Electroacupuncture for Acute Gouty Arthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Acute gouty arthritis (AGA) is an extremely painful inflammatory condition that affects millions of people worldwide, causing recurrent episodes of severe pain that can significantly limit daily activities. This systematic review and meta-analysis, conducted by researchers at the Chengdu University of Traditional Chinese Medicine, represents the first comprehensive study on the use of electroacupuncture in the treatment of acute gout. The researchers analyzed 15 randomized controlled trials involving 1,076 patients between 20 and 72 years of age, all diagnosed with acute gouty arthritis. The methodology rigorously followed PRISMA guidelines, ensuring high quality in data collection and analysis.

Studies were identified through a systematic search of eight Chinese and English databases, covering publications from inception through July 2023. Electroacupuncture was applied primarily at Sanyinjiao (SP-6) and Zusanli (ST-36), with stimulation frequencies ranging from 2 Hz to 100 Hz, and session durations of 20 to 40 minutes. Most studies used daily treatment over periods of 6 days to 2 weeks. The results demonstrated consistent superiority of electroacupuncture across multiple outcomes.

The efficacy rate was 14% higher compared with conventional drug treatment (RR = 1.14, 95% CI 1.10-1.19). Pain relief, measured by the Visual Analog Scale, showed an additional reduction of 2.26 points favoring electroacupuncture (MD = -2.26, 95% CI -2.71 to -1.81). Particularly impressive was electroacupuncture's ability to reduce serum uric acid levels by 31.6 µmol/L more than conventional treatment, suggesting benefits beyond simple pain relief. The safety analysis revealed a favorable profile for electroacupuncture, with 80% fewer adverse events compared with conventional medications.

While the medication group presented 19 cases of gastrointestinal symptoms and 6 of neurological symptoms, the electroacupuncture group showed a significantly lower incidence of side effects. Subgroup analyses explored different aspects of treatment, including isolated versus combined use of electroacupuncture, different sample sizes, and variations in stimulation frequency. Results indicated that combining electroacupuncture with conventional medication provided the best results in terms of efficacy, pain relief, and uric acid reduction. The methodological quality of the studies ranged from low to moderate, with limitations including absence of blinding (inherent to the nature of the intervention), heterogeneity between studies, and possible publication bias.

The GRADE assessment classified the evidence as low to very low for most outcomes, primarily due to methodological issues and data heterogeneity. From a mechanistic standpoint, the authors discuss how electroacupuncture may modulate the inflammatory response through the release of endogenous opioids and modulation of peripheral and central pain pathways. Electrical stimulation may influence activation of the NLRP3 inflammasome, a pathway crucial in the pathogenesis of gout. This research has important clinical implications, offering practitioners a complementary therapeutic option for patients who do not tolerate conventional medications or seek alternatives with a more favorable adverse-event profile.

Electroacupuncture emerges as a promising modality, especially when integrated with conventional treatment, providing synergistic benefits in the management of acute pain and control of uric acid levels.