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| Les deux révisions précédentes Révision précédente Prochaine révision | Révision précédente | ||
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acupuncture:evaluation:rhumatologie - orthopedie:11. spondylarthrite ankylosante [02 May 2019 07:22] Nguyen Johan [1.1.1. Zhang 2018 ☆] |
acupuncture:evaluation:rhumatologie - orthopedie:11. spondylarthrite ankylosante [28 Aug 2025 19:14] (Version actuelle) Nguyen Johan [1.1. Generic Acupuncture] |
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| + | /*English:Ankylosing Spondylitis*/ | ||
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| + | ======= Ankylosing Spondylitis ======= | ||
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| ====== Spondylarthrite ankylosante : évaluation de l'acupuncture ====== | ====== Spondylarthrite ankylosante : évaluation de l'acupuncture ====== | ||
| - | ===== Revues systématiques et méta-analyses ===== | + | ===== Systematic Reviews and Meta-Analysis===== |
| - | |☆☆☆ |Preuves en faveur d’une efficacité et d’un effet spécifique de l’acupuncture. | | + | |
| - | |☆☆| Preuves en faveur d’une efficacité de l’acupuncture.| | + | |
| - | | ☆ |Preuves en faveur d’une efficacité de l’acupuncture mais limitées qualitativement et/ou quantitativement.| | + | |
| - | |Ø |Absence de preuve ou preuves insuffisantes.| | + | ==== Generic Acupuncture ==== |
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| + | === Cao 2025 === | ||
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| + | Cao X, Zhang Y, Xiao Z, Peng J. Efficacy and safety of acupuncture combined with Western medicine in the treatment of ankylosing spondylitis: A systematic review and meta-analysis. Medicine (Baltimore). 2025 May 23;104(21):e42468. https://doi.org/10.1097/MD.0000000000042468 | ||
| + | ^Backgound| An autoimmune disease called ankylosing spondylitis (AS) is known to cause stiffness and pain in the joints. Acupuncture is a traditional Chinese medicine that has been used extensively to treat AS. It has several advantages, including safety, affordability, and few adverse effects. However, there is limited data to support its therapeutic effects. As a result, the goal of the current study is to assess acupuncture's reliability in treating AS in its entirety.| | ||
| + | ^Methods| Seven databases were searched from January 1, 2000, to July 31, 2024, for randomized controlled trials (RCTs) on acupuncture in conjunction with Western medicine to treat AS. The retrieved data was meta-analyzed using Review Manager 5.4 and Stata 17.0. The updated Cochrane risk of bias tool was used to evaluate the bias risk in RCTs.| | ||
| + | ^Results| The results revealed that combining Acupuncture and Western medicine led to better outcomes as far as effective rate (RR = 1.25, 95% confidence intervals (CI): 1.16-1.34); thoracic mobility (MD = 0.58, 95% CI: 0.43-0.73); Schober test (SMD = 0.83, 95% CI: 0.57-1.09); bath ankylosing spondylitis disease activity index (MD = -1.11, 95% CI: -1.46 to -0.76); visual analog scale for pain (MD = -1.02, 95% CI: -1.44 to -0.60); CRP (MD = -2.79, 95% CI: -4.14 to -1.43); ESR: (MD = -5.33, 95% CI: -6.63 to -4.02); and adverse reactions (RR = 0.58, 95% CI: 0.35-0.95) in contrast to treating AS with just Western treatment.| | ||
| + | ^Conclusion| When paired with Western therapy, acupuncture improves the effective rate, functional scores, and symptoms of people with AS while lowering adverse reactions.| | ||
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| + | === Zhang 2025 === | ||
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| + | Zhang D, Zhang GL, Peng B, Wu ZP, Yi XD, Zhao TY, Sun JF. Acupuncture for ankylosing spondylitis: An updated systematic review and meta-analysis. J Back Musculoskelet Rehabil. 2025 Mar;38(2):364-382. https://doi.org/10.1177/10538127241289339 | ||
