Acupuncture and electroacupuncture for the treatment of RA.

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.

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 was done up to September 2001 with MEDLINE, EMBASE, PEDro, Current Contents, Sports Discus and CINAHL. The Cochrane Field of Rehabilitation and Related Therapies and the Cochrane Musculoskeletal Review Group were also contacted for a search of their specialized registers. 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 control clinical trials in patients with RA were eligible. No language restrictions were applied. Abstracts were accepted.

DATA COLLECTION AND ANALYSIS: Two independent reviewers identified potential articles from the literature search. These reviewers extracted data using pre-defined extraction forms. Consensus was reached on all the extracted data. Quality was assessed by two reviewers using a five (5) point validated tool that measured the quality of randomization, double-blinding and description of withdrawals.

MAIN RESULTS: Two studies (n=84) met the inclusion criteria. One used acupuncture (~~David 1999~~) while the other used electroacupuncture (~~Man 1974~~). In the first study using acupuncture, no significant difference was found between groups for to erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), the visual analogue scale for pain (VAS P), the visual analogue scale for patient's global assessment (VAS G), the number of swollen joints, the number of tender joints, to the general health questionnaire (GHQ), the score on the modified disease activity scale (DAS) or in the decrease in analgesic intake. 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 (weighted mean difference of -2.0 with 95% CI -3.6,-4.0).

REVIEWER'S CONCLUSIONS: Although the results of the ~~Man 1974~~ study show that electroacupuncture may be beneficial to reduce symptomatic knee pain in patients with RA 24 hours post treatment, the reviewers concluded that the poor quality of the trial, including the small sample size proclude 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.