Intervention Review

Acupuncture and electroacupuncture for the treatment of rheumatoid arthritis

  1. Lynn Casimiro1,*,
  2. Les Barnsley2,
  3. Lucie Brosseau3,
  4. Sarah Milne4,
  5. Vivian Welch5,
  6. Peter Tugwell6,
  7. George A Wells7

Editorial Group: Cochrane Musculoskeletal Group

Published Online: 19 OCT 2005

Assessed as up-to-date: 21 AUG 2005

DOI: 10.1002/14651858.CD003788.pub2

How to Cite

Casimiro L, Barnsley L, Brosseau L, Milne S, Welch V, Tugwell P, Wells GA. Acupuncture and electroacupuncture for the treatment of rheumatoid arthritis. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD003788. DOI: 10.1002/14651858.CD003788.pub2.

Author Information

  1. 1

    University of Ottawa, School of Rehabilitation Sciences, Ottawa, Ontario, Canada

  2. 2

    Concord Hospital, Department of Rheumatology, Concord, New South Wales, Australia

  3. 3

    University of Ottawa, School of Rehabilitation Sciences, Faculty of Health Sciences, Ottawa, Ontario, Canada

  4. 4

    Children's Hospital of Eastern Ontario, Rehabilitation Center, Ottawa, Ontario, Canada

  5. 5

    University of Ottawa, Centre for Global Health, Institute of Population Health, Ottawa, Ontario, Canada

  6. 6

    Ottawa Hospital, Centre for Global Health, Institute of Population Health, Department of Medicine, Ottawa, Ontario, Canada

  7. 7

    University of Ottawa Heart Institute, Cardiovascular Research Reference Centre, Ottawa, Ontario, Canada

*Lynn Casimiro, School of Rehabilitation Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 OCT 2005




  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 초록
  5. 쉬운 말 요약
  6. 摘要
  7. எளியமொழிச் சுருக்கம்


Acupuncture has been used by rehabilitation specialists as an adjunct therapy for the symptomatic treatment of rheumatoid arthritis (RA). Acupuncture is a traditional Chinese medicine where thin needles are inserted in specific documented points believed to represent concentration of body energies. In some cases a small electrical impulse is added to the needles. Once the needles are inserted in some of the appropriate points, endorphins, morphine-like substances, have been shown to be released in the patient's system, thus inducing local or generalised analgesia (pain relief). This review is an update of the original review published in July 2002.


To evaluate the effects of acupuncture or electroacupuncture on the objective and subjective measures of disease activity in patients with RA.

Search methods

A comprehensive search of MEDLINE, EMBASE, PEDro, Current Contents , Sports Discus and CINAHL, initially done in September 2001, was updated in May 2005.The Cochrane Field of Rehabilitation and Related Therapies and the Cochrane Musculoskeletal Review Group were also contacted for a search of their specialized registries. Handsearching was conducted on all retrieved papers and content experts were contacted to identify additional studies.

Selection criteria

Comparative controlled studies, such as randomized controlled trials and controlled clinical trials in patients with RA were eligible. Trials published in languages other than French and English were not analyzed. Abstracts were excluded unless further data could be obtained from the authors.

Data collection and analysis

Two independent reviewers identified potential articles from the literature search and extracted data using pre-defined extraction forms. Consensus was reached on all the extracted data. Quality was assessed by two reviewers using a five point validated tool that measured the quality of randomization, double-blinding and description of withdrawals.

Main results

After the updated searches were conducted, five further potential articles were identified; however, these did not meet the inclusion criteria. Two studies involving a total of 84 people were included. One study used acupuncture while the other used electroacupuncture. In the acupuncture study, no statistically significant difference was found between groups for erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), visual analogue scale for patient's global assessment (VAS G), number of swollen joints and tender joints, general health questionnaire (GHQ), modified disease activity scale (DAS) or for the decrease in analgesic intake. Although not statistically significant, pain in the treatment group improved by 4 points on a 0-100mm visual analogue scale versus no improvement in the placebo group.
In the second study, using electroacupuncture, a significant decrease in knee pain was reported in the experimental group, 24 hours post treatment, when compared to the placebo group (WMD: -2.0 with 95% CI -3.6,-4.0). A significant decrease was found also at four months post-treatment (WMD -0.2, 95% CI: -0.36, -0.04)