| + | ^Backgound| Existing evidence is insufficient to support that acupuncture is effective in treating ankylosing spondylitis (AS) due to the constraints of acupuncture site and manipulation, and relatively straightforward study treatments and indicators.| | ||
| + | ^Objective| By incorporating high-quality original literature, this study aims to evaluate the effectiveness of acupuncture for AS and to demonstrate acupuncture as a non-drug supplementary and alternative means for treating AS.| | ||
| + | ^Methods| We searched seven databases from their inception to March 31, 2023. Only randomized controlled trials (RCTs) with PEDro score ≥ 6 that compared traditional acupuncture alone or in combination with non-acupuncture therapy on diagnostic AS were considered. The PEDro, ROB2, and STATA tools were used for quality evaluation and statistical analysis.| | ||
| + | ^Results| A total of **21 RCTs covering 1884 patients** were included. Meta-analysis showed that acupuncture had positive effects on Western medicine effective rate (RR = 1.223, 95%CI: 1.150, 1.301, P < 0.001), traditional Chinese medicine effective rate (RR = 1.175, 95%CI: 1.111, 1.243, P < 0.001), pain score (visual analogue scale, SMD = -0.666, 95%CI: -0.801, -0.531, P < 0.001), spinal function including bath ankylosing spondylitis function index score (SMD = -0.827, 95%CI: -0.945, -0.708, P < 0.001), bath ankylosing spondylitis disease activity index score (SMD = -1.069, 95%CI: -1.190, -0.949, P < 0.001), and bath ankylosing spondylitis metrology index score (SMD = -0.699, 95%CI: -0.887, -0.511, P < 0.001), ankylosing spondylitis quality of life score(SMD = -0.619, 95%CI: -0.917, -0.322, P < 0.001), C-reactive protein levels (SMD = -0.980, 95%CI: -1.092, -0.868, P < 0.001) and erythrocyte sedimentation rate value (SMD = -0.701, 95%CI: -0.810, -0.591, P < 0.001).| | ||
| + | ^Conclusion| Though with a high risk of bias, the high-quality studies indicate that acupuncture is a beneficial complementary and alternative therapy for AS patients, as it can reduce pain intensity and improve effective rate, spinal function, and anti-inflammatory response.| | ||
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| + | === Xuan 2020 === | ||
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| + | Xuan Y, Huang H, Huang H, Liu D, Hu X, Geng L, The Efficacy and Safety of Simple-Needling Therapy for Treating Ankylosing Spondylitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.Evid. Based Complementary Altern. Med.2020. 4276380. {{:medias securises:acupuncture:evaluation:rhumatologie - orthopedie:xuan-211869.pdf|[211869]}}. [[https://doi.org/10.1155/2020/4276380|doi]] | ||
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| + | ^ Background| Clinical investigators have found that the use of needling in the treatment of ankylosing spondylitis (AS) has a good clinical application prospect in recent years. However, these studies were insufficient to provide evidence for the efficacy and safety of simple-needling for AS. So, we performed a systematic review and meta-analysis to evaluate the efficacy and safety of simple-needling for treating AS. | | ||
| + | ^Methods|We searched the PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Wangfang database (Wanfang), Chinese Science and Technology Periodical Database (VIP), and any other gray literature sources for randomized controlled trials (RCTs) that used simple-needling to treat AS before June 2019 with the language restriction of Chinese and English. Researchers evaluated the retrieved literature studies and extracted valid data according to relevant requirements and used RevMan5.3 software for meta-analysis. | | ||
| + | ^Results|A total of **10 studies were included**, all of which were Chinese literature studies, involving **729 patients**. Compared with the control groups, simple-needling groups had a better effect on the clinical effective rate (RR = 1.20, 95% CI (1.11, 1.29), ), TCM syndrome score (MD = −5.26, 95% CI (−5.99, −4.53), ), symptom score (MD = −8.08, 95% CI (−10.18, −5.97), ), and Schober test outcome (MD = 0.39, 95% CI (0.15, 0.64), ). Sensibility analysis was based on the leave-one-out cross-validation procedure, and the results showed no significant changes. Most studies did not describe adverse reactions. The funnel plot suggested publication bias on clinical effectiveness.| | ||
