| ObjectiveDirect meta-analysis and Bayesian-based network meta-analysis were used to evaluate the effectiveness of acupuncture application in RA and the advantages and disadvantages of different acupuncture methods.Objectively evaluate the clinical efficacy of RA patients based on the difference in the efficacy of mesh meta-analysis,and explore which single acupuncture therapy can be used as an alternative therapy of western medicine methotrexate for rheumatoid arthritis,providing the basis for the clinical application of this therapy.MethodsReted meta-analysis:A Chinese-English database(RCTs)of acupuncture combined with DMARDs for RA ended until 31 MAY 2022,including Cochrane Library,EMBASE,Web of Science,CNKI,VIP,Wanfang,and SinoMed.Literature screening,data extraction,risk of bias assessment by two independent researchers,direct meta-analysis using the R software "metafor" program package,and Bayesian-based network meta-analysis using the"gemtc" data package.The mesh meta study used clinical response rate,post-treatment visual analog score(Visual analogue scoring,VAS),rheumatoid arthritis disease activity evaluation form(DAS 28),peripheral blood C-reactive protein(C-reactive protein,CRP)concentration,and erythrocyte sedimentation rate(erythrocyte sedimentation Rate,ESR)as outcome measures.Clinical study:The 90 subjects screened by the clinical Institute were all from Gui si yuan TCM clinics in Hong Kong from June 2022 to December 2022,which met the inclusion criteria for RA.According to the principle of randomization,we equally allocated the patients to the western medicine group,microacupuncture group and electroacupuncture group.30 patients in each group were treated with methotrexate alone,nanoacupuncture therapy and electroacupuncture therapy,respectively.After 12 weeks of treatment,the clinical efficacy of the three groups was evaluated.Based on the rapid fluctuation of blood sedimentation and C-reactive protein after drug treatment,it was observed for 4 weeks.Result:Reticular meta-analysis:After the search and literature screening,30 randomized controlled studies were included,totaling 2415 subjects.Subjects with common acupuncture,moxibustion,warm acupuncture and electroacupuncture were taken as the intervention group,and subjects treated with DMARDs alone as the control group.There were 1211 patients in the intervention group and 1204 patients in the control group.Direct meta-analysis showed that,The clinical effective rate of acupuncture combined with drug therapy was significantly higher than that of drug therapy(OR=3.36,95%CI 2.54-4.43);The VAS score after acupuncture and combination medication was significantly lower than medication(SMD=-0.85,95%CI-1.05～-0.65);The morning stiffness time after acupuncture treatment was significantly lower than that after drug treatment(SMD=-1.11,95%CI-1.25～-0.97);The DAS 28 score after acupuncture and combination medication was significantly lower than medication(SMD=-1.26,95%CI-1.41～-1.11);CRP concentration was significantly lower than medication(SMD=-0.63,95%CI-0.74～-0.52);ESR concentration was significantly lower than medication(SMD=-0.86,95%CI-0.96～-0.75).Based on Bayesian mesh meta-analysis:The results show that in terms of improving clinical efficacy,the probability of achieving the best effect is warm acupuncture+drug>general acupuncture+drug>moxibustion+drug>electroacupuncture acupuncture+drug>drug treatment.The probability of warm acupuncture+drugs is 41.9%,and the probability of ordinary acupuncture+ drugs is 30.5%.In terms of reducing VAS score,the probability is general acupuncture+drugs>electroacupuncture>drug>moxibustion>warm acupuncture+drugs.In terms of improving DSA 28 score,the probability that the best effect can be obtained was electroacupuncture+medication>general acupuncture+warm acupuncture+medication>warm acupuncture+medication>moxibustion+medication>drug therapy,respectively.Electroacupuncture+ drugs has 70.5%probability of the best effect,ordinary acupuncture+drugs has 27.4%probability of the best effect,warm acupuncture+drugs has 1.8%probability of the best effect,and moxibustion+drugs has 0.2%probability of the best effect.Clinical study:Before intervention,the age,sex,TJC(joint pain count),SJC(joint swelling count),sedimentation,C reactive protein,DAS 28 score,VAS score and HAQ score showed no significant statistical difference(P>0.05).After the intervention1.TJC(joint tenderness count):In-group comparison after treatment:P<0.05 was significant in western medicine group,microacupuncture group and electroacupuncture group compared with before treatment.Comparison between groups after treatment:P>0.05 between the western medicine group and the electroacupuncture group.Illustrated the electric acupuncture therapy and western medicine treatment can improve TJC level,and pure electric acupuncture therapy in improving the level of TJC and western medicine treatment effect,and western medicine treatment and treatment after pure needle,P<0.05 statistical significance,shows that in the improvement of TJC level,pure needle treatment and western medicine treatment can improve TJC level,but the curative effect of western medicine treatment is better than pure needle treatment.2.SJC(joint swelling count):Comparison between groups after treatment:P<0.05 was significant for western medicine,electroacupuncture,and electroacupuncture and before treatment.Comparison between groups after treatment:P>0.05 between the western medicine group and the electroacupuncture group.Explain the electric acupuncture therapy and western medicine treatment can improve SJC level,and pure electric acupuncture therapy in improving the level of SJC and western medicine treatment effect,and western medicine treatment compared with pure needle after treatment,P<0.05 statistical significance,shows that in the improvement of SJC level,pure needle treatment and western medicine treatment can improve SJC level,but the efficacy of western medicine treatment is better than pure needle treatment.3.Time of morning stiffness:In-group comparison after treatment:P<0.05 was significant in western medicine group,microacupuncture group and electroacupuncture group compared with before treatment.Comparison between groups after treatment:P>0.05 between the western medicine group and the electroacupuncture group.Explain the electric acupuncture therapy and western medicine treatment can