Comparison of efficacy of acupuncture-related therapies in treating Acute Gouty Arthritis: A Network Meta-Analysis of Randomized Controlled Trials

Acute gouty arthritis (AGA) is a painful inflammatory condition caused by the accumulation of uric acid crystals in the joints, manifesting as sudden intense pain and swelling. Although anti-inflammatory medications such as colchicine and NSAIDs are effective in controlling symptoms, they can cause significant gastrointestinal and cardiovascular adverse effects. This network meta-analysis examined 32 randomized controlled trials involving 2,434 patients to compare the efficacy of different acupuncture therapies in the treatment of AGA. The researchers analyzed eight therapeutic approaches: traditional acupuncture, therapeutic bloodletting, point application with herbs, fire acupuncture, electroacupuncture, and combinations of these treatments with Western medicine, comparing them with conventional treatment with medications alone.

The results demonstrated that point application with Chinese herbs achieved the best performance on most of the indicators evaluated. For pain improvement, measured by the visual analog scale (VAS), point application achieved 100% efficacy in the SUCRA ranking, followed by electroacupuncture combined with Western medicine (73.5%) and acupuncture with Western medicine (69.2%). On the total efficacy rate, point application again led with 85.2%, followed by traditional acupuncture (75.2%) and combined acupuncture (63%). For reduction in serum uric acid levels, a crucial marker in gout, point application showed 95% efficacy, followed by acupuncture with Western medicine (87.5%) and acupuncture alone (66.2%).

Traditional acupuncture stood out in reducing erythrocyte sedimentation rate (ESR), an inflammatory marker, with 95% efficacy, and presented the best safety profile with 83.1% in the ranking of lowest incidence of adverse events. Adverse events related to acupuncture were mainly mild, including needle dizziness, skin redness, and subcutaneous bruising, contrasting with the more significant gastrointestinal effects of conventional medications. The most commonly used acupuncture points included Zusanli (ST-36), Sanyinjiao (SP-6), Yinlingquan (SP-9), and Ashi points (local tender points). Modern studies suggest that stimulation of these points activates anti-inflammatory pathways, including the vagal-adrenal axis, and reduces pro-inflammatory cytokines such as TNF-α and interleukins.

The clinical implications are significant, suggesting that acupuncture therapies, especially point application with herbs, may offer an effective and safer alternative to conventional treatments for AGA. However, the study has important limitations: most of the included studies were of low to moderate methodological quality, with few using adequate blinding or allocation concealment. Some therapies, such as point application and fire acupuncture, were represented by few studies, limiting the reliability of the conclusions. Clinical heterogeneity across studies, including different disease severities, types of medications, and point selection, may have influenced the results.

Despite these limitations, the results suggest significant therapeutic potential for acupuncture modalities in the treatment of acute gout, justifying future studies with higher methodological quality and larger samples to confirm these promising findings.