| + | ^Conclusion|This systematic review and meta-analysis demonstrated that **simple-needling was effective as an intervention for AS**. However, due to the low quality of the methodology of included studies, the designs of clinical trials were not rigorously standardized. Therefore, it is necessary to carry out multiquality RCTs for verification.| | ||
| - | ==== acupuncture générique ==== | + | === Li 2019 === |
| + | Li Ping, Wang Yinjie, Tian Jigang. [Meta Analysis of the Randomized Controlled Trial of Acupuncture for Ankylosing Spondylitis]. Rehabilitation Medicine. 2019;Issue 3:66-72. [201714]. | ||
| + | ^ Objective| To evaluate the clinical effect of acupuncture in the treatment of ankylosing spondylitis and provide evidence-based medical evidence for clinical practice. | | ||
| + | ^Methods|Randomized controlled trials(RCT) about acupuncture(trial group)compared with medicines(control group) in the treatment of ankylosing spondylitis were collected from five major databases at home and abroad(CNKI, VIP database, Chinese Biomedical Database, Wanfang database, PubMed) from January 2000 to February 2018.Two independent reviewers screened the articles, extracted data and assessed the risk of bias. The evaluation of the quality was performed using Cochrane Risk of Bias evaluation criterion and Modified Jadad Scales; besides the data was analyzed by using RevMan5.3 software. Bi-categorized variables were represented by risk rate(RR) or odds ratio(OR) and its 95% confidence interval(CI) and continuous variables were represented by weighted mean difference(MD) and its 95% CI. | | ||
| + | ^Results|Finally, **11 clinical randomized controlled trials** were included. All of them were Chinese literatures. A total of **767 participants** involving 395 patients were included in the trial group and 372 patients in the control group. According to meta-analysis, the total effective rate of acupuncture in the treatment of ankylosing spondylitis was higher than that of the control group [RR=1.26, 95%CI(1.17, 1.35), P<0.000 01], and the difference was statistically significant(P<0.05). Thoracic distance [MD=0.41, 95%CI(0.26,0.56), P<0.000 01], finger distance [MD=-4.97, 95%CI(-9.06,-0.89), P=0.02], erythrocyte sedimentation rate [MD=-8.46, 95%CI(-14.00,-2.92), P=0.003], C-reactive protein [MD=-23.20,95%CI(-40.68,-5.73), P=0.009] of the trial group were significantly improved better than those of the control group, and the differences were statistically significant(P<0.05). However, there were no significant differences in improving the disease activity index of ankylosing spondylitis score [MD=-5.36, 95%CI(-12.99,-2.26), P=0.17], the functional index of ankylosing spondylitis score [MD=-4.25,95%CI(-8.81, 0.31), P=0.07] and the adverse reaction rate [OR=0.12, 95%CI(0.01, 1.64), P=0.11] between the two groups(P>0.05).The sensitivity analysis of the total effective rate was carried out by removing one of them one by one and then merging the effect quantity analysis. Meta-analysis results showed that the difference of total effective rate had statistical significance(P<0.05) after eliminating one of the documents in turn. The merging effect was determined by RR and the obtained RR was relatively stable. Sensitivity analysis showed that the research was homogeneous and the results of the meta-analysis were stable. | | ||
| + | ^Conclusion|Acupuncture has certain advantages in the treatment of ankylosing spondylitis, and it is helpful to improve the activity of thoracic spine, the activity of lumbar spine and the inflammatory markers(erythrocyte sedimentation rate, C-reactive protein) in patients with ankylosing spondylitis as a result. So acupuncture in the treatment of ankylosing spondylitis is worthy of clinical use. However, this study is based on literature data; the quality and quantity of literature maybe have significant influence on the final results. Therefore, it is necessary to conduct more high-quality and large-sample studies, so as to provide a more reliable evidence-based basis for the treatment of ankylosing spondylitis by acupuncture.| | ||
