Are acupuncture and electroacupuncture beneficial for alleviating pain among patients with rheumatoid arthritis?
Date of publication of the systematic review: October 2005
Design
Systematic review of 2 randomized controlled trials (RCTs).
Participants
84 patients with definite or classic rheumatoid arthritis. The reviewers did not report the mean age and gender proportion of the participants.
Intervention
One trial evaluated manual acupuncture applied at the liver 3 (Li3) point on each foot, once for four minutes (treatment duration: a total of five sessions at one week intervals). Six weeks of washing out interval was implemented before crossing over.
The other trial evaluated electroacupuncture applied in one of the knees at the GB 34, SP 9 and S43 acupuncture points, once for 15 minutes (treatment duration: one session).
Comparator
Comparison 1: Electroacupuncture versus sham acupuncture;
Comparison 2: Manual acupuncture versus sham acupuncture.
Major Outcomes
Outcome 1: Pain at 24 hours post treatment on as measured by pain reduction scale (score range 0 to 4, 0 means no pain);
Outcome 2: Pain at 4 months post treatment as measured by pain reduction scale (score range: 0 to 4, 0 means no pain);
Outcome 3: Pain at the end of treatment (5 weeks) as measured by the visual analogue scale (VASP, score range 0 to 100mm).
Settings
The reviewers did not state where the trials were conducted and whether the trials were conducted in inpatient or outpatient settings.
Comparison    Electroacupuncture versus sham acupuncture
Main Results
Compared to sham acupuncture, electroacupuncture showed significant decrease of knee pain at 24 hours post treatment on a pain reduction scale ranging 0 to 4 (mean difference (MD): -2.00, 95% CI: -3.60 to -0.40). A significant decrease in knee pain was also found at 4 months post treatment (MD: -0.20, 95% CI: -0.36 to -0.04).
Comparison 1: Electroacupuncture versus sham acupuncture in patients with rheumatoid arthritis
Outcomes (units) No. of studies (Total no. of participants) Mean/ No. of participants Heterogeneity test (I2) MD (95% CI) Overall quality of evidence*
Intervention Comparator
1 (NA) 1 (20) 2/ 10 4/ 10 Not applicable as there is only 1 study. -2.00 (-3.60 to -0.40) Moderate
2 (NA) 1 (20) 4/ 10 3.8/ 10 Not applicable as there is only 1 study. -0.20 (-0.36 to -0.04) Moderate
Keys: MD: mean difference; CI: confidence interval.
Comparison    Manual acupuncture versus sham acupuncture
Main Results
Compared to sham acupuncture, manual acupuncture did not show significant improvement on pain score measured by VAS scale (0 to 100mm) (MD: -7.00mm, 95% CI: -14.40 to 0.40).
Comparison 2: Manual acupuncture versus sham acupuncture in patients with rheumatoid arthritis
Outcomes (unit) No. of studies (Total no. of participants) Mean/ No. of participants Heterogeneity test (I2) MD (95% CI) Overall quality of evidence*
Intervention Comparator
3 (mm) 1 (55) 44/ 29 51/26 Not applicable as there is only 1 study. -7.00 (-14.40 to 0.40) Low
Keys: MD: mean difference; CI: confidence interval.
Comparison    Electroacupuncture versus sham acupuncture
Main Results
Compared to sham acupuncture, electroacupuncture showed significant decrease of knee pain at 24 hours post treatment on a pain reduction scale ranging 0 to 4 (mean difference (MD): -2.00, 95% CI: -3.60 to -0.40). A significant decrease in knee pain was also found at 4 months post treatment (MD: -0.20, 95% CI: -0.36 to -0.04).
Comparison 1: Electroacupuncture versus sham acupuncture in patients with rheumatoid arthritis
Outcomes (units) 1 (NA) 2 (NA)
No. of studies (Total no. of participants) 1 (20) 1 (20)
Mean/ No. of participants Intervention 2/ 10 4/ 10
Comparator 4/ 10 3.8/ 10
MD (95% CI) -2.00 (-3.60 to -0.40) -0.20 (-0.36 to -0.04)
Overall quality of evidence* Moderate Moderate
Keys: MD: mean difference; CI: confidence interval.
Comparison    Manual acupuncture versus sham acupuncture
Main Results
Compared to sham acupuncture, manual acupuncture did not show significant improvement on pain score measured by VAS scale (0 to 100mm) (MD: -7.00mm, 95% CI: -14.40 to 0.40).
Comparison 2: Manual acupuncture versus sham acupuncture in patients with rheumatoid arthritis
Outcomes (unit) 3 (mm)
No. of studies (Total no. of participants) 1 (55)
Mean/ No. of participants Intervention 44/ 29
Comparator 51/26
MD (95% CI) -7.00 (-14.40 to 0.40)
Overall quality of evidence* Low
Keys: MD: mean difference; CI: confidence interval.
Conclusion
Benefits
Compared to sham acupuncture, electroacupuncture can benefit patients with rheumatoid arthritis in the following two outcomes: pain at 24 hours post treatment and 4 months post treatment. The overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect. Compared to sham acupuncture, manual acupuncture did not show clear benefit for patients with rheumatoid arthritis in pain at the end of treatment. The overall quality of evidence is low. Further research is likely to have an important impact on our confidence in this estimate of effect.
Harms
Side effects were not measured in the included studies.
Link to Original Article
http://www.ncbi.nlm.nih.gov/pubmed/16235342
The synopsis is based on the following article:
Casimiro L, Barnsley L, Brosseau L, Milne S, Welch V, Tugwell P, Wells GA. Acupuncture and electroacupuncture for the treatment of rheumatoid arthritis. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD003788. DOI: 10.1002/ 14651858.CD003788.pub2.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.