acupuncture and electroacupunture for the treatment of ra

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Acupuncture and electroacupuncture for thetreatment of RA

Casimiro L, Brosseau L, Milne S, Robinson V, Wells G, Tugwell P

Cover sheet- Background- Methods- Results- Discussion- References- Tables & Graphs

This review should be cited as: Casimiro L, Brosseau L, Milne S, Robinson V, Wells G,Tugwell P. Acupuncture and electroacupuncture for the treatment of RA (CochraneReview). In: The Cochrane Library, Issue 3, 2002. Oxford: Update Software.

A substantive amendment to this systematic review was last made on 28 May 2002.Cochrane reviews are regularly checked and updated if necessary.

Background:Acupuncture has been used by rehabilitation specialists as an adjunct therapy

for the symptomatic treatment of rheumatoid arthritis (RA). Acupuncture is a traditionalChinese medicine where thin needles are inserted in specific documented points believed torepresent concentration of body energies. In some cases a small electrical impulse is addedto the needles. Once the needles are inserted in some of the appropriate points, endorphins,morphine-like substances, have been shown to be released in the patient's system, thusinducing local or generalised analgesia.

Objectives:To evaluate the effects of acupuncture or electroacupuncture on the objectiveand subjective measures of disease activity in patients with RA.

Search strategy:A comprehensive search was done up to September 2001 withMEDLINE, EMBASE, PEDro, Current Contents , Sports Discus and CINAHL. TheCochrane Field of Rehabilitation and Related Therapies and the Cochrane MusculoskeletalReview Group were also contacted for a search of their specialized registers.Handsearching was conducted on all retrieved papers and content experts were contacted toidentify additional studies.

Selection criteria:Comparative controlled studies, such as randomized controlled trials

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and control clinical trials in patients with RA were eligible. No language restrictions wereapplied. Abstracts were accepted.

Data collection and analysis:Two independent reviewers identified potential articles fromthe literature search. These reviewers extracted data using pre-defined extraction forms.Consensus was reached on all the extracted data. Quality was assessed by two reviewersusing a five (5) point validated tool that measured the quality of randomization, double-

blinding and description of withdrawals.

Main results:Two studies (n=84) met the inclusion criteria. One used acupuncture (David1999) while the other used electroacupuncture (Man 1974). In the first study usingacupuncture, no significant difference was found between groups for to erythrocytesedimentation rate (ESR), C-reactive protein (CRP), the visual analogue scale for pain(VAS P), the visual analogue scale for patient's global assessment (VAS G), the number ofswollen joints, the number of tender joints, to the general health questionnaire (GHQ), thescore on the modified disease activity scale (DAS) or in the decrease in analgesic intake.

In the second study, using electroacupuncture, a significant decrease in knee pain wasreported in the experimental group, 24 hours post treatment, when compared to the placebogroup (weighted mean difference of -2.0 with 95% CI -3.6,-4.0).

Reviewers' conclusions:Although the results of the Man 1974study show thatelectroacupuncture may be beneficial to reduce symptomatic knee pain in patients with RA24 hours post treatment, the reviewers concluded that the poor quality of the trial, includingthe small sample size proclude its recommendation. The reviewers further conclude thatacupuncture has no effect on ESR, CRP, pain, patient's global assessment, number ofswollen joints, number of tender joints, general health, disease activity and reduction ofanalgesics. These conclusions are limited by methodological considerations such as the typeof acupuncture (acupuncture vs electroacupuncture), the site of intervention, the lownumber of clinical trials and the small sample size of the included studies.

ackground

op of document Next section Previous section

cupuncture is a technique based on Chinese medical practice whereby needles are inserted into speciterior body locations to relieve pain and for other therapeutic purposes ( Dorland 1988). It affectsectroatropines mainly mediated by endorphins or seratonin, morphine-like compounds ( Dumoulin78). The impact of acupuncture can be enhanced by electrical current, termed electroacupuncture

http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500David19991http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500David19991http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Man19741http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Man19741http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#tophttp://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#s03CD003788http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#s09CD003788http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#rfG05@72890108091038352500Dorland19885http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#rfG05@72890108091038352500Dumoulin19785http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#rfG05@72890108091038352500Dumoulin19785http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#rfG05@72890108091038352500Dumoulin19785http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#rfG05@72890108091038352500Dumoulin19785http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#rfG05@72890108091038352500Dorland19885http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#s09CD003788http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#s09CD003788http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#s03CD003788http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#s03CD003788http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#tophttp://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#tophttp://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Man19741http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Man19741http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500David19991http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500David19991


