Systematic Reviews

Berman BM, Swyers JP, Ezzo J. The evidence for acupuncture as a treatment for rheumatologic conditions. Rheum Dis Clin North Am 2000;26:103-15. Summary (Abstract only) Individuals with rheumatic disorders, particularly those with more severe, chronic conditions, are likely to be frequent users of complementary and alternative medical therapies. Although large-scale clinical trials have yet to be conducted, there is moderately strong evidence that acupuncture may be effective for treating both osteoarthritis (OA) and fibromyalgia. The utility of acupuncture in treating rheumatoid arthritis has not been demonstrated in large, randomized controlled trials. Physicians who treat patients with rheumatic conditions should become knowledgeable about the literature on both the effectiveness of acupuncture for these conditions as well as its potential to cause adverse side-effects in particular patient groups. Comment Ernst’s 1997 systematic review of acupuncture as a symptomatic treatment in OA was inconclusive, although every group that was needled, whether by real acupuncture or penetrating sham, improved significantly. Since then there have been two further trials which are consistent with this finding, although they would not really change the rigorous mechanistic answer that acupuncture is no better a than penetrating sham. It is just a matter of time before we achieve the right methodological approach to demonstrate a difference between acupuncture and non-penetrating sham (i.e. almost a true placebo). I suspect that we will ultimately prove a specific effect of the needle in symptomatic treatment of OA. Berman performed a systematic review of acupuncture for fibromyalgia in 1999. His conclusions were tentatively positive, as they were based on the one high quality trial in the review. This reviewer has seen only the abstract of that review, but the paper referred to must have been Deluze et al from the BMJ in 1992. This landmark research demonstrated a positive effect for electroacupuncture (EA) in fibromyalgia. The only problem with this paper is a conceptual one. Most acupuncturists do not use EA in fibromyalgia patients! Maybe they should. If any budding acupuncturists feel the urge after reading the Deluze paper, this reviewer would suggest a very gentle start.