Comparison of Efficacy of Acupuncture-Related Therapy in the Treatment of Rheumatoid Arthritis: A Network Meta-Analysis of Randomized Controlled Trials

Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, leading to pain, stiffness, and progressive deterioration of bone and cartilage. Affecting approximately 0.3% to 1% of the world population, mainly people between 30 and 60 years of age, this condition represents a significant public health problem that dramatically impacts patients' quality of life. Although it has no cure, treatment with disease-modifying antirheumatic drugs (DMARDs) constitutes the current gold standard, as recommended by international medical societies. However, many patients do not respond adequately to these medications alone, leading to growing interest in complementary therapies such as acupuncture.

Acupuncture, based on traditional Chinese medicine, has shown promise in the treatment of rheumatoid arthritis when combined with DMARDs. There are several acupuncture modalities available, including electroacupuncture, warm needle, moxibustion, fire needle, and conventional acupuncture. However, until recently there was no direct comparison between these different techniques to determine which would be most effective. To fill this scientific gap, Chinese researchers conducted a comprehensive study using a methodology called network meta-analysis.

This study systematically analyzed 32 randomized controlled clinical trials that included 2,115 patients with rheumatoid arthritis, comparing different types of acupuncture combined with DMARDs versus DMARDs alone. The researchers searched for studies published in Chinese and international databases through October 2021, following rigorous selection criteria. All included patients had a confirmed diagnosis of rheumatoid arthritis according to criteria established by renowned medical societies. The network meta-analysis methodology allows multiple treatments to be compared simultaneously, even when they were not directly compared in the original studies, offering a more complete view of the relative efficacy of each therapeutic approach.

The results revealed important differences between acupuncture modalities. To measure disease activity using the DAS28 scale (which evaluates 28 joints for tenderness and swelling), electroacupuncture combined with DMARDs proved superior to all other approaches. This technique, which applies low-intensity electrical current to acupuncture needles, demonstrated greater efficacy in reducing overall disease activity. For pain control, measured by the visual analog scale, fire needle combined with DMARDs presented the best results.

The fire needle is a technique that heats the needle until it is red-hot before insertion, combining the effects of acupuncture with therapeutic heat. Surprisingly, none of the acupuncture therapies proved superior to DMARDs alone in reducing morning stiffness time, a common symptom of rheumatoid arthritis.

When researchers analyzed inflammatory markers in the blood, they found equally interesting results. For reducing C-reactive protein and erythrocyte sedimentation rate, both important indicators of inflammation, fire needle combined with DMARDs again proved most effective. For reducing rheumatoid factor, an antibody characteristic of rheumatoid arthritis, moxibustion combined with DMARDs was the most effective approach. Moxibustion involves burning an herb called mugwort near or on specific points of the body, generating therapeutic heat.

These findings suggest that different acupuncture modalities may have distinct mechanisms of action and be more appropriate for treating specific aspects of the disease.

The clinical implications of these results are significant for patients and healthcare professionals. For patients with rheumatoid arthritis who do not achieve adequate control with conventional medications alone, this study offers evidence on which types of acupuncture may be most beneficial when added to standard treatment. Electroacupuncture appears to be the most indicated choice for reducing overall disease activity, while fire needle may be preferable for pain and inflammation control. Moxibustion proved particularly useful for reducing rheumatoid factor.

It is important to emphasize that all of these techniques proved safe, with few adverse effects reported, mainly mild local reactions such as redness or small blisters on the skin. Adverse effects were less frequent in the groups that received acupuncture compared to those who used only medications.

For healthcare professionals, these findings suggest that the choice of acupuncture modality should be individualized according to the patient's clinical profile. Those with high disease activity may benefit more from electroacupuncture, while patients with predominant pain may respond better to fire needle. Integrating these complementary therapies into the treatment plan can enhance therapeutic results and improve patients' quality of life. In addition, the study reinforces the importance of a multidisciplinary approach in the treatment of rheumatoid arthritis, combining conventional medicine with evidence-based complementary practices.

The study presents some important limitations that must be considered in interpreting the results. Many of the studies included in the analysis did not adequately describe randomization and blinding methods, which can influence the reliability of the findings. The sample sizes in individual studies were relatively small, and there were variations in the types and doses of medications used, as well as in the selection of acupuncture points and duration of treatments. In addition, the analysis detected possible publication bias, suggesting that studies with negative results may not have been published.

Some acupuncture modalities had few studies available, limiting the robustness of the comparisons.

In summary, this network meta-analysis offers valuable evidence on the relative efficacy of different acupuncture modalities in the treatment of rheumatoid arthritis. Although all the techniques evaluated showed benefits when combined with DMARDs, electroacupuncture stood out for overall disease control, while fire needle and moxibustion proved superior for specific aspects such as pain and inflammatory markers. These results can guide more informed clinical decisions, allowing treatment to be personalized according to the individual needs of each patient. However, more high-quality studies, with larger samples and more rigorous methods, are needed to confirm these findings and establish standardized protocols for the clinical use of these complementary therapies in rheumatoid arthritis.