Feng Yun, Zhang Rui, Zhao Zhenni, He Yanyan, Pang Xiangtian, Wang Danwen, Sun Zhiling
College of Nursing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, 210023, China.
Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu Province, 210029, China.
Heliyon. 2023 Feb 26;9(3):e14014. doi: 10.1016/j.heliyon.2023.e14014. eCollection 2023 Mar.
The aim of this study was to evaluate the effect of electroacupuncture (EA) combined with medication on clinical efficacy, pain scores (Visual Analogue Scale, [VAS]), Disease Activity Score in 28 joints (DAS28), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and adverse events in treating patients with rheumatoid arthritis (RA).
A systematic search of PubMed, the Cochrane Library, Web of Science, Embase, SinoMed, China National Knowledge Infrastructure, Wanfang, and VIP until December 12, 2021 was used to identify randomized controlled trials (RCTs) on the EA treatment of RA. Study selection and data extraction were performed critically and independently by two reviewers. Cochrane criteria for risk of bias was used to evaluate the methodological quality of the trials. The Grading of Recommendations Assessment, Development, and Evaluation Methodology (GRADE) was applied to assess the quality of evidence from quantitative analysis.
Seventeen RCTs, including 1317 patients, satisfied the inclusion criteria. Compared with the control group, EA combined with medication had a superior effect on clinical efficacy (RR = 1.25 [95% CI = 1.18 to 1.33], < 0.00001), VAS score (MD = -1.34 [95% CI = -1.90 to -0.78], < 0.00001), DAS28 (MD = -0.76 [95% CI = -1.08 to -0.44], < 0.00001), CRP level (SMD = -1.46 [95% CI = -2.19 to -0.74], < 0.0001), and ESR (MD = -7.74 [95% CI = -13.77 to -1.72], = 0.01). Compared with the control group, the meta-analysis showed no significant changes in adverse events in the EA group (RR = 1.08 [95% CI = 0.51 to 2.25], = 0.85). The evidence level of the results from the 17 studies was very low to moderate.
EA combined with medication showed a superior effect than Western medicine alone in clinical efficacy, VAS, DAS28, CRP, and ESR. The clinical safety of EA warrants further investigation in experimental studies.
本研究旨在评估电针（EA）联合药物治疗类风湿关节炎（RA）患者时，对临床疗效、疼痛评分（视觉模拟评分法，[VAS]）、28个关节疾病活动评分（DAS28）、C反应蛋白（CRP）、红细胞沉降率（ESR）及不良事件的影响。
系统检索PubMed、Cochrane图书馆、科学网、Embase、中国生物医学文献数据库、中国知网、万方数据和维普资讯，检索截至2021年12月12日关于EA治疗RA的随机对照试验（RCT）。由两名研究者严格独立进行研究筛选和数据提取。采用Cochrane偏倚风险标准评估试验的方法学质量。应用推荐分级的评估、制定和评价方法（GRADE）评估定量分析证据的质量。
17项RCT（共1317例患者）符合纳入标准。与对照组相比，EA联合药物在临床疗效（RR = 1.25 [95%CI = 1.18至1.33]，P < 0.00001）、VAS评分（MD = -1.34 [95%CI = -1.90至-0.78]，P < 0.00001）、DAS28（MD = -0.76 [95%CI = -1.08至-0.44]，P < 0.00001）、CRP水平（SMD = -1.46 [95%CI = -2.19至-0.74]，P < 0.0001）和ESR（MD = -7.74 [95%CI = -13.77至-1.72]，P = 0.01）方面效果更优。与对照组相比，荟萃分析显示EA组不良事件无显著变化（RR = 1.08 [95%CI = 0.51至2.25]，P = 0.85）。17项研究结果的证据水平极低至中等。
EA联合药物在临床疗效、VAS、DAS28、CRP和ESR方面比单纯西药效果更优。EA的临床安全性值得在实验研究中进一步探究。