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Wong 1987). These substances cause analgesia by decreasing pain and modulating stress. They alsopport homeostasis by releasing regulators responsible for other hormones ( Wong 1987).

ased on these physiological effects, acupuncture could have potential benefits for the symptomaticeatment of RA. There is however, very little evidence to support the use or non use of acupuncture fomptomatic treatment of RA patients. Patient management recommendations have not supported the acupuncture due to the lack of scientific evidence to date ( Walker 1996). In fact, to our knowledge

ere are no existing evidence-based clinical practice guidelines in the scientific literature.

Objectives

o evaluate the effectiveness of acupuncture or electroacupuncture therapy for the relief of signs andmptoms of patients with RA, compared to placebo and other treatment interventions.

riteria for considering studies for this review

ypes of studies

ccording to a priori protocol, all comparative controlled trials, including randomized controlled trialsRCT) and controlled clinical trials without randomization (CCT), were included. Trials which used sa

tients as their own control were not accepted. The results were graded according to the strength of thudy design.

o language limitations were imposed. Abstracts were accepted.

ypes of participants

dult patients with classic or definite rheumatoid arthritis treated with acupuncture or electroacupunctny joint except the spine was considered.

ypes of intervention

cceptable interventions included acupuncture applications using any combination of parameters. Forample, use of electric current, stimulation of various points or types of needles employed were notscriminated with regards to the inclusion criteria.

ypes of outcome measures

he primary outcome measure was pain. All secondary outcome measures were from the potential cort identified by the OMERACT conference on rheumatoid arthritis outcomes ( OMERACT 1993),

http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#rfG05@72890108091038352500Wong19875http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#rfG05@72890108091038352500Wong19875http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#rfG05@72890108091038352500Walker19965http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#rfG05@72890108091038352500OMERACT19935http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#rfG05@72890108091038352500OMERACT19935http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#rfG05@72890108091038352500Walker19965http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#rfG05@72890108091038352500Wong19875http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#rfG05@72890108091038352500Wong19875


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cluding:umber of tender joints per patientumber of swollen joints per patienthysician global assessmentatient global assessmentunctional status.

ange of motion (ROM), strength, physiological outcomes such as skin and joint temperature were nocluded in the analysis.

earch strategy for identification of studies

ee: Collaborative Review Group search strategy

he literature search was conducted up to September 2001 according to the sensitive search strategy fo

CTs designed for the Cochrane Collaboration ( Dickersin 1994), with modifications proposed by Ha94. Additional terms for the study design were used to identify observational studies including: casentrol, cohort, comparative study, clinical trial. MEDLINE, EMBASE, HealthSTAR, Sports Discus,

INAHL, the Cochrane musculoskeletal group and the Cochrane field of physical and related therapieere searched using a keyword est textword search strategy (shown below). In addition, the reference included trials were searched and content experts were contacted for additional studies.

exp osteoarthritis/

osteoarthritis.tw.osteoarthrosis.tw.degenerative arthritis.tw.exp arthritis, rheumatoid/rheumatoid arthritis.tw.rheumatism.tw.arthritis, juvenile rheumatoid/caplan's syndrome.tw. felty's syndrome.tw. rheumatoid.tw. ankylosing spondylitis.tw. arthrosis.tw. sjogren$.tw. or/1-14 exp acupuncture acupuncture or electroacupuncture.tw. or/16-17 15 and 18

http://www.bireme.br/clibdata/HTM/[email protected]://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#rfG05@72890108091038352500Dickersin19945http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#rfG05@72890108091038352500Haynes19945http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#rfG05@72890108091038352500Haynes19945http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#rfG05@72890108091038352500Haynes19945http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#rfG05@72890108091038352500Haynes19945http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#rfG05@72890108091038352500Dickersin19945http://www.bireme.br/clibdata/HTM/[email protected]


