Acupuncture for gouty arthritis: A systematic review and meta-analysis of randomized controlled trials

Introduction: We examined the effects of acupuncture on gouty arthritis by comparing acupuncture versus—and in addition to—conventional treatment. Methods: We searched randomized controlled trials published from January 1, 2000, to December 31, 2022, from eight electronic databases (MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, KoreaMed, Korean Studies Information Service System, Research Information Service System, and Oriental Medicine Advanced Searching Integrated System, and China National Knowledge Infrastructure), and selected studies by eligibility criteria for meta-analysis. The Cochrane risk of bias tool was used, and meta-analysis was conducted using a random-effects model. Results: We retrieved 1,909 articles and selected 12 studies. Compared to conventional treatment, acupuncture was significantly better at reducing pain intensity (95% confidence interval [CI]: -2.03 to -1.09, p < 0.00001) and showed a better effective rate (95% CI: 1.03 to 1.17, p = 0.003). The combination of acupuncture with conventional treatment significantly improved pain intensity (95% CI: -2.18 to -0.76, p < 0.0001), pain relief duration (95% CI: -1.28 to -0.50, p < 0.00001), and serum uric acid (SUA) level (95% CI: -0.93 to -0.33, p < 0.0001) compared with conventional treatment alone. According to the Grading of Recommendations Assessment, Development and Evaluation methodology, acupuncture alone and acupuncture with conventional treatment showed a very low quality of evidence for reducing pain intensity as a primary outcome measure due to a high risk of bias and imprecision. Conclusions: Acupuncture might be a beneficial alternative or adjunctive treatment for patients with gouty arthritis. However, due to very low certainty in the evidence, well-powered and rigorously designed clinical trials are necessary to further validate these preliminary findings.