Authors' conclusions

Although the results of the study on electroacupuncture show that electroacupuncture may be beneficial to reduce symptomatic knee pain in patients with RA 24 hours and 4 months post treatment, the reviewers concluded that the poor quality of the trial, including the small sample size preclude its recommendation. The reviewers further conclude that acupuncture has no effect on ESR, CRP, pain, patient's global assessment, number of swollen joints, number of tender joints, general health, disease activity and reduction of analgesics. These conclusions are limited by methodological considerations such as the type of acupuncture (acupuncture vs electroacupuncture), the site of intervention, the low number of clinical trials and the small sample size of the included studies.


Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 초록
  5. 쉬운 말 요약
  6. 摘要
  7. எளியமொழிச் சுருக்கம்

Acupunture and electroacupuncture for rheumatoid arthritis

Does acupuncture work for treating rheumatoid arthritis?

Two studies of low to medium quality were reviewed and provide the best evidence we have today. The studies tested 84 people who had rheumatoid arthritis. The studies compared acupuncture to a placebo (fake therapy) or a steroid injection. Improvement was measured after one treatment or after five treatments given once per week.

What causes shoulder pain and how can acupuncture help?
Rheumatoid arthritis (RA) is a disease in which the body's immune system attacks its own healthy tissues. The attack happens mostly in the joints of the hands and feet and causes redness, pain, swelling and heat around the joints. Drug and non-drug treatments are used to relieve pain and/or swelling.

Acupuncture is a non-drug therapy being in which thin needles are inserted into the body at specific spots. It is thought that acupuncture works either by releasing chemical compounds in the body that relieve pain, by overriding pain signals in the nerves or by allowing energy (Qi) or blood to flow freely through the body. It is not known whether acupuncture works or is safe.

What do the studies show?
In one study, people had acupuncture or fake therapy for five weeks, once per week. Pain, number of swollen and tender joints, disease activity, overall well-being, lab results, or amount of pain medication needed was about the same whether they had acupuncture or fake therapy.

In the other study, people had acupuncture with an electric current going through the needles at specific or real acupuncture spots in the knee or at fake spots in the knee. Knee pain while at rest, while moving or while standing decreased more in the people who had the real acupuncture. The improvement lasted up to 4 months after acupuncture. Unfortunately, the authors of this review believe that this trial was of low quality and may overestimate how well acupuncture works.

How safe is it?
Side effects were not measured in the studies.

What is the bottom line?
The quality of the evidence is 'silver'.

From the little evidence that there is, acupuncture does not appear to improve the symptoms of rheumatoid arthritis.



  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 초록
  5. 쉬운 말 요약
  6. 摘要
  7. எளியமொழிச் சுருக்கம்

류마티스 관절염에 대한 침 치료 및 침 전기 자극


침 치료는 류마티스 관절염의 증상 치료를 위한 보조적 요법으로 재활치료 전문가들이 사용해 왔다. 침 치료는 인체의 기운이 모인다고 여겨지는 경혈에 가는 침을 놓는 전통 중의학 치료 중 하나이다. 때때로 침에 약간의 전기 자극을 가한다. 사전 연구에서는, 침을 적절한 경혈에 놓으면 엔돌핀 (몰핀과 비슷한 화학 물질) 이 체내에 분비되어 국소적 혹은 전신적 진통 (통증 경감) 이 이루어짐을 제시하였다. 이 리뷰는 2002년 6월 출간된 초판을 업데이트한 것이다.


침 치료 혹은 침 전기 자극이 류마티스 관절염 환자의 주관적, 객관적 측면 상 질병 활성도에 미치는 효과를 평가함.

