Systematic Review and Meta-analysis of Electoacupunture Efficacy on Acute Gout

Ji Hye Hwang; Aejin Song; Ho-Sueb Song; Hwang, Ji Hye; Song, Aejin; Song, Ho-Sueb

doi:10.13048/jkm.22022

JKM > Volume 43(2); 2022 > Article

Hwang, Song, and Song: Systematic Review and Meta-analysis of Electoacupunture Efficacy on Acute Gout

Review Article

The Journal of Korean Medicine 2022; 43(2): 92-109.

Published online: June 1, 2022

DOI: https://doi.org/10.13048/jkm.22022

Systematic Review and Meta-analysis of Electoacupunture Efficacy on Acute Gout

Ji Hye Hwang¹

, Aejin Song²

, Ho-Sueb Song¹^{, *}

¹Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Gachon University

²Gachon Institute of Korean Medicine

Correspondence to: Ho-Sueb Song, Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Gachon University,, Seongnam 13120, Korea, Tel:+82-32-770-1342

Received April 12, 2022 Revised May 23, 2022 Accepted May 25, 2022

Abstract

Objectives

The objective of this study was to appraise the effect of electroacupuncture (EA) for the treatment of acute gout.

Methods

Since no suitable study could be found in the domestic database, we performed a literature search up to the end of December 2020 using four international electronic databases. Randomized controlled trials (RCTs) evaluating the effectiveness of EA in the treatment of acute gout were included. The risk of bias was evaluated from the Cochrane risk of bias tool.

Results

Eight appropriate RCTs were included and analyzed. Three evaluation tools were mainly used: Total Effective Rate (TER), Uric acid (UA), and Pain score (VAS). In the case of TER, in all eight cases, electroacupuncture alone and combined treatment showed a statistically significant level of improvement compared to Western medicine treatment. In the case of VAS score, electroacupuncture alone and combined treatment showed a more significant effect than Western medicine treatment. In the case of UA level, electroacupuncture combined treatment showed a more significant effect than western medicine treatment. Although not all three evaluation tools were used in all studies, the majority of studies showed that electroacupuncture was effective for acute gout patients.

Conclusions

The results of this study suggest that EA treatment may be effective for acute gout. It should be noted, however, that the studies included in this study were geographically biased, small in number, and mostly at high risk of bias. More well-designed studies are needed in the future.

Keywords: Gout, Acupunture, Electroacupuncture, Acute gouty arthritis, Systematic review, Randomized controlled trial, Meta-analysis

Acknowledgments

This research was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), which is funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HF20C0179).

Fig. 1

A flow chart describing the trial selection process.

Fig. 2

Risk of bias summary (A) and graph (B)

A. +: low risk of bias, −: high risk of bias, ?: unclear risk of bias.

Fig. 3

Meta analysis outcome of total efficiency rate between electroacupuncture alone or combined treatment vs. western medicine treatment.

A. Electroacupuncture vs. Western medicine treatment, B. Electroacupuncture+Blood-letting puncture vs. Western medicine treatment, C. Electroacupuncture+Blood-letting puncture+Moxibustion vs. Western medicine treatment, D. Electroacupuncture+Pharmacopuncture vs. Western medicine treatment.

Fig. 4

Meta analysis outcome of pain score (VAS) between electroacupuncture alone or combined treatment vs. western medicine treatment.

Fig. 5

Meta analysis outcome of uric acid between electroacupuncture alone or combined treatment vs. western medicine treatment.

Table 1

Summary of the Randomized Controlled Trials of Electroacupuncture alone or combined treatment for acute gout

No.	Study ID	Study design	Sample size	Gender		Age (Mean)	Intervention (n)	Comparison (n)	Duration	F/U	Outcome measurements	Results	Adverse events
No.	Study ID	Study design	Sample size	M	F	Age (Mean)	Intervention (n)	Comparison (n)	Duration	F/U	Outcome measurements	Results	Adverse events
1	Xie (2007)	RCT	60	20	10	40~70 (56±3.2)	Electroacupuncture (30)	Western medicine treatment (30) - allopurinol	10d	-	① TER ② UA	① 93.3/83.3 ② 402.67±46.06/401.80±50.24	nr
1	Xie (2007)	RCT	60	18	12	42~69 (57±3.4)	Electroacupuncture (30)	Western medicine treatment (30) - allopurinol	10d	-	① TER ② UA	① 93.3/83.3 ② 402.67±46.06/401.80±50.24	nr

2	Yin (2005)	RCT	60	21	9	31~69 (59.7±6.8)	Electroacupuncture (30)	Western medicine treatment (30) - indomethacin - benzbromarone	6d	-	① TER ② UA	① 90.0/86.7 ② 310.61±74.20/332.75±58.46	nr
2	Yin (2005)	RCT	60	19	11	34~76 (62.5±7.4)	Electroacupuncture (30)		6d	-	① TER ② UA	① 90.0/86.7 ② 310.61±74.20/332.75±58.46	nr

3	Zou (2006)	RCT	90	26	4	32~70	Electroacupuncture (60)	Western medicine treatment (30) - indomethacin - allopurinol	6d	-	① TER ② VAS ③ UA	① 86.7/100.0/90.0 ② 4.87±1.59/3.29±1.46/6.11±1.37 ③ 443.39±47.19/403.22±32.61/395.57±34.84	nr
				28	2	31~71
				27	3	35~71