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clinical trial.pt. randomized controlled trial.pt. tu.fs. dt.fs. random$.tw. placebo$.tw. ((sing$ or doubl$ or tripl$) adj (masked or blind$)).tw

sham.tw. or/20-27 18 and 28

Methods of the review


wo independent reviewers (VR, LB) examined the titles and abstracts of the trials identified by thearch strategy to select trials that met the inclusion criteria. All trials classified as relevant by at least the reviewers were retrieved. The retrieved articles were re-examined to ensure they met the inclusi

iteria and were assessed for quality. The results of the individual trials were extracted from each of thcluded trials using pre-determined extraction forms by two independent reviewers (LB, VR). The daas cross-checked by a third reviewer (LC). The extraction forms were developed and pilot-tested, ban other forms used by the Cochrane musculoskeletal review group. The extraction form documentedecific information about acupuncture therapy. The final data values were based on consensus of the viewers. Most outcomes were continuous in nature and the results are presented as weighted mean

fferences (WMD). Relative risks would have been calculated for dichotomous outcomes.

escription of studies

ee: Tables of studies

he literature search and handsearching identified eight potential articles. Of these, two RCT studies wcluded involving 84 RA patients ( David 1999, Man 1974)

x trials were excluded for the following reasons: 1) Tukmashi 2000: Not a clinical trial; 2) Depei 19o numerical data; 3) Devyani 1985: Literature review; 4) Camerlain 1981: Data not analysable; 5)amerlain 1976: Population mixed (not confined to RA patients); 6) Shen 1973: Incomplete data withtients used as their own control.

the first included study ( David 1999), a cross-over design was used. Sixty-four patients between thes of 46 and 66 were randomly assigned to an experimental or placebo group. Eight participantsithdrew prior to the start of the study. In the experimental group, the treatment consisted of inserting

http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#tophttp://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#s04CD003788http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#s02CD003788http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#s07CD003788http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500David19991http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Man19741http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Tukmashi20002http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Depei19922http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Devyani19852http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Camerlain19812http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Camerlain19762http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Shen19732http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500David19991http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500David19991http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Shen19732http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Camerlain19762http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Camerlain19812http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Devyani19852http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Depei19922http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Tukmashi20002http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Man19741http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500David19991http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#s07CD003788http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#s02CD003788http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#s02CD003788http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#s04CD003788http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#s04CD003788http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#tophttp://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#top
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edle (0.25 x 30 mm) in the liver 3 (Li3) point found on each foot, for a total of two needles. The lengapplication was four minutes. The needles however, were manipulated for five seconds, two minute

ter being inserted. In the placebo group, the guides for needle insertion were placed without pressuree surface of the skin at the Li3 points, but the needles were not inserted. In both groups the patients weated supine with a screen blocking their vision from the waist down. The intervention took place fortal of five sessions at one week interval. Once the five sessions were completed, a wash-out period ox weeks was prescribed before the patients were crossed-over into the other group (experimental or

acebo) for an additional five weeks of intervention. The outcome measures were assessed for all patiior to the start of the first five weeks, post-intervention #1, prior to the start of the 2nd five weeks, potervention #2 and upon follow-up at six weeks post treatment.

the second included study ( Man 1974), a parallel design was used. Twenty patients of undeterminee with knee pain were randomly assigned to an experimental or a placebo group. In the experimentaoup, electroacupuncture at 6.26 5mA was applied once for 15 minutes using three 1.5 cm long needlhe needles were inserted in one of the knees at the GB 34, SP 9 and S43 acupuncture points. The othenee was injected with 50mg of hydrocortisone, hence the parallel design. In the placebo group

ectroacupuncture was applied to three incorrect points around the knee using the same instrumentatiothe experimental group. The other knee was also injected with 50mg of hydrocortisone. The outcomeasure was a pain reduction scale ranging from 0 to 4 where grade zero indicated no reduction in paiade one indicated a marked decrease in pain, grade two indicated a moderate decrease in pain, graderee indicated a minimal decrease in pain and grade four indicated no decrease in pain. Pain was asses

n the basis of the degree of discomfort reported by the patient at rest, during knee flexion/extension auring weight bearing as well as walking activities. The outcome measure was assessed 24 hours aftereatment, weekly for four weeks and monthly for three months.