| === Zhang 2018 ☆ === | === Zhang 2018 ☆ === | ||
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| ^Conclusion|The existing research evidence shows that acupuncture and moxibustion is superior to monotherapy and sulfasalazine, acupuncture + moxibustion + cupping, acupuncture +moxibustion + bee, moxibustion + bee acupuncture for the best treatment of this disease. But the exact conclusion still needs a lot of high-quality RCTs to be confirmed. | | ^Conclusion|The existing research evidence shows that acupuncture and moxibustion is superior to monotherapy and sulfasalazine, acupuncture + moxibustion + cupping, acupuncture +moxibustion + bee, moxibustion + bee acupuncture for the best treatment of this disease. But the exact conclusion still needs a lot of high-quality RCTs to be confirmed. | | ||
| - | === Lv 2015 (vs traitements médicamenteux) ★ === | + | === Lv 2015 (vs Disease-modifying Antirheumatic Drugs) ★ === |
| Lv ZT, Zhou X, Chen AM. [Acupuncture Therapy versus Disease-modifying Antirheumatic Drugs for the Treatment of Ankylosing Spondylitis--a Meta-analysis]. Forsch Komplementmed. 2015;22(6):395-402. {{:medias+securises:acupuncture:evaluation:rhumatologie+-+orthopedie:lv-190122.pdf|[190122]}} | Lv ZT, Zhou X, Chen AM. [Acupuncture Therapy versus Disease-modifying Antirheumatic Drugs for the Treatment of Ankylosing Spondylitis--a Meta-analysis]. Forsch Komplementmed. 2015;22(6):395-402. {{:medias+securises:acupuncture:evaluation:rhumatologie+-+orthopedie:lv-190122.pdf|[190122]}} | ||
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| - | ==== Techniques particulières ==== | + | ==== Special Acupuncture Techniques ==== |
| === Moxibustion === | === Moxibustion === | ||
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| + | == Dong 2020 == | ||
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| + | Dong Li, Bin-Bin Yang, Min-Min Chang, Xin Yuan, ... Shu-Jie Tang. Moxibustion for ankylosing spondylitis: A systematic review and meta-analysis. European Journal of Integrative Medicine. 2020;35. [212069]. [[https://www.sciencedirect.com/science/article/pii/S1876382020301773|doi]] | ||
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| + | ^ Introduction |Both moxibustion and western medicine are widely used in the treatment of Ankylosing Spondylitis in China. However, which is better for the disease? Up to now, no review and meta-analyses have been published and the answer is still unclear. The aim of this research was to compare the effectiveness of moxibustion versus western medicine in the treatment of ankylosing spondylitis. | | ||
| + | ^Methods |The PubMed, Cochrane Library, EMBASE, China Biology Medicine Data, Web of Science, CNKI, VIP, and Wanfang database were searched from their inception through November 1st, 2019. A meta-analysis was performed using the RevMan 5.3 software and the evidence level was assessed using the GRADE system. | | ||
| + | ^ Results| **Seventeen studies with 1235 patients** were included. Pooled analysis showed a favorable effect of moxibustion in total effective rate (RR = 1.14, 95 % CI: 1.07–1.21; P < 0.0001), VAS (MD = −0.82, 95 % CI: −1.08 to −0.56; P < 0.00001), gastrointestinal reaction (RR = 0.11, 95 % CI: 0.03–0.44; P = 0.002), CRP (MD = −1.14, 95 % CI: −1.99 to −0.29; P = 0.008), TNF-α (MD = −1.32, 95 % CI: −2.21 to −0.43; P = 0.004), finger-to-floor distance (MD = −3.02, 95 % CI: −4.81 to −1.23; P = 0.0009; MD = −8.19, 95 % CI: −9.73 to −6.65; P < 0.00001) and Schober test (MD = 0.50, 95 % CI: 0.17–0.82; P = 0.003), while no significant differences were found in BASDAI (MD = 0.12, 95 % CI: −0.53 to 0.76; P = 0.72), abnormal liver function (RR = 0.20, 95 % CI: 0.02–1.66; P = 0.14), ESR (MD = −1.55, 95 % CI: −5.54 to 2.43; P = 0.45), occiput to wall distance (MD = −0.58, 95 % CI: −1.43 to 0.28; P = 0.19) and thoracic expansion (MD = 0.04, 95 % CI: −0.07 to 0.14; P = 0.50) between the two groups. | | ||