검색 전략

MEDLINE, EMBASE, PEDro, Current Contents , Sports Discus, CINAHL 을 폭넓게 검색한 2011년 9월 검색 결과를, 2005년 5월 업데이트하였다. 코크란 재활 및 관련 치료 필드 (The Cochrane Field of Rehabilitation and Related Therapies) 와코크란 근골격계 그룹이 별도로 보유한 임상시험 목록 역시 검색하였다. 검색된 모든 논문에 대해 수기 검색을 하였으며, 이 외에도 별도의 연구가 있는지 해당 분야의 전문가에게 연락하였다.

선정 기준

류마티스 관절염 환자에 대한 무작위 대조 연구 및 비무작위 대조 연구 등 대조 임상연구가 선정 대상이었다. 영어 및 프랑스어로 보고된 임상시험만 분석하였다. 초록만 발표된 경우, 초록 저자에게 추가 자료를 얻을 수 있는 경우에만 분석 대상으로 포함시켰다.

자료 수집 및 분석

두 명의 저자가 각각 독립적으로 문헌 검색 결과에서 잠정적인 분석 대상 연구들을 선정하고, 미리 준비한 양식을 이용하여 자료를 추출하였다. 추출한 모든 자료에 대하 연구자 간 의견 일치를 이루었다. 연구자 두 명이, 타당도가 검증된 5점 척도를 이용하여 무작위 배정, 연구 탈락 보고 및 이중 맹검에 대한 질을 평가하였다.

주요 결과

업데이트 검색을 통해 5개의 추가적 연구를 확인하였으나, 선정 기준에 맞지 않아 배제한 뒤, 최종적으로 두 연구 (84명) 를 분석하였다. 한 연구는 침 치료를, 다른 연구는 침 전기 자극을 이용하였다. 침 치료 연구에서는, 적혈구 침강 속도 (ESR), C-반응성 단백질 (CRP), 환자 관점 상 전반적 평가를 위한 시각 상사 척도, 종창 관절의 수 및 압통 관절 수, 전반적 건강 설문지, 수정판 질병 활성 척도, 진통제 사용량 감소 면에서 대조군과 뚜렷한 통계적 차이를 확인할 수 없었다. 비록 통계적으로는 뚜렷하지 않았지만, 통증은 치료군에서 시각 상사 척도 상 (0-100점 만점), 4점의 호전을 보인 반면 플라시보 군에서는 호전이 없었다.침 전기 자극 연구에서는, 침 전기 자극 군에서 치료 24시간 이후 플라시보 군에 비해 무릎 통증이 뚜렷하게 감소하였음을 보고하였다. (WMD -2.0, 95% CI -3.6 ~ -4.0) 이 뚜렷한 통증 감소는 치료 4달 후에도 확인되었다. (WMD -0.2, 95% CI -0.36 ~ -0.04)

연구진 결론

비록 침 전기 자극 연구에서, 류마티스 관절염 환자의 무릎 통증을 치료 24시간 및 4개월 후 호전을 보고하였지만, 리뷰 저자들은 연구의 낮은 질 및 작은 표본 수로 인해 침 전기 자극의 사용을 권고하기 어렵다고 결론내렸다. 또한 리뷰 저자들은 침 치료가 적혈구 침강 속도, C-반응성 단백질, 환자 관점 상 전반적 평가, 종창 관절 수, 압통 관절 수, 전반적 건강, 질병 활성도 및 진통제 사용량 감소 측면에서 효과가 없다고 결론지었다. 침 치료의 종류 (침 대 침 전기 자극), 침 치료 부위, 적은 임상시험 갯수, 분석 대상 임상시험들의 적은 표본 수 등 방법론적 측면들을 고려해 볼 때, 이 결론은 제한적이다.


쉬운 말 요약

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 초록
  5. 쉬운 말 요약
  6. 摘要
  7. எளியமொழிச் சுருக்கம்

류마티스 관절염에 대한 침 치료 및 침 전기 자극

침은 류마티스 관절염 치료에 도움이 되는가?

