Update on the Clinical Effect of Acupuncture Therapy in Patients with Gouty Arthritis: Systematic Review and Meta-Analysis

This systematic review and meta-analysis examined the efficacy and safety of acupuncture in the treatment of acute gouty arthritis, a painful inflammatory condition caused by the deposition of monosodium urate crystals in the joints due to excess uric acid in the blood. Gout is one of the most prevalent forms of inflammatory arthritis in developed countries, especially in older men, and its incidence has increased in recent decades. The researchers conducted a comprehensive search across multiple databases (PubMed, EMBASE, CENTRAL, ISI Web of Science, and CNKI) from inception through October 2015, identifying 28 randomized controlled trials involving 2,237 patients with gouty arthritis. All studies were conducted by Chinese investigators and published between 2002 and 2015.

The studied population included 1,174 patients in the acupuncture group and 1,063 in the control group, with ages ranging from 18 to 80 years. Participants were diagnosed with gouty arthritis according to criteria established by the American College of Rheumatology or the State Administration of Traditional Chinese Medicine. Acupuncture treatments included manual acupuncture and electroacupuncture, applied alone or in combination with other therapies such as Chinese herbal medicine, acupoint injection, or local block therapy. The most commonly used acupuncture points were SP-6 (Sanyinjiao), ST-36 (Zusanli), and Ashi points (local tender points).

Treatment was administered daily or every other day, with needles retained for 20-30 minutes per session, and treatment duration ranged from 5 to 28 days. The control group received conventional Western medications, including colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs), allopurinol, benzbromarone, celecoxib, probenecid, meloxicam, and ibuprofen. The primary outcomes evaluated were clinical efficacy and frequency of adverse events, while secondary outcomes included clinical parameters such as serum uric acid, pain intensity using the visual analog scale (VAS), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). The pooled data analysis revealed that acupuncture was significantly more effective than Western medicine in making patients symptom-free after 24 hours, with an odds ratio of 2.71 (95% CI 2.22-3.32).

In addition, acupuncture demonstrated superior capacity to reduce serum uric acid levels, with a mean difference of 41.30 μmol/L in favor of acupuncture. Regarding pain relief, measured by the VAS scale, acupuncture showed significant improvement with a mean difference of 1.92 points. The researchers also observed that acupuncture was more effective in lowering ESR, although no statistically significant difference was found for CRP. A particularly important aspect was safety: the frequency of adverse events in the acupuncture group was significantly lower than in the control group (OR 0.08; 95% CI 0.03-0.23).

Reported adverse events included mainly gastrointestinal reactions, central nervous system reactions, leukopenia, skin rash, and fainting during acupuncture treatment. To investigate possible sources of heterogeneity across studies, the researchers performed meta-regression, testing factors such as type of acupuncture, combined therapy, and duration of treatment. The type of acupuncture (manual versus electroacupuncture) was identified as a factor significantly correlated with heterogeneity in uric acid results. Assessment of publication bias through funnel plots and statistical tests did not indicate significant bias.

However, the authors identified several important limitations: the methodological quality of the included studies was considered poor, without details on allocation concealment and with the inability to blind participants and practitioners. Most of the studies were written in Chinese, limiting the dissemination of the research, and only ten studies reported adverse events. In addition, not all studies strictly followed the treatment guidelines established by the American College of Rheumatology.