| + | ^Conclusion |Compared with western medicine, moxibustion had a favorable effect in alleviating pain, improving lumbar activity and reducing inflammatory reaction in people with ankylosing spondylitis. However, considering the limitations of this study, the evidence is not conclusive and high quality trials are needed in the future to further confirm this conclusion. | | ||
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| + | == Hu 2020 == | ||
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| + | Hu J, Mao Y, Zhang Y, Ye D, Wen C, Xie Z. Moxibustion for the treatment of ankylosing spondylitis: a systematic review and meta-analysis. Ann Palliat Med. 2020;9(3):709-720. [217488]. [[https://doi.org/10.21037/apm.2020.02.31|doi]] | ||
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| + | ^Background|To systematically evaluate the efficacy of moxibustion in the treatment of ankylosing spondylitis (AS). | | ||
| + | ^Methods|Seven electronic databases were systematically searched for relevant studies for inclusion from databases inception to December 31, 2018. Randomized controlled trials investigating the efficacy of moxibustion for AS treatment versus Western medicine (Wm) treatment were included for systematic review and meta-analysis. Effect estimates were pooled using the fixed or random-effects models. Between-study heterogeneity and publication bias were also assessed. Stratification analyses were further performed based on the treatment plan of experimental groups. | | ||
| + | ^Results|**Twenty-six studies** were eligible for inclusion with a total of **1,944 AS patients**. Meta-analysis showed that compared with those receiving Wm treatment alone, patients receiving moxibustion combined with Wm treatment or moxibustion alone had a higher clinical efficacy rate [odds ratio (OR) =4.21, 95% confidence interval (CI): 2.91 to 6.10, P<0.001 for moxibustion combined with Wm versus Wm; OR =2.43, 95% CI: 1.62 to 3.65, P<0.001 for moxibustion alone versus Wm]. In addition, patients receiving moxibustion combined with Wm treatment had lower levels of C-reactive protein [weighed-median difference (WMD) =-6.33, 95% CI: -9.64 to -3.01, P<0.001] and erythrocyte sedimentation rate (WMD =-7.86, 95% CI: -11.26 to -4.46, P<0.001) after treatment, respectively. Furthermore, moxibustion could also improve Schober test scores (WMD =0.85, 95% CI: 0.15 to 1.55, P=0.017), occipital-wall distances (WMD =-0.55, 95% CI: -0.92 to -0.19, P=0.003), and finger-ground distances (WMD =-3.64, 95% CI: -5.61 to -1.68, P<0.001) of AS patients. | | ||
| + | ^Conclusions|This study suggests that moxibustion is an effective complementary treatment for AS patients. However, further large-scale multicenter clinical trials are needed to confirm these findings. | | ||
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| ^Conclusion|The clinical effects of Moxibustion Combined with Western medicine in the treatment of Ankylosing Spondylitis certain and the safety is superior to the western medicine group. But the existing researches need to be verified in more high-quality randomized and double-blind multicenter studies due to their poor quality. | | ^Conclusion|The clinical effects of Moxibustion Combined with Western medicine in the treatment of Ankylosing Spondylitis certain and the safety is superior to the western medicine group. But the existing researches need to be verified in more high-quality randomized and double-blind multicenter studies due to their poor quality. | | ||
| - | == Dong 2018 (moxibustion sur le dumai)☆ == | + | == Dong 2018 (Moxibustion on Governor Vessel)☆ == |
