Currently available data cannot validate acupuncture as a treatment for rheumatoid arthritis (RA), say researchers who call for better designed randomized controlled trials.
"Acupuncture is an ancient Chinese technique of inserting and manipulating fine needles to stimulate specific anatomic points and is often used for the treatment of conditions associated with pain and is supported by evidence of biologic mechanisms," explain Chenchen Wang (Tufts Medial Center, Boston, Massachusetts, USA) and colleagues.
"However, despite the fact that acupuncture is widely used for pain relief in a number of conditions including severe knee osteoarthritis, acute postoperative pain, musculoskeletal disorders, and other health conditions, evidence for the effect of acupuncture for pain relief in RA is scarce," the authors say.
A systematic review of the efficacy of acupuncture in RA was recently published but, according to Wang and team, "was limited by the methodological weakness inherent in the studies selected for inclusion."
Wang and co-workers therefore performed a more comprehensive systematic search for well-designed trials of acupuncture in RA patients.
The investigators looked for randomized controlled trials published in English and Chinese that reported original data comparing acupuncture with placebo or other active therapies for RA.
Studies were only selected if patients were classified according to the American College of Rheumatology criteria and used a primary outcome measure of tender joint count and secondary measures, such as the effect of acupuncture on a pain scale.
This screening procedure reduced the number of suitable abstracts from 936 to 8, including a total of 536 individuals with RA.
Despite some favourable results, analysis of these trials could not support the efficacy of acupuncture in RA, overall.
For example, while one randomized controlled trial showed that one session of electroacupuncture significantly improved knee pain in 20 patients with seropositive RA, compared with sham electroacupuncture, a second randomized crossover study of 56 patients with RA reported no significant differences between traditional and sham acupuncture in terms of either pain relief or inflammation.
Concluding, the authors recommend that "future large-scale acupuncture studies should have double-blind, randomized, placebo-controlled designs, and use appropriate control groups and validated longer-term outcome measures for RA."
The findings are reported in the journal Arthritis Care and Research.