Acupuncture for gouty arthritis: A PRISMA-compliant protocol for a systematic review and meta-analysis of randomized controlled trials

Signaling pathways in uric acid homeostasis and gout: From pathogenesis to therapeutic interventions

Uric acid is a product of purine degradation, and uric acid may have multiple physiologic roles, including the beneficial effects as an antioxidant and neuroprotector, maintenance of blood pressure during low salt ingestion, and modulation of immunity. However, overproduction of metabolic uric acid, and/or imbalance of renal uric acid secretion and reabsorption, and/or underexcretion of extrarenal uric acid, e.g. gut, will contribute to hyperuricemia, which is a common metabolic disease. Long-lasting hyperuricemia can induce the formation and deposition of monosodium urate (MSU) crystals within the joints and periarticular structures. MSU crystals further induce an acute, intensely painful, and sterile inflammation conditions named as gout by NLRP3 inflammasome-mediated cleavage of pro-IL-1β to bioactive IL-1β. Moreover, hyperuricemia and gout are associated with multiple cardiovascular and renal disorders, e.g., hypertension, myocardial infarction, stroke, obesity, hyperlipidemia, type 2 diabetes mellitus and chronic kidney disease. Although great efforts have been made by scientists of modern medicine, however, modern therapeutic strategies with a single target are difficult to exert long-term positive effects, and even some of these agents have severe adverse effects. The Chinese have used the ancient classic prescriptions of traditional Chinese medicine (TCM) to treat metabolic diseases, including gout, by multiple targets, for more than 2200 years. In this review, we discuss the current understanding of urate homeostasis, the pathogenesis of hyperuricemia and gout, and both modern medicine and TCM strategies for this commonly metabolic disorder. We hope these will provide the good references for treating hyperuricemia and gout.

The effect of acupuncture on pain and swelling of arthritis animal models: A systematic review and meta-analysis

Arthritis, the inflammation of joints, attributes to the patient's pain, joint deformation, and limited range of motion. Emerging studies have shown the effects of acupuncture on different types of arthritis. We aimed to assess the effects of acupuncture on arthritis animal models and summarize the related mechanisms. We retrieved studies that met our criteria from PubMed, MEDLINE, EMBASE and the Research Information Service System. The quality assessment was evaluated by using the Systematic Review Centre for Laboratory Animal Experimentation's risk of bias tool. The pain withdrawal latency, pain withdrawal threshold, and paw volume data were digitized using Engauge Digitizer software. The meta-analysis was performed, and the figures were generated using RevMan software. The meta-analysis of data from 21 animal studies revealed that acupuncture increased tolerance to pain stimuli, and reduced swelling in arthritis animals. Although the number of included studies is insufficient, the results suggest acupuncture to be effective in improving arthritis-induced inflammation and pain by regulating the nervous and immune system.

Effects of Warm Needle Acupuncture plus Xitong Waixi Lotion in Patients with Knee Osteoarthritis: A Randomized Controlled Trial

Objective

To evaluate the effect of warm needle acupuncture plus Xitong Waixi lotion on the levels of IL-1, TNF-α, and MMP-3 in patients with knee osteoarthritis.

Methods

Eighty patients with knee osteoarthritis admitted to our hospital from October 2019 to June 2021 were recruited and assigned via the random number table method at a ratio of 1 : 1 to receive either Xitong Waixi lotion (conventional group) or warm needle acupuncture plus Xitong Waixi lotion (combined group). Outcome measures included clinical efficacy, inflammatory cytokine level, Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, visual analogue scale (VAS) score, Hospital for Special Surgery (HSS) knee score, and adverse reactions.

Results

Warm needle acupuncture plus Xitong Waixi lotion was associated with a significantly higher clinical efficacy versus Xitong Waixi lotion alone (P=0.006). Patients in the combined group had significantly lower levels of interleukin (IL)-1, tumor necrosis factor-α (TNF-α), and matrix metalloproteinase-3 (MMP-3) than those in the conventional group (P=0.020). Warm needle acupuncture plus Xitong Waixi lotion resulted in significantly lower WOMAC scores and VAS scores and higher HSS scores for the patients versus Xitong Waixi lotion (P=0.012). The two groups had a similar incidence of adverse events (P=0.068).

Conclusion

Warm needle acupuncture plus Xitong Waixi lotion effectively alleviates the inflammatory response and knee pain in patients with knee osteoarthritis, with significant clinical effects and a high safety profile.

