REVIEW - Acupuncture and electroacupuncture for the treatment of rheumatoid arthritis

[Guest guest]

Cochrane Database Syst Rev. 2005 Oct 19;(4):CD003788.

Acupuncture and electroacupuncture for the treatment of rheumatoid

arthritis.

Casimiro L, Barnsley L, Brosseau L, Milne S, V, Tugwell P, Wells G,

Casimiro L.

BACKGROUND: Acupuncture has been used by rehabilitation specialists as an

adjunct therapy for the symptomatic treatment of rheumatoid arthritis (RA).

Acupuncture is a traditional Chinese medicine where thin needles are

inserted in specific documented points believed to represent concentration

of body energies. In some cases a small electrical impulse is added to the

needles. Once the needles are inserted in some of the appropriate points,

endorphins, morphine-like substances, have been shown to be released in the

patient's system, thus inducing local or generalised analgesia (pain

relief). This review is an update of the original review published in July

2002. OBJECTIVES: To evaluate the effects of acupuncture or

electroacupuncture on the objective and subjective measures of disease

activity in patients with RA. SEARCH STRATEGY: A comprehensive search of

MEDLINE, EMBASE, PEDro, Current Contents , Sports Discus and CINAHL,

initially done in September 2001, was updated in May 2005.The Cochrane Field

of Rehabilitation and Related Therapies and the Cochrane Musculoskeletal

Review Group were also contacted for a search of their specialized

registries. Handsearching was conducted on all retrieved papers and content

experts were contacted to identify additional studies. SELECTION CRITERIA:

Comparative controlled studies, such as randomized controlled trials and

controlled clinical trials in patients with RA were eligible. Trials

published in languages other than French and English were not analyzed.

Abstracts were excluded unless further data could be obtained from the

authors. DATA COLLECTION AND ANALYSIS: Two independent reviewers identified

potential articles from the literature search and extracted data using

pre-defined extraction forms. Consensus was reached on all the extracted

data. Quality was assessed by two reviewers using a five point validated

tool that measured the quality of randomization, double-blinding and

description of withdrawals. MAIN RESULTS: After the updated searches were

conducted, five further potential articles were identified; however, these

did not meet the inclusion criteria. Two studies involving a total of 84

people were included. One study used acupuncture while the other used

electroacupuncture. In the acupuncture study, no statistically significant

difference was found between groups for erythrocyte sedimentation rate

(ESR), C-reactive protein (CRP), visual analogue scale for patient's global

assessment (VAS G), number of swollen joints and tender joints, general

health questionnaire (GHQ), modified disease activity scale (DAS) or for the

decrease in analgesic intake. Although not statistically significant, pain

in the treatment group improved by 4 points on a 0-100mm visual analogue

scale versus no improvement in the placebo group. In the second study, using

electroacupuncture, a significant decrease in knee pain was reported in the

experimental group, 24 hours post treatment, when compared to the placebo

group (WMD: -2.0 with 95% CI -3.6,-4.0). A significant decrease was found

also at four months post-treatment (WMD -0.2, 95% CI: -0.36, -0.04) AUTHORS'

CONCLUSIONS: Although the results of the study on electroacupuncture show

that electroacupuncture may be beneficial to reduce symptomatic knee pain in

patients with RA 24 hours and 4 months post treatment, the reviewers

concluded that the poor quality of the trial, including the small sample

size preclude its recommendation. The reviewers further conclude that

acupuncture has no effect on ESR, CRP, pain, patient's global assessment,

number of swollen joints, number of tender joints, general health, disease

activity and reduction of analgesics. These conclusions are limited by

methodological considerations such as the type of acupuncture (acupuncture

vs electroacupuncture), the site of intervention, the low number of clinical

trials and the small sample size of the included studies.

PMID: 16235342

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=16235342 & itool=iconabstr & query_hl=3 & itool=pubmed_DocSum

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org