatic conditions. Cochrane criteria were used to assess the risk of bias. A total of 14 RCTs met our inclusion criteria. All were of low methodological quality. The meta-analysis of the eight RCTs suggested favorable effects of moxibustion on the response rate compared with conventional drug therapy [n = 631; relative risk (RR), 1.13; 95% confidence intervals (CIs), 1.02 to 1.26; P = 0.02] with high heterogeneity (I (2) = 58%). A subgroup analysis showed significant effects of moxibustion on the RR compared with drug therapy in patients with knee osteoarthritis, whereas it failed to do so in rheumatoid arthritis. The results of meta-analysis of the six RCTs suggested favorable effects of moxibustion plus drug therapy on the response rate compared with conventional drug therapy alone (n = 433; RR, 1.25; 95% CIs, 1.09 to 1.43; P = 0.02) with high heterogeneity (I (2) = 62%). This systematic review fails to provide conclusive evidence for the effectiveness of moxibustion compared with drug therapy in rheumatic conditions. The total number of RCTs included in this review and their methodological quality were low. These limitations make it difficult to draw firm conclusions.