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Rheumatology Advance Access originally published online on August 18, 2008
Rheumatology 2008 47(12):1747-1753; doi:10.1093/rheumatology/ken330
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

REVIEWS

Acupuncture for rheumatoid arthritis: a systematic review

M. S. Lee1,2,*, B.-C. Shin3,* and E. Ernst2

1Department of Medical Research, Korea Institute of Oriental Medical, Daejeon, South Korea, 2Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, UK and 3Department of Oriental Rehabilitation Medicine, College of Oriental Medicine, Wonkwang University, Iksan, South Korea.

Correspondence to: M. S. Lee, Department of Medical Research, Korea Institute of Oriental Medicine, 461-24 Jeonmin-dong, Yuseong-gu, Daejeon 305-811, South Korea. E-mail: drmslee{at}gmail.com; mslee{at}kiom.re.kr


  Abstract

The aim of this systematic review is to evaluate the available evidence, from randomized clinical trials (RCTs), of acupuncture for treating patients with RA. Systematic searches were conducted on 17 databases up to April 2008 without the language restriction. All RCTs of acupuncture, with or without electrical stimulation or moxibustion, for patients with RA were considered for inclusion. A total of 236 potentially relevant studies were identified and eight RCTs were included. Four RCTs compared the effects of manual or electro-acupuncture with penetrating or non-penetrating sham acupuncture and failed to show specific effects of acupuncture on pain [n = 88; weighted mean differences (WMD), 10 cm VAS –0.46; 95% CI –1.70, 0.77; P = 0.46; heterogeneity: {tau}2 = 0.19; {chi}2 = 2.38; P = 0.30; I 2 = 16%] or other outcome measures. One RCT compared manual acupuncture with indomethacin and suggested favourable effects of acupuncture in terms of total response rate. Three RCTs tested acupuncture combined with moxibustion, vs conventional drugs and failed to show that acupuncture plus moxibustion was superior to conventional drugs in terms of response rate (n = 345; RR 1.12; 95% CI 0.99, 1.28; P = 0.08; heterogeneity: {tau}2 = 0.00; {chi}2 = 1.34; P = 0.51; I2 = 0%), pain reduction (n = 105; WMD, 10 cm VAS 1.53; 95% CI –0.57, 3.63; P = 0.15; heterogeneity: {tau}2 = 1.18; {chi}2 = 1.81; P = 0.18; I2 = 45%) or joint swelling index (n = 105; WMD, 10 cm VAS 0.25; 95% CI –1.31, 1.82; P = 0.75; heterogeneity: {tau}2 = 0.18;{chi}2 = 1.14; P = 0.28; I2 = 13%). In conclusion, penetrating or non-penetrating sham-controlled RCTs failed to show specific effects of acupuncture for pain control in patients with RA. More rigorous research seems to be warranted.

KEY WORDS: Acupuncuture, Moxibustion, Rheumatoid arthritis, Pain, Systematic review

*M. S. Lee and B.-C. Shin equally contributed to this work.

Submitted 14 March 2008; revised version accepted 11 July 2008.
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