Zhongguo gu shang = China journal of orthopaedics and traumatology · 2025
[Evidence evaluation of electroacupuncture treatment for gouty arthritis based on GRADE and integrated evidence chain-based efficacy evaluation of traditional Chinese medicine].
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Zhu Ke, Wei Guang-Cheng, Zhang Xin-Wen, Ma Rui, Luo Ye, Zhang Xie-Yu, Shi Jin-Jie, Yang Yue, Li Xiao-Xu, Yang Hong-Yu, Zhao Jia-He, Du Jie-Yang, Ya Yu-Long, Peng Jiu-Cheng, Cao Wei
Аннотация
OBJECTIVE: To evaluate quality of evidence for electroacupuncture in treating gouty arthritis (GA) by grading of recommendations assessment, development and evaluation (GRADE) method and integrated evidence chain-based efficacy evaluation of traditional Chinese medicine (iEC-Eff).
METHODS: Literatures published on PubMed, Web of Science, Cochrane Library, Embase, China national knowledge infrastructure(CNKI), Chinese science and technology journal database (VIP), and Wanfang medical journal database databases and Chinese biomedical (CBM) literature database were included by computer, the retrieval period was from establishment of database to April 2025, including randomized controlled trials (RCTS), experimental studies and clinical experience literature on electroacupuncture treatment of GA. The quality of RCTS was evaluated using Cochrane risk of bias tool andstandards for reporting interventions in clinical trials of acupuncture (STRICTA). Meta-analysis was conducted by Stata 18 software. The quality of evidence for outcome measures was rated by GRADE tool. Multi-dimensional evidence was integrated through iEC-Eff.
RESULTS: In the GRADE evaluation, the evidence for indicators such as blood uric acid and visual analogur scale (VAS) for pain of single electroacupuncture intervention was grade C(low-quality evidence). The combination of acupuncture and medication reduced blood uric acid and improved the inflammatory indicators C-reactive protein (CRP) and erythrocyte sedimentation reaction (ESR) was grade B (moderate-quality evidence). The evidence for indicators such as cytokines was Grade C (low-quality evidence). In iEC-Eff evaluation, clinical empirical evidence was rated as grade B, experimental research evidence was rated as grade A, clinical trial evidence was rated as Grade B, and comprehensive assessment was BAB (intermediate evidence). The differences between GRADE and iEC-Eff evaluation systems stem from the fact that the former has a high requirement for the rigor of research design, while the latter conforms to the overall model of traditional Chinese medicine. Electroacupuncture combined with Western medicine has advantages in reducing uric acid and anti-inflammation, but high-quality RCT verification is required.
CONCLUSION: Electroacupuncture treatment for gouty arthritis could improve symptoms such as redness, swelling, heat and pain in the joints, lower blood uric acid levels, and alleviate joint inflammatory responses (such as ESR, CRP and other indicators). The evidence quality is relatively high and it has a good clinical application prospect. GRADE and Eff-iEC each have their own advantages in the evidence evaluation of electroacupuncture treatment for gouty arthritis. In the future, it is necessary to combine the two to optimize the evaluation system of the efficacy of traditional Chinese medicine and promote the accumulation of evidence-based medical evidence and international recognition of electroacupuncture treatment for GA.
METHODS: Literatures published on PubMed, Web of Science, Cochrane Library, Embase, China national knowledge infrastructure(CNKI), Chinese science and technology journal database (VIP), and Wanfang medical journal database databases and Chinese biomedical (CBM) literature database were included by computer, the retrieval period was from establishment of database to April 2025, including randomized controlled trials (RCTS), experimental studies and clinical experience literature on electroacupuncture treatment of GA. The quality of RCTS was evaluated using Cochrane risk of bias tool andstandards for reporting interventions in clinical trials of acupuncture (STRICTA). Meta-analysis was conducted by Stata 18 software. The quality of evidence for outcome measures was rated by GRADE tool. Multi-dimensional evidence was integrated through iEC-Eff.
RESULTS: In the GRADE evaluation, the evidence for indicators such as blood uric acid and visual analogur scale (VAS) for pain of single electroacupuncture intervention was grade C(low-quality evidence). The combination of acupuncture and medication reduced blood uric acid and improved the inflammatory indicators C-reactive protein (CRP) and erythrocyte sedimentation reaction (ESR) was grade B (moderate-quality evidence). The evidence for indicators such as cytokines was Grade C (low-quality evidence). In iEC-Eff evaluation, clinical empirical evidence was rated as grade B, experimental research evidence was rated as grade A, clinical trial evidence was rated as Grade B, and comprehensive assessment was BAB (intermediate evidence). The differences between GRADE and iEC-Eff evaluation systems stem from the fact that the former has a high requirement for the rigor of research design, while the latter conforms to the overall model of traditional Chinese medicine. Electroacupuncture combined with Western medicine has advantages in reducing uric acid and anti-inflammation, but high-quality RCT verification is required.
CONCLUSION: Electroacupuncture treatment for gouty arthritis could improve symptoms such as redness, swelling, heat and pain in the joints, lower blood uric acid levels, and alleviate joint inflammatory responses (such as ESR, CRP and other indicators). The evidence quality is relatively high and it has a good clinical application prospect. GRADE and Eff-iEC each have their own advantages in the evidence evaluation of electroacupuncture treatment for gouty arthritis. In the future, it is necessary to combine the two to optimize the evaluation system of the efficacy of traditional Chinese medicine and promote the accumulation of evidence-based medical evidence and international recognition of electroacupuncture treatment for GA.