Spondylarthrite ankylosante : évaluation de l'acupuncture

1. Revues systématiques et méta-analyses

☆☆☆	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.

1.1. acupuncture générique

1.1.1. Zhang 2018 ☆

Zhang Zhu-Heng, Wang Jing, Fu Yu, et al. [Meta Analysis of Clinical Randomized Controlled trials [Research Literature on Acupuncture and Moxibustion Treatment of Ankylosing Spondylitis]. Chinese Journal of Basic Medicine in TCM. 2018;24(12):1743. [193195].

Objective	Evaluate the clinical efficacy and safety of acupuncture in the treatment of ankylosing spondylitis (AS) , and provide evidence for the application of acupuncture in the treatment of ankylosing spondylitis.
Methods	Collect clinical randomized controlled trials ( RCTs) of acupuncture treatment of AS. Search the medical electronic bases including PubMed, Embase, Cochrane library retrieval, China CNKI, Wanfang Data and VIP data by computer to find the application of acupuncture and Western medicine in the treatment of ankylosing spondylitis. Retrieval time were from inception to December 2016. The data were extracted independently by 2 researchers, and the data were extracted and evaluated independently according to the Cochrane system evaluation methodology. The Meta analysis was made by Revman 5. 3 software.
Results	A total of 21 studies were included, involving a total of 1820 patients (950 in treatment group, 870 in control group). The results of Meta analysis showed that the effects of acupuncture was superior to western medicine in terms of the efficiency rate(RR = 3. 25, 95% CI 2. 52 to 4. 20) , thoracic expansion degree (SMD =0. 32, 95% CIO. 09 to 0. 54) , finger ground distance ( SMD = - 1. 01 , 95% CI - 1. 27 to 0. 76) , pillow wall distance (SMD = -0.73,95% CI -1. 19 to 0.27), Schober test( SMD = 0.37,95% CIO. 22 to 0.53) , erythrocyte sedimentation rate (ESR) (SMD = -0.80, 95% CI - 1.21 to -0.40).
Conclusion	The acupuncture treatment of AS has certain advantages compared with western medicine, but it still needs more high-quality, low-risk randomized controlled literature to verify and support.

1.1.2. Zhang 2018 ☆

Zhang Xiao, Luo Xiaozhou, Cao Qiuyu, Deng Gan, Tang Chunzhi. [Efficacy of Acupuncture and Sulfasalazine for Ankylosing Spondylitis: A Network Meta-analysis]. Chinese Archives of Traditional Chinese Medicine. 2018;10:. [182494].

Objective	To evaluate the clinical efficacy of acupuncture and moxibustion in the treatment of ankylosing spondylitis by using the random effects model based on Bayesian theory.
Methods	A computer-controlled search of Google Scholar, Pub Med, Cochrane Library, CNKI, VIP, CBM and Wanfang database were published from the publication to October 2017. Randomized controlled trials/acombined randomized controlled trials on acupuncture for ankylosing spondylitis( RCT/CCT) literature were assessed the risk of quality and bias by two researchers in accordance with the Cochrane Handbook 5. 1. 0. Stata 14. 0 was used to draw the network structure diagram and Ge MTC 0. 14. 3 to do the statistics.
Results	The final 25 studies met the inclusion criteria, a total of 2208 cases, involving sulfasalazine, acupuncture, moxibustion, bee acupuncture, acupuncture + moxibustion, acupuncture + moxibustion + cupping, moxibustion +bee needle and other 9 kinds of interventions. The results of network Meta-analysis showed that the combination of sulfasalazine and acupuncture, sulfasalazine and moxibustion, sulfasalazine and acupuncture + moxibustion, sulfasalazine and acupuncture + moxibustion + canister, sulfasalazine and acupuncture + canister, sulfasalazine and acupuncture + bee needle, sulfasalazine and moxibustion + bee needle, needle and needle + moxibustion, acupuncture and acupuncture +moxibustion + cupping, moxibustion and acupuncture + moxibustion, moxibustion and acupuncture + moxibustion + cupping. The total effective rate between bee needle and acupuncture + moxibustion + cupping was statistically significant. According to the best possible curative effect, the order from high to low is acupuncture + moxibustion + cupping, acupuncture + moxibustion + bee, moxibustion + bee acupuncture, acupuncture + moxibustion, acupuncture + cupping, moxibustion, acupuncture, bee acupuncture, Sulfapyridine.
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.