4	Jin (2012)	RCT	60	27	3	38~60	Electroacupuncture+ Blood-letting puncture(30)	Western medicine treatment (30) - colchicine - indomethacin	14d	-	① TER ② VAS	① 90.0/83.3 ② 3.34±1.20/5.98±1.63,	nr
4	Jin (2012)	RCT	60	29	1	40~65	Electroacupuncture+ Blood-letting puncture(30)	Western medicine treatment (30) - colchicine - indomethacin	14d	-	① TER ② VAS	① 90.0/83.3 ② 3.34±1.20/5.98±1.63,	nr

5	Yan (2018)	RCT	64	22	10	26~63 (43.22±3.46)	Electroacupuncture+ Blood-letting puncture(32)	Western medicine treatment (32) - colchicine - indomethacin	14d	-	① TER ② UA ③ VAS	① 96.88/81.25 ② 379.35±41.31/403.12±38.17 ③ 1.13±0.24/3.03±1.21	Intervention(1) Comparison(12)
5	Yan (2018)	RCT	64	24	8	25~63 (40.16±3.22)	Electroacupuncture+ Blood-letting puncture(32)	Western medicine treatment (32) - colchicine - indomethacin	14d	-	① TER ② UA ③ VAS		Intervention(1) Comparison(12)

6	Zhong (2009)	RCT	65	21	13	30~70 (53.2)	Electroacupuncture+ Blood-letting puncture(34)	Western medicine - colchicine (31)	7d	-	① TER ② UA	① 91.2/83.9 ② 244±40.23/322±61.51	U
6	Zhong (2009)	RCT	65	19	12	33~65 (55.2)	Electroacupuncture+ Blood-letting puncture(34)	Western medicine - colchicine (31)	7d	-	① TER ② UA	① 91.2/83.9 ② 244±40.23/322±61.51	U

7	Guo (2017)	RCT	109	32	23	32~70 (50.91±5.36)	Electroacupuncture+ Blood-letting puncture+Moxibustion (55)	Western medicine treatment (54) - colchicine	30d	-	① TER ② UA ③ VAS	① 96.36/85.19 ② 361.22±43.23/393.31±51.01 ③ 1.75±1.46/2.88±1.49	Comparison(8)
7	Guo (2017)	RCT	109	33	21	33~69 (50.86±5.34)	Electroacupuncture+ Blood-letting puncture+Moxibustion (55)	Western medicine treatment (54) - colchicine	30d	-	① TER ② UA ③ VAS		Comparison(8)

8	Zou (2007)	RCT	60	24	6	32~70	Electroacupuncture+ Pharmacopuncture (30)	Western medicine treatment (30) - indomethacin - allopurinol	6d	-	① TER ② VAS ③ UA	① 100/93.3 ② 3.27±1.48/6.08±1.55 ③ 405.56±27.28/440.64±42.68	nr
8	Zou (2007)	RCT	60	25	5	31~72	Electroacupuncture+ Pharmacopuncture (30)		6d	-	① TER ② VAS ③ UA		nr

RCT: randomized controlled trial, nr: not reported, d: day, TER: total efficiency rate, UA: uric acid, VAS: visual analogue scale.

Table 2

Electroacupuncture Treatment method

No.	Study ID	acupuncture points for one treatment.	acupuncture point	acupuncture depth	needle size	number of treatments	Strength	Treatment cycle	Another intervention
1	Xie (2007)	nr	SP6, LR4, SP9, SP10, BL33, BL23 Point Combination - upper limbs: LI4, TE2, LI2 lower limbs: ST2, LR3	nr	nr	10	Pts	1d 1t, 30min	-
2	Yin (2005)	4	ST36, SP3, A-Shi Point 2	35 mm	0.25×40mm	6	Pts 2Hz, 100Hz/	1d 1t, 30min	-
3	Zou (2006)	3	ST36, SP3, A-Shi Point	nr	0.25×40mm	6	0.5 mA 10 min & 1 mA 10 min & 2 mA 10min	1d 1t, 30min	-
4	Jin (2012)	8	SP6, SP9, GB34, ST40, LR3, SP3, LI11, LI4	nr	0.25×40mm	14	nr	1d 1t, 40min	Blood-letting puncture
5	Yan (2018)	7	A-Shi Point	nr	0.30×40mm	14	nr	Electroacupuncture: 1d 1t, 30min Blood-letting puncture: bid	Blood-letting puncture
6	Zhong (2009)	22	SP6, SP9, ST36, LI11, LI4, SP2, SP3, LR2, LR3, KI3, KI6, LR4, BL60, BL62, GB40, EX-LE5, SP10, ST34, TE4, TE5, LI5, GB12	nr	1 ~ 1.5 寸	7	Pts	1d 1t, 30min	Blood-letting puncture
7	Guo (2017)	12	SP6, SP9, ST36, EX-LE10, SP4, A-Shi Point, LR3 Point Combination - Shirezubi(湿热阻痹证): LI11, SP9; Yureneiyu(瘀热内郁证): SP10, LI4; Tanshizuzh(i(痰湿阻滞证): ST40, SP9; Ganshenyinxu(肝肾阴虚证): KI3	nr	nr	30	Pts	1d 1t, 30min	Blood-letting puncture+ Moxibustion
8	Zou (2007)	3	ST36, SP3, A-Shi Point	nr	0.25×40mm	6	2Hz or 100Hz/0.5 mA 10 min & 1 mA 10 min & 2 mA 10min	1d 1t, 30min	Pharmacopuncture

nr: not reported, Pts: Patient tolerance standards, d: day, t: time, min: minute, bid: 2 times a day

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