Methodological quality

ee: Table of included studies

ethodological quality was assessed using a validated assessment tool ( Jadad 1996). The componentuality focus on randomization, double-blinding and description of withdrawals. Two independentviewers (LB, VR) assessed quality and differences were resolved by consensus (LC). Quality was ussubgroup analyses to test the hypothesis that poorly conducted trials demonstrate greater efficacy oftervention under evaluation. Each item (i.e. randomization, blinding and withdrawals) was examinedparately for its effect.

he median methodological quality of the two RCTs was 3 ( David 1999score was 4, Man 1974scoreas 2). Both the David 1999and Man 1974studies were double-blind.

esults

http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Man19741http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#s07CD003788http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#rfG05@72890108091038352500Jadad19965http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500David19991http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Man19741http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500David19991http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Man19741http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Man19741http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500David19991http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Man19741http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500David19991http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#rfG05@72890108091038352500Jadad19965http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#s07CD003788http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Man19741


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d the acupuncture technique was questionable. It is unclear why only one point was treated bilateralld why Li3 was selected. Although the authors attempted to explain their choice, these decisions are nerally accepted ( Tukmachi 2000). Similarly, the treatment time and the frequency chosen can also

uestioned. The authors did however, strengthen their results by choosing four of the OMERACT 199imary outcome measures; number of swollen joints, number of tender joints, patient global assessmed functional status.

the Man 1974study, a significant decrease in knee pain was reported with electroacupuncture at 24st treatment, when comparing the experimental to the placebo group. No difference was found at ono or three months post-treatment. One can conclude that the effects of the electroacupuncture in thean 1974study were only short term. The research methodology was not as clearly outlined in this tri

he age of the participants was not included. The purpose of the hydrocortisone injection was not cleascribed and may in fact have impacted on the results. The outcome measure used is not currentlycognised and did not provide strong objective data. Furthermore, no means or standard deviations wported and for the purpose of this review, they were calculated from the graphical representation of tta. The quality of the data was therefore strongly impacted by poor reporting and a weak outcome

easure.

enerally, methodological considerations that may have impacted on the results of the included studiee the randomization method, quality of double-blinding, sample size, study duration and selection of

utcome measures. Clearly, the treatment application protocol differed between studies, one usedupuncture while the other used electroacupuncture. This fundamental difference exemplifies the lackandardization in application methods and contributes to the difficulty of pooling data. Also, in thisview, only two RCTs that met the inclusion criteria, were retrieved from the literature. Furthermore,w quality observed in the Man 1974study may have caused an overestimation of effect. In particular

tients were subjectively questioned on improvement and this constituted the only outcome measure.andardized outcomes measures ( OMERACT 1993) and measurement periods should be used tocilitate the pooling of data of several studies. Reporting data should also be standardized among thecluded RCTs. Mean and standard deviation of every outcome should be provided systematically.

eviewers' conclusions

mplications for practice

lthough the results of the Man 1974study show that electroacupuncture may be beneficial to reducemptomatic knee pain in patients with RA , the authors of this systematic review note that the effectsere only short-term not exceeding 24 hours of relief. The poor quality of the trial, including the smallmple size proclude its recommendation. Acupuncture has not yet been shown in the literature to havfect on ESR, CRP, pain, patient's global assessment, number of swollen joints, number of tender joinneral health, disease activity and reduction of analgesics. These conclusions are limited byethodological considerations such as the site of intervention, the low number of clinical trials and the

mall sample size of the included studies.

http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#rfG05@72890108091038352500Tukmachi20005http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#rfG05@72890108091038352500OMERACT19935http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Man19741http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Man19741http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Man19741http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#rfG05@72890108091038352500OMERACT19935http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Man19741http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Man19741http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#rfG05@72890108091038352500OMERACT19935http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Man19741http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Man19741http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#stG05@72890108091038352500Man19741http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#rfG05@72890108091038352500OMERACT19935http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#rfG05@72890108091038352500Tukmachi20005


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mplications for research

his review has not clearly proven efficacy of acupuncture or electroacupuncture in the symptomaticeatment of RA. The conclusions are limited by the methodological considerations such as poor qualitthe trials, the high methodological variability, the low number of clinical trials, the small sample siz

e included studies. No harmful side effects were reported. More sensitive and valid clinical outcome

ould be used in studies on the use of acupuncture to reflect the physiological effects found in theientific literature. More focus should be made on the optimal characteristics of the therapeuticplication of acupuncture on different human RA joints. If sufficient studies were ever available on thbject it is recommended that acupuncture and electroacupuncture be reviewed separately.

cknowledgements

he authors wish to thank Jessie McGowen, Catherine Lamothe, Shannon Rees and Lucie Lavigne for

eir indispensable contributions. The authors also wish to thank Maria Judd, CMSG coordinator for hlp with final drafts.