1.1.3. Lv 2015 (vs traitements médicamenteux) ★

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. [190122]

Objectives	We conducted a meta-analysis evaluating the efficacy and safety of acupuncture compared to disease-modifying antirheumatic drugs in patients with ankylosing spondylitis.
Methods	Four databases including Pubmed, EMBASE, Cochrane library, and ISI Web of Science were searched in December 2014, taking also the reference section into account. Randomized controlled trials that aimed to assess the efficacy of acupuncture therapy were identified. The inclusion criteria for the outcome measurements were the clinical effect, ESR, occipital wall test, chest expansion, CRP and finger ground distance. Finally, six studies met these inclusion criteria. Two reviewers screened each article independently and were blinded to the findings of each other.
Results	We analyzed data from 6 RCTs involving 541 participants. Acupuncture therapy could further improve the clinical effect (OR = 3.01; 95% CI, 1.48-6.13; P = 0.002) and reduce ESR level (SMD = -0.77; 95% CI, -1.46 to -0.08; P = 0.03) compared to DMARDs; a combination of acupuncture and DMARDs could further improve clinical effect (OR = 3.20, 95% CI, 1.36-7.54; P = 0.008), occipital-wall distance (SMD = -0.84; 95% CI, -1.37 to -0.31; P = 0.002), chest expansion (SMD = 0.38; 95% CI, 0.16-0.60; P = 0.0009), and finger-ground distance (SMD = -0.48; 95% CI, -0.87 to -0.09; P = 0.02) as compared to DMARDs treatment alone.
Conclusions	Our findings support that acupuncture therapy could be an option to relieve symptoms associated with AS. These results should be interpreted cautiously due to the generally poor methodological qualities of the included trials.

1.1.4. Gong 2007 ★

Gong XM, Ren K. [Acupuncture therapy in the rehabilitative treatment of ankylosing spondylitis a systematic review]. Chinese J Rehabil Med. 2007;22:537. [181461].

目的:系统评价针灸促进强直性脊柱炎的康复和减少其远期发病率的效果.方法:计算机互联网检索MEDLINE(1978-2006)、中国学术期刊全文数据库(1994-2006)、中国生物医学全文数据库(1995-2006)、Highwire 文献数据库,获取所涉及针灸治疗强直性脊柱炎的随机或半随机对照试验;而后选择符合纳入标准的临床试验,评价其方法学质量,并从中获取患者基本情况、干预措施、终点指标和结果等相关资料进行系统评价.结果:共有7个小规模的临床随机对照试验.合计555例患者符合纳入标准,但因其在试验设计、报道上存在明显缺陷,以及试验之问存存较大差异.不符合Meta分析条件,因而只能进行定性分析;结果显示针灸治疗强直性脊柱炎具有一定的疗效(P＜0.001).结论:针灸治疗强直性脊柱炎有效,但入选的7个随机对照试验规模小,质量不高,降低了这一结论的可靠性.开展高质量、内在真实性好的相关随机对照试验非常必要
Automatic translation
Objective	To evaluate the promotion of acupuncture ankylosing spondylitis rehabilitation and long-term effect of reducing its incidence.
Method	Computer Internet to retrieve MEDLINE (1978-2006), China Academic Journal Full-text Database (1994-2006), the full text of Chinese Biomedical Database (1995-2006), Highwire literature database, get involved in acupuncture and moxibustion treatment of ankylosing spondylitis randomized or quasi-randomized controlled trials; then select clinical trials met the inclusion criteria to evaluate methodological quality, and to obtain the basic condition of the patient, intervention and other measures, endpoints and results Info systematic evaluation.
Results	A total of seven small-scale randomized controlled trials in patients with a total of 555 cases met the inclusion criteria, but because there are obvious flaws in the experimental design, reports, and test it. Q. exist large differences exist does not meet the conditions of Meta-analysis, which can only qualitative analysis; results showed that acupuncture treatment of ankylosing spondylitis have a certain effect (P <0.001).
Conclusion	Acupuncture effective treatment of ankylosing spondylitis, but selected seven randomized controlled trials are small, the quality is not high, reducing the reliability of this conclusion. conduct high-quality, good internal validity relevant randomized controlled trials is necessary

