"Chinese General Medicine" medical evidence-based | acute gouty arthritis treatment: acupuncture or western medicine?

The incidence of gout is increasing year by year worldwide, and acute attacks of gouty arthritis are the main cause
of suffering for gout patients.
Conventional treatment of acute gout has large side effects, and the efficacy of acupuncture treatment is clear, but it is still unclear
which therapy is the best choice.

Chinese Journal of General Practice published a network meta-analysis
of the efficacy and effects of different acupuncture therapies on the effects of different acupuncture therapies on blood uric acid and pain in the treatment of acute gouty arthritis.
This article overcomes the previous defect of only one acupuncture therapy compared with Western medicine or other therapies for the treatment of acute gout, and ranks the relevant outcome indicators of multiple acupuncture therapy interventions for acute gout, so as to obtain the optimal treatment and improve the evidence-based basis for clinical practice
.

Research Tips:

Total Efficiency:

Electroacupuncture [OR=1.
18, 95% CI (1.
01, 1.
39), P<0.
05], warm acupuncture [OR=1.
17, 95% CI (1.
03, 1.
32), P<0.
05], fire acupuncture [OR=1.
13, 95% CI(1.
03, 1.
24), P<0.
05] have higher overall effective rates in the treatment of acute gouty arthritis than Western drugs
.

Lowering blood uric acid levels:

Electroacupuncture (standardized mean difference (SMD=-144.
46, 95%CI (-248.
77, -40.
14), P<0.
05], acupuncture [SMD=-98.
83, 95% CI (-159.
51, -38.
15), P<0.
05] are superior to Western drugs
in reducing blood uric acid levels.

Research Methods:

Database:

In this network meta-analysis, randomized controlled trials (RCTs) of five acupuncture therapies (electroacupuncture, acupuncture, blood prick, warm acupuncture, fire acupuncture) for the treatment of acute gouty arthritis were searched from databases such as PubMed, EMBase, The Cochrane Library, CNKI, Wanfang Data Knowledge Service Platform, VIP, and China Biomedical Database (CBM).
2019-09-20
。

Interventions:

The intervention group was given electroacupuncture, acupuncture, blood prick, warm acupuncture or fire acupuncture alone; The control group was given Western medicine or any of the above acupuncture treatments
.

Outcome measures:

Clinical efficacy (clinically cured, effective, ineffective, total effective rate), blood uric acid, pain level

Quality evaluation:

The Cochrane Risk of Bias assessment tool recommended in version 5.
1 of the Cochrane Manual for Systematic Reviews was used

Statistical methods:

Risk of bias was assessed using RevMan 5.
3 software and meta-analyses
were performed using fixed-effect and random-effects models.
Stata 14.
0 was used for network meta-analysis, which combined direct and indirect comparisons to derive the ranking between interventions, and plotted network evidence; dichotomous variables were assessed using odds ratios (OR) and continuous variables and 95% confidence intervals (CI) were assessed using standardised mean difference (SMD); Interventions were ranked by area under the curve (SUCRA
).

Research results:

A total of 23 RCTs, all Chinese literature, including 1684 patients
, were included in this analysis.

Meta-analysis results showed:

:backhand_index_pointing_right: A total of 22 literature reports the total effective rate, in terms of improving the total effective rate, fire acupuncture, blood prick, acupuncture, warm acupuncture are superior to Western medicine, and electroacupuncture is superior to acupuncture
.

Table 1 Meta-analysis of the total efficacy of different acupuncture therapies in the treatment of acute gouty arthritis

backhand_index_pointing_right: A total of 16 literature reports that blood uric acid, fire acupuncture, blood pricking, acupuncture, warm acupuncture and moxibustion can effectively reduce blood uric acid levels
than Western medicine.

Table 2 Meta-analysis of blood uric acid comparison of different acupuncture therapies for acute gouty arthritis

backhand_index_pointing_right: A total of 6 literature reported VAS score, and fire injection was more effective than Western medicine in reducing VAS score
.

Table 3 Meta-analysis of VAS scores for different acupuncture therapies in acute gouty arthritis

The results of the network meta-analysis showed that:

The three outcomes of total effective rate, blood uric acid and VAS score were all reflected in the star-shaped structure formed by Western medicine, and none of them formed a triangular closed ring
.

Note: VAS= Visual analogue scoring method; A is fire acupuncture, B is western medicine, C is blood prick, D is acupuncture, E is electroacupuncture, F is warm acupuncture; The thicker the line represents the greater the number of studies between the two studies, and the larger the node, the larger the sample size

Figure 1 Network of evidence for the network analysis of different acupuncture therapies for the treatment of acute gouty arthritis

:backhand_index_pointing_right: Total effective rate: A total of 22 articles were included, involving 6 treatment measures, in terms of improving the total effective rate, electroacupuncture, warm acupuncture and fire acupuncture were superior to Western medicine, and the cumulative total effective rate of 6 therapies was > in order of electroacupuncture (94.
5%)> blood lancet (62.
4%)> fire acupuncture (51.
5%)> warm acupuncture (49.
9%)> acupuncture (41.
5%) Western medicine (20.
0%)
.

Table 4 Total effective reticular meta-analysis of different acupuncture therapies in the treatment of acute gouty arthritis [OR(95% CI)]

backhand_index_pointing_right: Blood uric acid: a total of 16 articles were included, involving 6 treatment measures, in terms of reducing blood uric acid levels, electroacupuncture and acupuncture were superior to Western medicine, and the cumulative SUCRA order of 6 therapies to reduce blood uric acid levels was electroacupuncture (94.
1%)> acupuncture (77.
6%)> blood prick (42.
9%)> warm acupuncture (42.
2%)> Fire acupuncture (39.
8%) > Western medicine (3.
4%)
.

Table 5 Meta-analysis of blood uric acid network with different acupuncture therapies for acute gouty arthritis [SMD (95% CI)]

backhand_index_pointing_right: VAS score: A total of 6 articles involving 4 treatment measures were included, and fire acupuncture was better than Western medicine in reducing VAS score, and the cumulative SUCRA ranking of the 4 therapies was fire acupuncture (91.
9%)> blood prick (56.
7%)> acupuncture (29.
3%) > Western medicine (22.
1%)
.

Table 6 VAS score network meta-analysis of different acupuncture therapies for acute gouty arthritis [SMD (95% CI)] Study limitations and later research directions:

1.
The description of study quality in the included literature was not detailed, especially in terms of
allocation concealment and blinding.
In the future, researchers should follow the CONSORT reporting standard to improve the quality of
research reports.

2.
The quality of evidence was not graded by GRADE in this study, because other factors were not taken into account, there may be certain limitations, which may cause obstacles to the understanding of the authenticity and reliability of the conclusions of this study by policymakers and readers, and need to be continuously improved
in the future.

3.
All included studies were Chinese and the results were all positive, which may be subject to publication bias
.
In future studies, clinical trials of acupuncture therapy should follow STRICTA standards and improve reporting standards
.