Tianjin University of Traditional Chinese Medicine, Tianjin, China.
Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang, China.
Front Immunol. 2022 Mar 7;13:829409. doi: 10.3389/fimmu.2022.829409. eCollection 2022.
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). 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.
The 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.
A 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.
The 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.
https://www.crd.york.ac.uk/prospero/#recordDetails, CRD42021278233.
类风湿关节炎（RA）的难治性、复发性和致残性严重影响了患者的生活质量，成为一个主要的公共卫生问题。作为一种经典的补充和替代疗法，针灸通常与改善病情的抗风湿药物（DMARDs）联合用于治疗 RA。然而，针灸有多种类型，不同的针灸疗法疗效不同。在这项研究中，我们评估了不同针灸疗法联合 DMARDs 治疗 RA 的临床疗效。
在 PubMed、Cochrane 图书馆、EMBASE、Web of Science、中国知网、维普数据库、万方数据库和中国生物医学文献服务系统中检索英文和中文数据库，检索时间截至 2021 年 10 月，查找针灸联合 DMARDs 治疗 RA 的随机对照试验（RCTs）。由两名研究人员独立进行文献筛选、数据提取和偏倚风险评估，并使用 Stata14.2 和 GeMTC 0.14.3 软件进行数据分析。
共纳入 32 项 RCT，共 2115 例 RA 患者。网络荟萃分析结果如下：在改善 DAS28 评分方面，电针+DMARDs 的疗效最佳。在改善 VAS 评分方面，火针+DMARDs 的疗效最佳。在改善晨僵时间方面，与 DMARDs 相比，针刺相关疗法联合 DMARDs 并不能更好地改善 RA 患者的晨僵时间。在降低 CRP 和 ESR 方面，火针+DMARDs 的疗效最佳。在降低 RF 方面，艾灸+DMARDs 的疗效最佳。
8 种不同治疗方法的综合比较结果表明，电针联合 DMARDs 是改善 DAS28 评分的最佳联合治疗方法，而在改善疼痛和血清学标志物方面，火针联合 DMARDs 和艾灸联合 DMARDs 是最佳联合治疗方法。然而，由于研究数量有限，无法确定火针和艾灸哪种方法更好。临床上应根据实际情况选择合适的治疗方法。
https://www.crd.york.ac.uk/prospero/#recordDetails，CRD42021278233。