1.2. Techniques particulières

1.2.1. Moxibustion

1.2.1.1. Lu 2018 ☆

Lu Yang , Sun Shu-Ning , Chen Guo-Ming , et al. [Meta-analysis of the Clinical Efficacy of Moxibustion in Treating Ankylosing Spondylitis]. Shanghai Journal of Acupuncture and Moxibustion. 2018;37(5):583. [188158].

Objective	To evaluate the clinical efficacy of moxibustion in treating ankylosing spondylitis.
Method	By computer retrieval, literatures about randomized controlled trial on moxibustion in treating ankylosing spondylitis were collected from Pubmed, Embase, China Biology Medicine disc (CBMdisc), China National Knowledge Infrastructure (CNKI), and WanFang database. After data extraction and quality evaluation by using Cochrane Review Handbook 5 . 1, the eligible clinical trials underwent meta-analysis by using RevMen5 .3 software.
Result	A total of 25 articles met the inclusion criteria, including 2 087 cases with 1 048 cases in the experiment group and 1 039 cases in the control group. The meta-analysis showed that the total effective rate of moxibustion in treating ankylosing spondylitis was superior to that of Western medicine [RR=1 . 1 7, 95%CI (1 .04, 1 .32), P=0.008]. Moreover, the total effective rate of moxibustion plus Western medicine in treating ankylosing spondylitis was superior to that of Western medicine [RR=1.14, 95%CI (1.09, 1.18), P<0.01].
Conclusion	Compared to Western medicine alone, moxibustion and moxibustion plus Western medicine can produce a better clinical efficacy and less adverse reactions. But due to the relative low quality of the eligible clinical studies, more randomized double-blind clinical trials with multiple centers and high quality are expected for further verification.

1.2.1.2. Sun 2018 ☆

Sun Shu-Ning , Lu Yang , Chen Guo-Ming , Chen Xing-Hua , Chen Xin-Lin. [Meta-analysis of Adjuvant Therapy with The Moxibustion in The Treatment of Ankylosing Spondylitis]. Journal of Basic Chinese Medicine. 2018;24(8):1122. [181093].

0bjective	To systematically review the effectiveness and safety of adjuvant therapy with the Moxibustion in the treatment of Ankylosing Spondylitis AS.
Method	Such databases as Pubmed, Embase, CBM,CNKI, VIP database and WanFang Data are searched to collect randomized clinical trials on the effectiveness and safety of Moxibustion Combined with Western medicine contrast using Western medicine for Ankylosing Spondylitis. According to the inclusion and exclusion criteria, literature was screened, data were extracted, and the methodological quality of included studies was also assessed. Then, Meta-analysis was performed using RevMan 5. 3 software.
Results	18RCTs were included eventually among a total of 1452 cases on Moxibustion combined with Western medicine in the treatment of Ankylosing Spondylitis. Compared with the control group, the effectiveness of Moxibustion combined with Western medicine in the treatment of AS is superior than using Western medicine. It can improve the ESR score, the CRP score and shorten the Lime of morning stiffness. And there are less untoward effect by using Moxibustion.
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.

1.2.1.3. Dong 2018 (moxibustion sur le dumai)☆

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].

Objective	To systematically evaluate the clinical efficacy of moxibustion on Governor Vessel in treating ankylosing spondylitis.
Methods	Databases such as Pub Med, Embase, The Cochrane Library, CBM, CNKI, VIP and WANFANG DATA were retrieved by computer to find randomized controlled trials(RCT)of treating ankylosing spondylitis with moxibustion on Governor Vessel alone or combined with western medicine(from the establishment of the databases to March 2018).Two researchers independently screened the literature, extracted the literature and assessed the risk of bias, and analyzed the data using software Rev Man 5.3.
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.

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