Rheumatoid arthritis is an immune-mediated multi-system inflammatory disease that mainly involves synovium and joints. It has a high incidence and a long course of disease. This paper evaluates the clinical effect of acupuncture and moxibustion combined with Duhuo Jisheng Decoction in treating rheumatoid arthritis through a systematic evaluation.
PubMed, Embase, CNKI, Sinomed, WanFang, and VIP were searched for randomized controlled trials (RCTs) regarding acupuncture and moxibustion combined with Duhuo Jisheng Decoction for treating rheumatoid arthritis. The retrieval time was from the inception of the databases to August 2020. Two researchers independently conducted literature search, screening and data extraction. According to RCT risk of bias tool provided by Cochrane collaboration network, a bias risk assessment of all included literatures was conducted followed by Meta-analysis using RevMan 5.3 software.
A total of 16 RCTs were included, and scored according to the modified Jadad scale, including 1 article with 4 points, 4 articles with 3 points, 8 articles with 2 points, and 3 articles with 1 point. The overall quality of the included RCTs was low. A total of 1 551 cases were involved in these 16 RCTs, including 777 cases in the trial group (Duhuo Jisheng Decoction) and 774 cases in the control group (western medicine). The results of meta-analysis showed acupuncture and moxibustion combined with Duhuo Jisheng Decoction were all better than the control group in terms of overall response rate (relative risk (RR)=1.20, 95% confidence interval (CI): 1.15 to 1.25, P < 0.000 01), morning stiffness time (weighted mean difference (WMD)=-0.86, 95% CI: -1.13 to -0.58, P < 0.000 01), 20-meter walk time (WMD=-4.64, 95% CI: -5.24 to -4.04, P < 0.000 01), joint swelling index (< 49 years old) (WMD=-2.42, 95% CI: -2.58 to -2.26, P < 0.000 01), erythrocyte sedimentation rate (WMD=-1.56, 95% CI: -1.73 to -1.40, P < 0.000 01), C-reactive protein (WMD=-1.18, 95% CI: -1.34 to -1.02, P < 0.000 01), rheumatoid factor (WMD=-2.26, 95% CI: -2.55 to -1.97, P < 0.000 01), tumor necrosis factor-α (WMD=-42.28, 95% CI: -47.47 to -37.09, P < 0.000 01) and adverse reaction incidence (RR=0.36, 95% CI: 0.17 to 0.80, P=0.01).
Compared with western medicine, acupuncture and moxibustion combined with Duhuo Jisheng Decoction for treating rheumatoid arthritis has advantages in the overall response rate, improvement of clinical symptoms, incidence of adverse reactions, and safety, but due to the limitations of literature quality and publication bias, high-quality, multicenter, large-sample RCTs are required to further assess the efficacy and safety.