otential conflict of interest

or a detailed description of the Cochrane Musculoskeletal Review Group's (CMSG) statement ontential conflict of interest please refer to the scope document. The scope can be found on the Cochrabrary at www.cochrane.org. You must log on to the Cochrane Library and under "About the Cochraollaboration" select "Collaborative Review Groups - CRGs" . The scope will appear when you select

Cochrane Musculoskeletal Group".

eferences


eferences to studies included in this review

avid 1999(published data only)

David J, Townsend S, Sathananan R. The Effect of Acupuncture on Patients with RA: ARandomized, Placebo-Controlled Cross-Over Study. Rheumatology 1999;38:864-869.

an 1974(published data only)

Man SC, Baragar FD. Preliminary Clinical Study of Acupuncture in RA. The Journal of

http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#tophttp://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#s07CD003788http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#s05CD003788http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#s05CD003788http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#s05CD003788http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#s07CD003788http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#s07CD003788http://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#tophttp://www.bireme.br/cgi-bin/wxislind.exe/iah-cochrane/?IsisScript=/users/www/cgi-bin/iah-cochrane/fulltext.xis&ID=15&DB=2&user=BRI0208922&lang=P#top


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Rheumatology 1974;1(1):126-129.

indicates the major publication for the study

eferences to studies excluded from this review

amerlain 1976

Camerlain M, Myhal D. L'Acupuncture en Rhumatology. L'Union Mdicale du Canada1976;105:552-556.

amerlain 1981

Camerlain M, Leung CY, Santerre A, Munan L, Myhal D. valuation de l'acupuncture dansl'arthrite rhumatoide. L'Union mdicale du Canada 1981;110:1041-1044.

epei 1992

Depei X, Jianzhong H, Zhongyi A, Zuolu S. Acupuncture Treatment of RheumatoidArthritis and Exploration of Acupuncture Manipulations. Journal of Traditional ChineseMedicine 1992;12:35-40.

evyani 1985

Devyani BS. Acunpuncture for Rheumatoid Arthritis: An Analysis of Literature. Seminarsin Arthritis and Rheumatism 1985;14(4):225-231.

hen 1973

Shen AC, Whitehouse MJ, Powers TR, Rhodes CY, Engleman EP. A Pilot Study of theEffects of Acupuncture in Rheumatoid Arthritis. Arthritis and Rheumatism 1973;16(4):569-570.

ukmashi 2000

Tukmashi ES. Acupuncture for Rheumatoid Arthritis. Acupuncture in medicine 2000;18(1):70-73.

dditional references

ickersin 1994

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Dickersin K, Scherer R, Lefebvre C. Identifying relevant studies for systematic reviews.BMJ 1994;309:1286-91.

orland 1988

Dorland's illustrated medical dictionnary 27th ed. Toronto: Saunders, 1988.

umoulin 1978

Dumoulin J, Bisschop G. lectrothrapie 3ime ed. Paris: Maloine, 1978.

aynes 1994

Haynes R, Wilczynski N, McKibbon KA, Walker CJ, Sinclair JC. Developing optimalsearch strategies for detecting clinically sound studies in MEDLINE. J Am Med Info Assoc1994;1:447-58.

adad 1996

Jadad A, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gravaghan DJ. Assessing thequality of reports of randomized clinical trials: is blinding necessary? Controlled ClinicalTrials 1996;17:1-17.

neker 1999

Lineker S, Wood H. The Arthritis Society: Consultation and Therapy Services. Toronto:The Arthritis Society, 1990.

MERACT 1993

OMERACT. Conference on outcome measures in rheumatoid arthritis clinical trials. In:Journal of Rheumatology. Vol. 20. 1993:526-591.

ukmachi 2000

Tukmachi E. Acupuncture and rheumatoid arthritis. Rheumatology 2000;39:1153-1154.

Walker 1996

Walker JM, Helewa A. Physical therapy in arthritis. Montral: W.B. Saunders company,1996.



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Wong 1987

Wong T, Cheng R. The science of acupuncture 2nd ed. Hong Kong: Kola Mayland co.,1987.

over sheet

op of document Next section

Acupuncture and electroacupuncture for the treatment of RA

Reviewer(s) Casimiro L, Brosseau L, Milne S, RobinsonV, Wells G, Tugwell P

Contribution of Reviewer(s) VR extracted and analyzed data andselected trials for the original review.

LB contributed to the data extraction,updated the selection of the reference list,updated the analyses and update of theinterpretation of results.