낮은-중간 질의 두 연구를 분석하여, 현재 얻을 수 있는 최선의 근거를 확인하였다. 총 84명의 류마티스 관절염 환자에 대한 2개의 연구를 분석하였다. 침 치료는 플라시보 (가짜 치료) 혹은 스테로이드 주사 요법과 비교되었다. 1회 치료 후 혹은 주 1회 간격 총 5회의 치료 후 호전도를 평가하였다.

무엇이 류마티스 관절염 환자의 통증을 일으키며, 침은 어떻게 이를 치료하는가?류마티스 관절염은 정상 면역 체계가 자신의 건강한 조직을 공격하는 질환이다. 이는 대부분 손, 발 관절에서 일어나며, 발적, 통증, 종창 및 관절 주변 발열을 일으킨다. 통증 및 종창 완화를 위해 여러 약물 / 비약물 치료법들이 사용된다.

침 치료는 비약물적 방법으로, 몸의 특정한 지점에 가는 침을 자입한다. 침은 통증을 완화시키는 화학적 성분을 몸 속에 분비하거나 신경에 전달되는 통각 신호를 추월함으로써, 또는 몸 속으로 기혈 순환이 원활하도록 함으로써 효과를 나타낸다고 여겨진다. 침 치료가 실제로 효과적인지, 안전한지는 알려져 있지 않다.

연구 결과는 어떠한가
한 연구에서는, 침 치료 혹은 가짜 치료를 주 1회 총 5주 간 제공하였다. 통증, 종창 관절 수, 압통 관절 수, 질병 활성도, 전반적 안녕감, 실험실적 검사 결과, 진통제 사용량 면에서, 침 치료 결과는 가짜 치료 결과와 거의 같았다.

다른 연구에서는, 무릎 부위 진짜 혹은 가짜 경혈에 침을 놓고 전류를 통하게 하였다. 쉴 때, 움직일 때, 서 있을 때 무릎 통증은 진짜 경혈에 침을 놓았을 경우 더 감소하였다. 이는 침 치료 4개월 후에도 지속되었다. 하지만, 이 연구의 질이 낮아 침 치료 효과를 과대평가했을 수도 있다고 본다.

침 치료는 얼마나 안전한가?침 치료의 부작용이 있었는지 평가한 임상 시험은 없었다.

결론은 무엇인가?근거의 질은 '중간 (silver)' 에 속한다.

현존 근거가 없는 것을 볼 때, 침 치료는 류마티스 관절염의 증상을 호전시키는 것으로 보이지 않는다.


위 내용은 김건형 (부산대학교 한의학전문대학원) 님이 번역하였습니다. 번역내용과 관련한 궁금점은 으로 연락주시기 바랍니다.



  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 초록
  5. 쉬운 말 요약
  6. 摘要
  7. எளியமொழிச் சுருக்கம்







搜尋包括MEDLINE, EMBASE, PEDro, Current Contents, Sports Discus and CINAHL, The Cochrane Field of Rehabilitation and Related Therapies and the Cochrane Musculoskeletal Review Group (直到2005年5月)。同時手動搜尋所選文章之參考文獻及徵詢專家以發現另外的研究。






搜尋更新之後,發現5篇可能的文章,但是這5篇並沒有符合條件,只有收錄2個研究包含84例病患。分別各有一篇研究針灸及電針灸。在針灸研究方面血球沉降速度ESR,C反應蛋白Creactive protein (CRP),病患整體評估的視覺類比量表(VAS G), 關節腫脹數目及關節疼痛數目,整體健康問卷,調整疾病活動量表DAS,消炎止痛藥物使用減少,並未有顯著差異。疼痛減少方面雖未達顯著差異,針灸組減少4點(0 – 100mm 視覺類比量表visual analogue scale)。在第二項研究電針灸明顯減少膝蓋疼痛,24小時後加權平均差異WMD: −2.0, 95% 信賴區間CI −3.6, −4.0),在治療四個月時也顯著減少加權平均差異WMD −0.2 (95% 信賴區間CI 0.36, −0.04)。