improve the morning stiffness time,and pure electric acupuncture therapy on improving the morning stiffness time and western medicine treatment effect,and western medicine treatment after treatment with pure needle,P<0.05 statistical significance,that in improving the morning stiffness time,pure needle treatment and western medicine treatment can improve the morning stiffness time,but the curative effect of western medicine treatment is better than the pure needle treatment.4.ESR(blood sedimentation rate):In-group comparison after treatment:P<0.05 was statistically significant in western medicine group and electroacupuncture group and before treatment.However,it was not statistically significant for P>0.05 compared with pre-treatment group.Comparison between groups after treatment:P>0.05 between the western medicine group and the electroacupuncture group.It shows that both electroacupuncture therapy and western medicine treatment can improve ESR level,and the efficacy of pure electroacupuncture therapy is comparable to that of western medicine treatment in the improvement of ESR level,while western medicine treatment is compared with pure electroacupuncture treatment after treatment,P<0.05 is statistically significant,indicating that the efficacy of western medicine treatment is better than that of pure electroacupuncture treatment in the improvement of ESR level.5.CPR(C reactive protein):In-group comparison after treatment:P<0.05 was significant in western medicine,electroacupuncture and electroacupuncture groups compared with before treatment.Comparison between groups after treatment:P>0.05 was not statistically significant compared with the western medicine group,indicating that both western medicine,microacupuncture and electroacupuncture could improve CPR level.6.VAS score:Comparison between groups after treatment:P<0.05 was significant in western medicine,microacupuncture and before treatment.It showed that VAS score could be improved by western medicine,microacupuncture and electroacupuncture.Comparison between groups after treatment:the P>0.05 after treatment was compared with that after treatment,indicating that the efficacy of electroacupuncture and electroacupuncture was close to western medicine treatment in the improvement of VAS score.7.HAQ score:Comparison between groups after treatment:P<0.05 was significant for western medicine,electroacupuncture,and electroacupuncture and before treatment.It shows that HAQ score can be improved by western medicine,acupuncture and electroacupuncture.Comparison between groups after treatment:P>0.05 after treatment compared with western medicine group,indicating that the efficacy of acupuncture and electroacupuncture was close to western medicine treatment in the improvement of HAQ score.8.DAS 28 score:In-group comparison after treatment:P<0.05 was significant in western medicine group,microacupuncture group and electroacupuncture group compared with before treatment.Comparison between groups after treatment:P>0.05 between the western medicine group and the electroacupuncture group.This paper shows that electric acupuncture therapy and western medicine treatment can improve DAS 28 score,and pure electroacupuncture therapy in improving DAS 28 score,while western medicine treatment is compared with pure acupuncture after treatment,P<0.05 has statistical significance,indicating that in improving DAS 28 score,pure acupuncture treatment and western medicine treatment can improve DAS 28 score,but the curative effect of western medicine treatment is better than pure acupuncture treatment.9.Efficiency of disease activity after treatment:After 3 months of treatment,DAS 28 score scale,in the microacupuncture group,4 were effective,16 were effective,10 were ineffective,66.67%,in the electroacupuncture group,9 were effective,6 were effective,81.46%,in the western medicine group,13 were effective,4 were ineffective,and the effective rate was 85.19%.There was no statistical difference between the effective rate of microacupuncture group and electroacupuncture group and that of western medicine group.ConclusionReted meta-analysis:in RA patients,compared with drug treatment alone,common acupuncture,electroacupuncture,warm acupuncture,moxibustion,etc.,can reduce inflammatory response,improve symptoms and improve efficiency.Among the four acupuncture methods,warm needle acupuncture has the best effect in improving efficiency,and ordinary acupuncture has the best effect in relieving pain.In terms of improving the DSA 28 score,electroacupuncture was the best effective.Clinical research:this clinical study after a needle,electric needle,and western medicine treatment,three groups of rheumatoid joint disease patients health improved,and change has statistical significance,illustrates the western medicine treatment or a needle treatment,needle treatment can improve for rheumatoid arthritis,and the benefit of electric acupuncture is better than the needle treatment and effect close to the effect of western medicine methotrexate.But according to the results of the clinical study can be seen,whether improve TJC,SJC,morning time,inflammatory factors or das 28 score,western medicine is better than pure needle treatment,but in improving VAS score and HAQ score,simple needle treatment effect can be close to the efficacy of western medicine treatment,it seems to show that whether electric needle treatment or pure needle treatment,acupuncture therapy to improve the symptoms of pain in patients with rheumatoid arthritis.In clinical studies,in the improvement of DAS 28 score,the efficacy of electroacupuncture therapy is indeed better than that of electroacupuncture therapy alone,and its efficacy is close to that of western medicine treatment.Through the effective rate of disease activity after treatment,we can see that the effective rate of microacupuncture was 66.67%,electroacupuncture was 81.48%,and western medicine was 85.19%..It can be seen that electric needle in disease activity effective effect close to the curative effect of western medicine methotrexate,it shows that electric acupuncture may be a single acupuncture therapy to the greatest extent can bring benefits for patients with rheumatoid arthritis therapy,may also be pure acupuncture therapy can be used as a western medicine methotrexate treatment of rheumatoid arthritis. |
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