LC was responsible for writing themanuscript, contributed to data extractionand updated the analyses and interpretationof results.

GW and PT contributed theirmethodological expertise and commentedon early drafts.

MJ provided feedback and editorial supportfor final drafts.

Issue protocol first published Information not availableIssue review first published Information not available

Date of last minor amendment 23 April 2002

Date of last substantive amendment 28 May 2002

Most recent changes Information not supplied by reviewer

Date new studies sought but none

found

Information not supplied by reviewer

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Date new studies found but not yet

included/excluded


Date new studies found and included/

excluded


Date reviewers' conclusions section

amended


Contact address Lynn CasimiroFull Time LecturerSchool of Rehabilitation SciencesUniversity of Ottawa451 Smyth RoadOttawaOntarioCANADAK1H 8M5

Telephone: 613-562-5800 extension: 8129Facsimile: 613-562-5428E-mail: [email protected]

Cochrane Library number CD003788

Editorial group Cochrane Musculoskeletal Group

Editorial group code HM-MUSKEL

ources of support

xternal sources of support to the review

Multiple sources of funding, see CMSG scope for complete list TRANSNATIONAL

ternal sources of support to the review

none CANADA

ynopsis

ne study shows electroacupuncture decreased pain in patients with rheumatoid arthritis.

lthough the results of one study show that electroacupuncture may be beneficial to reduce symptomanee pain in patients with rheumatoid arthritis 24 hours after treatment, the reviewers concluded that th

or quality of the trial, including the small number of patients included in the study proclude its

http://www.bireme.br/clibdata/HTM/[email protected]://www.bireme.br/clibdata/HTM/[email protected]


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commendation. Acupuncture has not been shown in the literature to have an effect on erythrocytedimentation rate, C-reactive protein , pain, patient's global assessment, number of swollen joints,

umber of tender joints, general health, disease activity and reduction of analgesics. These conclusione limited by methodological considerations such as the type of acupuncture (acupuncture vsectroacupuncture), the inconsistencies at the site of intervention, the low number of clinical trials ande small sample size of the included studies.

ables & Graphs

op of document Previous section

MetaView graphsThe figures and graphs in Cochrane Reviews display the Peto Odds Ratio and the Weighted Me

Difference by default. These are not always the methods used by reviewers when combining da

in their review. You should check the text of the review for a description of the statistical metho

used. List of comparisons Table of included studies Table of excluded studies Table of ongoing studies

ist of comparisons

op of document Next table Previous table

g 01 ACUPUNCTURE VS PLACEBO (END OF TREATMENT -24HRS)

01.01.00 *Pain (0-4 scale, 0-no pain)

g 02 ACUPUNCTURE VS PLACEBO, (END OF TREATMENT- 5 WEEKS)

02.01.00 Pain (0-100 scale, 0-no pain)02.02.00 Swollen joints count02.03.00 Tender joints count02.04.00 Disease Activity (Scale 1-10)02.05.00 Global Health Questionnaire (Scale 1-10)

g 03 ELECTROACUPUNCTURE VS PLACEBO (FOLLOW-UP 24 HOURS)

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03.01.00 Pain (number of patients improved)

g 04 ELECTROACUPUNCTURE VS PLACEBO (FOLLOW-UP 1MONTH)


g 05 ELECTROACUPUNCTURE VS PLACEBO (FOLLOW-UP 2 MONTHS)






ables of other data


ables of other data are not available for this review

dditional tables


dditional tables are not available for this review

able of included studies


Study Methods Participants Interventions Outcomes NotesAllocatio

concealme

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David

1999

Randomized,cross-overdesign. Samplesize: 64(8withdrawals)Group 1:29acupuncture

Group 2: 27placeboTreatmentduration: 5weeks6 weeks breakcross-overs inother groupsfor 5weeks,

follow up after6 weeks post-treatment

Inclusion:definite orclassical R.A.,18 to 75 yearsold. Mean agefor group 1:61 Group 2:

57Diseasedurationgroup 1: 8Diseaseduration group2: 12

Group 1: 5 treatmentsof acupuncture 4min.at weekly intervalsGroup 2: 5 placeboonly guide for needleis placed for 4 min

Size of needles : 0.25x 30mm Totalnumber of sites: 2(Li3), Duration oftreatment: 4 min.,Total number oftreatment sessions: 5

CRP, ESR,VAS pain,VAS globalassessment,Swollenjoint, Tenderjoint, GHQ,

modifiedDAS,Analgesics

R=2B=1W=1

A

Man

1974

Randomized,Parallel design,Sample size:20, Electro-acupunctureduration: 15

min., Follow-up: 1x 24hours,4xweekly and3x monthlyExperimentalgroup: 10,Control group:10

Inclusion:definite andclassic R.A.present for 5years orlonger, Pain in

both knees,Diseaseduration: 5years or more.Group 1: 3males and 7females,Group 2: 3males and 7

females.