在針灸治療24小時及4月後,針灸及電針灸減少類風濕性關節炎患者膝蓋疼痛。但研究品質不佳及樣本少,無法結論建議。回顧者更結論針灸在血球沉降速度ESR、C反應蛋白CRP、疼痛、病患整體評估、 關節腫脹數目及關節疼痛數目、整體健康狀況、疾病活性、與消炎止痛藥物使用減少,並未有顯著效果。結論因研究方法品質不佳、治療的種類(針灸及電針灸)、治療的部位、試驗數量少及樣本少而受限。



此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。


請問針灸是否可治療類風濕關節炎? 兩項中低品質研究被進行了回顧,並提供我們至今日最好的證據。該研究測試了84位風濕性關節炎患者。該研究比較了針灸、安慰劑(假治療)或類固醇注射。改善狀況在每週 1次治療或每週5次治療後被測定。 什麼原因導致肩部疼痛以及針灸如何有助治療?類風濕關節炎(RA)是一種疾病,而人體的免疫系統攻擊其自身的健康組織。大多攻擊手腳關節,造成紅腫,疼痛,關節周圍的腫脹和熱。藥物和非藥物治療可以緩解疼痛和/或腫脹。針灸是一種非藥物療法,用細針插入到身體的特定點。據認為,針灸可以透過釋放人體的化學物質來減輕疼痛,通過壓過重寫神經疼痛信號或允許能量(Qi)或血液在體內自由流動。目前還不知道針灸的效用或安全性。 研究顯示的是什麼?在一項研究中患者接受針灸或假治療 5週,每週一次。無論是針灸或假治療,其疼痛,腫脹數和關節疼痛、疾病活動,整體健康,實驗室結果,或所需要的止痛藥量結果都相同。在另一項研究,接受針灸的患者在膝蓋接受針灸讓電流透過細針到特定點或實際針灸點或在膝蓋假點。真正有針灸的人可改善膝關節休息、移動或站立時的疼痛。針灸後持續的改善最多可達4個月。不幸的是,這次回顧的作者認為,這次試驗是低品質,可能高估針灸功效。安全性如何呢?這次研究沒有測量副作用。什麼是底線?品質的證據是‘銀’級。從這些稀少的證據認為,針灸似乎沒有改善類風濕關節炎症狀。


எளியமொழிச் சுருக்கம்

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 초록
  5. 쉬운 말 요약
  6. 摘要
  7. எளியமொழிச் சுருக்கம்

முடக்கு வாதத்திற்கான குத்தூசி மற்றும் மின்-குத்தூசி சிகிச்சை

முடக்கு வாதத்திற்கு குத்தூசி சிகிச்சை வேலை செய்யுமா?

குறைந்த முதல் இடைநிலை தரம் கொண்ட இரண்டு ஆய்வுகள் திறனாய்வு செய்யப்பட்டன, மற்றும் அவை இன்றைக்கான சிறந்த ஆதாரத்தை நமக்கு அளிக்கிறது. முடக்கு வாதம் கொண்ட 84 மக்களை இந்த ஆய்வுகள் பரிசோதித்தன. இந்த ஆய்வுகள், குத்தூசியை போலி சிகிச்சை அல்லது ஒரு ஸ்டீராய்டு ஊசியோடு ஒப்பிட்டன. வாரம் ஒரு முறை அளிக்கப்பட்ட ஒரு சிகிச்சை அல்லது ஐந்து சிகிச்சைகளுக்கு பிறகு, முன்னேற்றங்கள் அளவிடப்பட்டன.

தோள் வலியை எது ஏற்படுத்துகிறது மற்றும் குத்தூசி சிகிச்சை எவ்வாறு உதவ முடியும்?முடக்கு வாதம் என்பது, உடலின் நோய் தடுப்பாற்றல் அமைப்பை உடலின் சொந்த ஆரோக்கியமான திசுக்களே தாக்கும் ஒரு நோயாகும். இந்த தாக்குதல் பெரும்பாலும் கைகள், மற்றும் கால்களில் உள்ள மூட்டுகளில் ஏற்படும் மற்றும் மூட்டுகள் சுற்றி சிவத்தல், வலி, வீக்கம் மற்றும் வெப்பத்தை ஏற்படுத்தும். வலி மற்றும் வீக்கத்தை குறைப்பதற்கு மருந்துகள் அல்லது மருந்தில்லா-சிகிச்சைகள் பயன்படுத்தப்படுகின்றன.

