Efficacy and Safety of Acupuncture Combined with Herbal Medicine in Treating Gouty Arthritis: Meta-Analysis of Randomized Controlled Trials

This meta-analysis was the first comprehensive evaluation of the efficacy of acupuncture combined with Chinese herbal medicine for gouty arthritis, including 14 randomized clinical trials with 1,065 participants. Gouty arthritis is a painful inflammatory condition caused by the accumulation of uric acid crystals in the joints, traditionally treated with nonsteroidal anti-inflammatory drugs and corticosteroids, which can cause significant adverse effects with prolonged use. The researchers conducted a systematic search of multiple databases, including PubMed, Cochrane Library, EMBASE, and Chinese databases, through March 2021. Only randomized clinical trials comparing acupuncture combined with Chinese herbal medicine versus conventional therapies, acupuncture alone, herbal medicine alone, or anti-inflammatory drugs were included.

The methodology strictly followed PRISMA guidelines for systematic reviews. The experimental intervention consisted of acupuncture (including electroacupuncture, three-edged needle bloodletting, and auricular acupuncture) combined with Chinese herbal medicine (traditional formulas and Chinese patent medicines). The most frequently used acupuncture points included Yinlingquan 阴陵泉 (SP-9), Zusanli 足三里 (ST-36), Sanyinjiao 三阴交 (SP-6), Quchi 曲池 (LI-11), and Taichong 太冲 (LR-3), often combined with local pain points (ashi points). Treatments lasted between 5 and 21 days, with daily or alternate-day sessions.

The results demonstrated consistent superiority of the combined therapy. Compared with conventional therapy, the combined treatment showed 11% higher clinical efficacy (RR 1.11, 95% CI 1.06-1.15, p < 0.00001). Compared with acupuncture alone, efficacy was 22% higher (RR 1.22, 95% CI 1.06-1.41, p = 0.007), and versus herbal medicine alone, 31% higher (RR 1.31, 95% CI 1.08-1.57, p = 0.005). The reduction in uric acid levels was significantly greater with combined therapy (-85.63 μmol/L, 95% CI -102.89 to -68.37, p < 0.00001) compared with acupuncture alone.

Improvement on the visual analog pain scale was also greater (-0.78 points, 95% CI -1.12 to -0.45, p < 0.00001) versus anti-inflammatory drugs. Crucially, the incidence of adverse events was significantly lower in the combined therapy group (OR 0.16, 95% CI 0.08-0.32, p < 0.00001). Reported adverse events were primarily gastrointestinal reactions in the control groups, while the experimental group exhibited mainly mild discomfort related to needle insertion. The clinical implications are substantial, suggesting that integrating acupuncture with Chinese herbal medicine offers an effective and safe therapeutic alternative for patients with gouty arthritis, particularly those who experience significant adverse effects with conventional medications.

The approach demonstrated benefits in both clinical and laboratory parameters, including reduced pain, local inflammation, and serum uric acid levels.