Group 1: one kneetreated withelectroacupunctureand steroid injectionin the other knee(50mg), Group 2: One

knee treatedincorrectly andsteroid injection inthe other knee (50mg).Electroacupuncturesites for experimentalgroup: GB 34, SP 9, S43,

Electroacupuncturesites for controlgroup: 3 points withno known effects.Size of needles: 1,5cm long, Totalnumber of needles: 3+ connected toelectro-stimulator

Painreductionscale 0-4.Number ofpatients withsignificant

decrease inpain. 10/10,24 hrs: 9/10,1m: 9/10,2m: 7/10,3m: 0/10, 4m

R=1B=1W=0

A



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6.26 at 5mA.Duration oftreatment : 15 min.,Total number oftreatment sessions: 1

able of excluded studiesop of document Previous table

Study Reason for exclusion

Camerlain 1976 Mixed population (not confined to RA patients)

Camerlain 1981 Data not analysable

Depei 1992 No numerical data

Devyani 1985 Literature Review

Shen 1973 Incomplete data, patients own control, no means or standarddeviations

Tukmashi 2000 Not a clinical trial

able of ongoing studies

op of document Previous table

table of ongoing studies is not available for this review

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TAVIEW:Acupuncture and electroacupuncture for the treat

ART DATA

01 Acupuncture vs Placebo (end of treatment -

hrs)

C 01 01 Y *Pain (0-4 scale, 0-no

in) Favo

eatment Favours control

01 01 00 Man 1974 1974 0 10 2.00 1.83 0 10

00 1.83 0.00 0.00 0 A

02 Acupuncture vs Placebo, (end of treatment- 5

eks)C 02 01 Y Pain (0-100 scale, 0-no

in) Favou


02 01 00 David 1999 1999 0 29 44.00 25.51 0 26

.00 31.89 0.00 0.00 0 A

C 02 02 Y Swollen joints

unt

vours treatment Favours control

02 02 00 David 1999 1999 0 29 2.00 5.10 0 26

00 2.60 0.00 0.00 0 A

02 02 00 Man 1974 1974 0 1 0.00 0.00 0 1

00 0.00 0.00 0.00 0 A

C 02 03 Y Tender joints

unt

vours treatment Favours control

02 03 00 David 1999 1999 0 29 5.50 10.20 0 26

00 5.10 0.00 0.00 0 A

C 02 04 Y Disease Activity (Scale 1-

Favours


02 04 00 David 1999 1999 0 29 4.80 2.80 0 26

90 1.66 0.00 0.00 0 A

C 02 05 Y Global Health Questionnaire (Scale 1-

Favours treatment

vours control

02 05 00 David 1999 1999 0 29 4.00 3.83 0 26

00 7.65 0.00 0.00 0 A

03 Electroacupuncture vs placebo (follow-up 24

urs)

D 03 01 Y Pain (number of patients

proved) Favour

ntrol Favours treatment

03 01 00 Man 1974 1974 10 10 0.00 0.00 1 10

00 0.00 0.00 0.00 0 A

04 Electroacupuncture vs placebo (follow-up

onth)

D 04 01 Y Pain (number of patientsproved) Favour


04 01 00 Man 1974 1974 10 10 0.00 0.00 0 10

00 0.00 0.00 0.00 0 A


nths)


proved) Favour


05 01 00 Man 1974 1974 9 10 0.00 0.00 0 10

00 0.00 0.00 0.00 0 A


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nths)


proved) Favour


06 01 00 Man 1974 1974 7 10 0.00 0.00 0 10

00 0.00 0.00 0.00 0 A


nths)


proved) Favour


07 01 00 Man 1974 1974 0 10 0.00 0.00 0 10

00 0.00 0.00 0.00 0 A

D DATA

acupuncture and electroacupunture for the treatment of ra

Documents