| Dong Long-Cong, Deng Lu-Da, Lan Wei-Ya, Fu Ying-Yue, Pan Jian-Xiang, Xiang Kai-Wei. [Meta-analysis of Clinical Efficacy of Moxibustion on Governor Vessel in Treating Ankylosing Spondylitis]. Rheumatism and Arthritis. 2018;(9):30-5. [181201]. | Dong Long-Cong, Deng Lu-Da, Lan Wei-Ya, Fu Ying-Yue, Pan Jian-Xiang, Xiang Kai-Wei. [Meta-analysis of Clinical Efficacy of Moxibustion on Governor Vessel in Treating Ankylosing Spondylitis]. Rheumatism and Arthritis. 2018;(9):30-5. [181201]. | ||
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| ^Results|A total of **10 RCT articles with 705 sample cases** were included, including 352 experimental groups and 353 control groups. The results of Meta-analysis showed that the effective rate of moxibustion on Governor Vessel was higher in seven articles(RR = 1.23, 95%CI = [1.13, 1.35], P < 0.000 01), and their VAS(WMD =-1.35, 95%CI =[-2.16, 0.53], P = 0.001), morning stiffness time(WMD =-1.35, 95%CI =[-2.16, 0.53], P = 0.001), C-reactive protein(WMD =-10.36, 95%CI =[-17.48, -3.24], P = 0.004)and erythrocyte sedimentation rate(WMD =-8.80, 95%CI =[-12.11, -5.49], P < 0.000 01)were better than those of the control group. Six of them mentioned adverse reactions, and 4 of them didn’t. | | ^Results|A total of **10 RCT articles with 705 sample cases** were included, including 352 experimental groups and 353 control groups. The results of Meta-analysis showed that the effective rate of moxibustion on Governor Vessel was higher in seven articles(RR = 1.23, 95%CI = [1.13, 1.35], P < 0.000 01), and their VAS(WMD =-1.35, 95%CI =[-2.16, 0.53], P = 0.001), morning stiffness time(WMD =-1.35, 95%CI =[-2.16, 0.53], P = 0.001), C-reactive protein(WMD =-10.36, 95%CI =[-17.48, -3.24], P = 0.004)and erythrocyte sedimentation rate(WMD =-8.80, 95%CI =[-12.11, -5.49], P < 0.000 01)were better than those of the control group. Six of them mentioned adverse reactions, and 4 of them didn’t. | | ||
| ^Conclusion| Moxibustion on Governor Vessel has some advantages over other treatments with Western medicine alone. Higher-quality randomized controlled double-blind trials will be needed to verify the curative effect of moxibustion on Governor Vessel in treating ankylosing spondylitis. | | ^Conclusion| Moxibustion on Governor Vessel has some advantages over other treatments with Western medicine alone. Higher-quality randomized controlled double-blind trials will be needed to verify the curative effect of moxibustion on Governor Vessel in treating ankylosing spondylitis. | | ||
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| + | ===== Clinical Practice Guidelines ===== | ||
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| + | | ⊕ positive recommendation (regardless of the level of evidence reported) \\ Ø negative recommendation (or lack of evidence) | | ||
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| + | ==== Korean Society of Spondyloarthritis Research 2023 Ø ==== | ||
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| + | Seo MR, Yeo J, Park JW, Lee YA, Lee JH, Kang EH, Ji SM, Kwon SR, Kim SK, Kim TJ, Kim TH, Kim HW, Park MC, Shin K, Lee SH, Lee EY, Cha HS, Shim SC, Yoon Y, Lee SH, Lim JH, Baek HJ; Korean Society of Spondyloarthritis Research. Korean treatment recommendations for patients with axial spondyloarthritis. J Rheum Dis. 2023 Jul 1;30(3):151-169. https://doi.org/10.4078/jrd.2023.0025. | ||
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| + | Seo MR, Yeo J, Park JW, Lee YA, Lee JH, Kang EH, Ji SM, Kwon SR, Kim SK, Kim TJ, Kim TH, Kim HW, Park MC, Shin K, Lee SH, Lee EY, Cha HS, Shim SC, Yoon Y, Lee SH, Lim JH, Baek HJ; Korean Society of Spondyloarthritis Research. Korean treatment recommendations for patients with axial spondyloarthritis. Korean J Intern Med. 2023 Sep;38(5):620-640. https://doi.org/10.3904/kjim.2023.194. Epub 2023 Jul 24. PMID: 37482652. | ||
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| + | | Recommendation 17. We suggest that spa and acupuncture not be provided to patients with axSpA as therapies (GoE, low; SoR, weak; LoA, 80.6%)| | ||
