Efficacy and Safety of Acupuncture for Acute Gouty Arthritis: A Systematic Review and Network Meta-Analysis

Acute gouty arthritis is a debilitating inflammatory condition caused by the deposition of uric acid crystals in the joints, characterized by intense pain, redness, swelling, and functional limitation. Although conventional treatments such as anti-inflammatories, colchicine, and corticosteroids are effective, they often cause significant adverse effects, including gastrointestinal problems and hepatic and renal alterations. In this context, acupuncture has emerged as a promising complementary therapy, based on the meridian theory of traditional Chinese medicine and with growing scientific evidence of its efficacy. This study represents the most comprehensive analysis to date of different acupuncture techniques for acute gouty arthritis.

The researchers conducted a systematic review and network meta-analysis, an advanced statistical method that allows simultaneous comparison of multiple treatments, even when they were not directly compared in the original studies. Seven databases in English and Chinese were analyzed, resulting in the inclusion of 37 randomized controlled trials involving 2,801 patients. The techniques investigated included conventional acupuncture, fire acupuncture (red-hot needles), electroacupuncture, therapeutic bloodletting, moxibustion, and acupotomy, all compared alone or in combination with conventional medications. The results clearly demonstrated the superiority of combined therapies.

Fire acupuncture emerged as the most effective treatment for increasing cure rates, with an odds ratio 5.65 times greater than pharmacological treatment alone. This technique, which uses heated needles, demonstrated the ability to rapidly inhibit the inflammatory cascade through modulation of the NALP3 inflammasome and interleukin-1β, central mechanisms in the pathogenesis of gout. Conventional acupuncture combined with medications proved more effective for reducing pain, measured by the visual analog scale, and for lowering serum uric acid levels, the main marker of the disease. Therapeutic bloodletting combined with pharmacotherapy was superior for reducing erythrocyte sedimentation rate, an important inflammatory marker.

Proposed mechanisms of action include modulation of pro-inflammatory cytokines such as IL-1, IL-8, and TNF-α, increased anti-inflammatory cytokines such as IL-4 and IL-10, and influence on metabolic pathways related to uric acid. In addition to efficacy, the safety profile was favorable, with a lower incidence of adverse events in groups receiving acupuncture compared with conventional treatments alone. However, the study has important limitations that must be considered. The methodological quality of the included studies was heterogeneous, with many not adequately describing methods of randomization, allocation concealment, or blinding.

The variability in acupuncture techniques, point selection, depth and duration of treatments, as well as in the conventional medications used, may have introduced significant clinical heterogeneity. In addition, many studies had small sample sizes, potentially limiting the precision of results. The clinical implications are substantial. The study provides robust evidence that acupuncture, especially when combined with conventional medications, offers superior benefits to pharmacological treatments alone for acute gouty arthritis.

Fire acupuncture emerges as a particularly promising option for refractory cases or when aiming to maximize cure rates. The integration of these therapies may allow a reduction in the doses of conventional medications, minimizing adverse effects without compromising efficacy. For clinical practice, the results suggest that integrative protocols should be considered as first-line therapy for patients with acute gouty arthritis, especially those with contraindications or intolerance to conventional treatments. Individualization of treatment, considering clinical presentation, severity of symptoms, and patient preferences, remains fundamental to optimizing therapeutic outcomes.