குத்தூசி சிகிச்சை, மெல்லிய ஊசிகளைக் கொண்டு உடலின் சில குறிப்பிட்ட இடங்களில் செலுத்தப்படும் ஒரு மருந்தில்லா சிகிச்சையாகும். வலியை குறைக்கும் வேதியல் கூட்டு பொருள்களை உடலினுள் வெளியிடுவதன் மூலம், வலி அறிவிப்பு குறிகைகளை முந்தி செல்வதன் மூலம், அல்லது ஆற்றலை அல்லது இரத்த ஓட்டத்தை உடலினுள் தடையற்று ஓட அனுமதிப்பதன் மூலம் குத்தூசி சிகிச்சை வேலை செய்கிறது என்று எண்ணப்படுகிறது. குத்தூசி சிகிச்சை வேலை செய்யுமா அல்லது பாதுகாப்பானதா என்பது தெரியவில்லை.

ஆய்வுகள் என்ன காட்டுகின்றன?ஒரு ஆய்வில், மக்கள் குத்தூசி சிகிச்சை அல்லது போலி சிகிச்சையை, வாரம் ஒரு முறை, ஐந்து வாரங்களுக்கு மேற்கொண்டனர். வலி, வீக்க மற்றும் மென்மையான மூட்டுகளின் எண்ணிக்கை, நோய் தீவிர நிலை, ஒட்டுமொத்த ஆரோக்கியம், ஆய்வக முடிவுகள், அல்லது தேவைப்பட்ட வலி நிவாரண மருந்துகளின் அளவு ஆகியவை குத்தூசி சிகிச்சை அல்லது போலி சிகிச்சை மேற்கொண்ட மக்களில் ஒரே மாதிரியாக இருந்தன.

மற்றொரு ஆய்வில், குத்தூசி சிகிச்சையோடு ஊசிகளின் மூலம் மின்சாரம் கடத்தப்பட்டு, முழங்காலில், குறிப்பிட்ட அல்லது உண்மையான அல்லது போலியான குத்தூசி புள்ளிகளில் மக்களுக்கு செலுத்தப்பட்டன. உண்மையான குத்தூசி சிகிச்சை மேற்கொண்ட மக்களில், ஓய்வின் போது , நகரும் போது ,மற்றும் நிற்கும் போது ஏற்படும் முழங்கால் வலி வெகுவாக குறைந்தது. இந்த முன்னேற்றம், குத்தூசி சிகிச்சையின் நான்கு மாதங்களுக்கு பிறகு நீடித்தது. துரதிர்ஷ்டவசமாக, இந்த திறனாய்வின் ஆசிரியர்கள், இந்த சோதனை தரம் குறைந்தது எனவும் மற்றும் குத்தூசி சிகிச்சை எவ்வளவு அதிகமாக வேலை செய்யும் என்பதை அதிகப்படியாக கணக்கிட்டு இருக்கலாம் என்று நம்புகின்றனர்.

எந்த அளவு இது பாதுகாப்பானது?பக்க விளைவுகள் இந்த ஆய்வுகளில் அளவிடப்படவில்லை.

அடிப்படை சாராம்சம் என்ன?ஆதாரத்தின் தரம், 'வெள்ளி' ஆகும்.

இருப்பில் இருக்கும் சிறிய ஆதாரத்திலிருந்து, முடக்கு வாதத்தின் அறிகுறிகளை குத்தூசி சிகிச்சை முன்னேற்றாது என்று தெரிகிறது.

மொழிபெயர்ப்பு குறிப்புகள்

மொழி பெயர்ப்பாளர்கள்: சிந்தியா ஸ்வர்ணலதா ஸ்ரீகேசவன், ப்ளசிங்டா விஜய், தங்கமணி ராமலிங்கம், ஸ்ரீகேசவன் சபாபதி.