Meta-Analysis Suggests Benefit of Electroacupuncture in Acute Gouty Arthritis

Professor Dezhong Peng

Credit: AACMC

A systematic review and meta-analysis suggested that electroacupuncture, particularly in combination with conventional drug therapy, may benefit the treatment of acute gouty arthritis.¹

A team of investigators from China reviewed 15 randomized controlled trials (RCTs) on the effectiveness of electroacupuncture for acute gouty arthritis. Examination of the trials revealed electroacupuncture combined with medication was associated with better efficacy, an immediate analgesic effect, and better serum uric acid reduction versus medication alone.

“Electroacupuncture is an extremely viable complementary alternative treatment for individuals with acute gouty arthritis who cannot undergo primary treatment due to contraindications, those who do not want to take systemic medications or those who prioritize temporary pain alleviation,” wrote the investigative team, led by Dezhong Peng, College of Acupuncture-Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine.

Often the first symptom in patients with gout, acute gouty arthritis presents as acute inflammation with episodes of severe pain in the joints of lower extremities.² This intermittent pain can significantly limit the functionality of the affected area and its unpredictability can affect a patient’s quality of life, mood, and social functioning. Current treatment protocols for acute gout attacks included oral anti-inflammatory treatments, but these medications take time to achieve effect and can lead to adverse events.

As a result, Peng and colleagues noted it is clinically important to obtain alternative treatments with minimal side effects to reduce pain linked to gouty arthritis.¹ They indicated acupuncture, a traditional Chinese medicine treatment, could meet the required criteria to be considered a potential tool for pain management. Despite a lack of guidelines, or meta-analyses, on its use, electroacupuncture has been used to treat patients with acute gouty arthritis.

In this systematic review, the investigative team evaluated the efficacy and safety of electroacupuncture in acute gouty arthritis treatment to guide clinical practice. The team searched eight Chinese and English-language databases to include all electroacupuncture RCTs from inception until July 2023. Two reviewers independently reviewed the screening results identifying 242 studies and included 15 RCTs (n = 1076) in the meta-analysis.

During the meta-analysis, investigators compared the efficacy rate, visual rating scale (VAS) for pain, serum uric acid level (SUA), immediate analgesic effect, and the incidence of adverse events, between electroacupuncture and conventional medications.

Upon analysis, investigators observed a significant difference in the efficacy of electroacupuncture versus conventional medication treatment for acute gouty arthritis (risk ratio [RR], 1.14; 95% CI, 1.10 - 1.19; P <.00001). Meanwhile, a random effects model in the analysis revealed the analgesic effect of electroacupuncture was greater than conventional Western medicine (mean difference [MD], –2.26; 95% CI, –2.71 to –1.81; P <.00001).

Peng and colleagues also found a notable difference in the effect of electroacupuncture and conventional medicine on serum uric acid levels (MD, -31.60; 95% CI, –44.24 to –18.96; P <.00001). There were also statistically significant differences in analgesic relief between the electroacupuncture plus medication group and the group only receiving medication (MD, –1.85; 95% CI, –2.65 to –1.05; P <.00001).

Among the 15 included studies, five studies reported on adverse events in the electroacupuncture group versus the conventional medication group. Among these studies, investigators identified significant heterogeneity in the incidence of adverse events between the electroacupuncture and conventional drug groups (RR, 0.20; 95% CI, 0.04 to 0.88; P = .03).

Peng and colleagues indicated the lack of comprehensive evidence on the mechanisms involved in acupuncture for treating acute gouty arthritis means future research is necessary. As the study’s level of evidence is low, they urge caution in the interpretation of these findings.

“Conducting additional well-designed multicenter clinical trials with larger sample sizes and more extended treatment periods is essential to validate and consolidate these findings,” investigators wrote.

References

1. _{Ni Z, Xiao Q, Xia Z, Kuang K, Yin B, Peng D. Electroacupuncture for acute gouty arthritis: a systematic review and meta-analysis of randomized controlled trials. Front Immunol. 2024;14:1295154. Published 2024 Jan 4. doi:10.3389/fimmu.2023.1295154}
2. _{Stewart S, Dalbeth N, Gaffo A. The challenge of gout flare measurement. Best Pract Res Clin Rheumatol. 2021;35(4):101716. doi:10.1016/j.berh.2021.101716}