Différences
Ci-dessous, les différences entre deux révisions de la page.
| Les deux révisions précédentes Révision précédente Prochaine révision | Révision précédente | ||
|
acupuncture:evaluation:rhumatologie - orthopedie:11. spondylarthrite ankylosante [19 Dec 2020 06:44] Nguyen Johan [1.2.1.4. Dong 2018 (moxibustion sur le dumai)☆] |
acupuncture:evaluation:rhumatologie - orthopedie:11. spondylarthrite ankylosante [28 Aug 2025 19:14] (Version actuelle) Nguyen Johan [1.1. Generic Acupuncture] |
||
|---|---|---|---|
| Ligne 6: | Ligne 6: | ||
| ===== Systematic Reviews and Meta-Analysis===== | ===== Systematic Reviews and Meta-Analysis===== | ||
| - | |☆☆☆ |Evidence for effectiveness and a specific effect of acupuncture. | | + | |
| - | |☆☆| Evidence for effectiveness of acupuncture.| | + | |
| - | | ☆ |Evidence for effectiveness of acupuncture mais limitées qualitativement et/ou quantitativement.| | + | |
| - | |Ø |No evidence or insufficient evidence.| | + | |
| ==== Generic Acupuncture ==== | ==== Generic Acupuncture ==== | ||
| + | |||
| + | |||
| + | === Cao 2025 === | ||
| + | |||
| + | |||
| + | 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.| | ||
| + | |||
| + | === Zhang 2025 === | ||
| + | |||
| + | |||
| + | 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.| | ||
| === Xuan 2020 === | === Xuan 2020 === | ||
| Ligne 90: | Ligne 107: | ||
| ^ 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. | | ^ 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. | | ^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. | | ||
| + | |||
| + | == Hu 2020 == | ||
| + | |||
| + | |||
| + | 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]] | ||
| + | |||
| + | ^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. | | ||
| Ligne 121: | Ligne 148: | ||
| ^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. | | ||
| + | |||
| + | |||
| + | ===== Clinical Practice Guidelines ===== | ||
| + | |||
| + | | ⊕ positive recommendation (regardless of the level of evidence reported) \\ Ø negative recommendation (or lack of evidence) | | ||
| + | |||
| + | ==== Korean Society of Spondyloarthritis Research 2023 Ø ==== | ||
| + | |||
| + | 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. | ||
| + | |||
| + | 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. | ||
| + | |||
| + | | Recommendation 17. We suggest that spa and acupuncture not be provided to patients with axSpA as therapies (GoE, low; SoR, weak; LoA, 80.6%)| | ||
