Acupuncture for pain relief in patients with rheumatoid arthritis: A systematic review

Objective. To systematically review the efficacy of acupuncture on pain relief in patients with rheumatoid arthritis (RA). Methods. We performed a comprehensive search of 12 western and Chinese databases and reference lists through March 2008. We included randomized controlled trials with pain as an end point, measured by tender joint count (TJC) or a pain scale. We also reviewed the effect of acupuncture on morning stiffness, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level. Study quality was assessed by Jadad score. Differences between treatment groups were pooled as mean or median change (P value). Results. Eight studies met eligibility criteria with a total of 536 subjects. There were 4 placebo-controlled trials and 4 active-controlled trials. Average study duration was 11 weeks. Mean +/- SD acupuncture points and sessions were 11 +/- 8 and 42 +/- 62, respectively. Average duration of needle insertion was 24 minutes. Six studies reported a decrease in pain for acupuncture versus controls; the mean or median changes of acupuncture-decreased TIC pain ranged from 1.5 to 6.5. In addition, 4 studies reported a significant reduction in morning stiffness (mean change -29 minutes), but the difference was nonsignificant versus controls, With regard to inflammatory markers, 5 studies observed a reduction in ESR (mean change -3.9 mm/hour) and 3 observed a CRP level reduction (mean change -2.9 mg/dl); only 1 study showed a significant difference for both ESR and CRP. Conclusion. Despite some favorable results in active-controlled trials, conflicting evidence exists in placebo-controlled trials concerning the efficacy of acupuncture for RA. Rigorous and well-controlled randomized trials are warranted.