Exploring the Clinical Point Selection Rules of Acupuncture and Moxibustion in the Treatment of Infantile Enuresis Based on Data Mining Technology

In order to explore the clinical point selection rules of acupuncture and moxibustion in the treatment of infantile enuresis based on data mining technology, first, it introduces the principle of data mining technology, the global optimization strategy of information extraction + genetic search. In China Biomedical Literature Database, CNKI, Weipu, Wanfang. Use "enuresis," "enuresis," "leathering," "urinary discharge," "drowning," "bedwetting," "nocturia," "drowning," "moxibustion," "moxibustion," and "moxibustion" as search terms, take (enuresis + enuresis + urination + urination + addiction + bedwetting), (moxibustion + moxibustion + moxibustion)" as the retrieval style. The analysis of the use of moxibustion, the law of acupoint selection by different moxibustion methods, and the frequency analysis of meridian use show that most of the moxibustion methods are used (62 articles, of which 3 articles use 2 moxibustion methods), including non-suppurative moxibustion, ginger moxibustion, medicinal cake moxibustion, salt moxibustion, mild moxibustion, warm acupuncture moxibustion, bird pecking moxibustion, circling moxibustion, and warm moxibustion; among them, mild moxibustion has the highest frequency of use 24 and non-suppurative moxibustion and salt-separated moxibustion have the lowest frequency of use1; there are 4 non-moxibustion methods, which are medicated thread moxibustion methods. Different moxibustion methods for acupoint selection have their own emphasis. The 63 included literatures included 63 prescriptions for moxibustion, 11 prescriptions for acupoints. Analyzing the frequency of acupoint selection, a total of 18 ear acupoints are involved, and the total frequency of auricular acupoints is 54 times; 44 points are involved (including 1 odd point outside the meridian), the total frequency of acupoints is 300 times, and the total frequency of meridian points is 298, and the total frequency of Jingwaiqi acupoints (Sishencong) is 2. The results can provide great help for the clinical selection of acupuncture points for the treatment of infantile enuresis.

Clinical Effect of Acupuncture Combined with Traditional Chinese Medicine Application on the Treatment of Functional Dyspepsia in Children and the Influence on Serum 5-HT and NO Levels

Objective

To explore the clinical effect of acupuncture combined with traditional Chinese medicine (TCM) application on the treatment of functional dyspepsia (FD) in children and the influence on serum 5-HT and NO levels.

Methods

94 FD children admitted to the pediatric department of our hospital from March 2019 to March 2020 were selected as the research object and divided into the study group (n = 45) and reference group (n = 49) by the number table method. The routine Western medicine therapy was given to the reference group and the combination therapy of acupuncture and TCM application was given to the study group to analyze the effect of different therapies on FD children by detecting their serum 5-hydroxytryptamine (5-HT) and nitric oxide (NO) levels and electrogastrogram (EGG) before and after treatment.

Results

The sex ratio, mean age, mean duration of disease, mean weight, mean BMI value, and residence of children in the two groups were not significantly different (P > 0.05); after treatment, the study group obtained significantly lower symptom scores and shorter disappearance time of clinical symptoms when comparing with the reference group (P < 0.001); the total clinical effective rate of the study group was significantly higher than that of the reference group (P < 0.05); the treated serum 5-HT and NO levels of children in both groups were significantly lower than those before treatment (P < 0.05), and in the between-group comparison, those of the study group were significantly lower (P < 0.05); and the treated AP, FP, and normal slow wave ratio of gastric antrum and body were significantly higher in the study group than in the reference group (P < 0.05).

Conclusion

The combination therapy of acupuncture and TCM application is a reliable method for improving the clinical symptoms in FD children. This strategy greatly reduces the levels of serum factors in child patients and shortens the corresponding treatment time. Further research will be conducive to establishing a better solution for such patients.

Bee Venom Alleviated Edema and Pain in Monosodium Urate Crystals-Induced Gouty Arthritis in Rat by Inhibiting Inflammation

Bee venom (BV) acupuncture has anti-inflammatory and analgesic effects; therefore, it was used as a traditional Korean medicine for various musculoskeletal disorders, especially arthritis. In this study, we investigated the effect of BV on monosodium urate (MSU) crystal-induced acute gouty rats. An intra-articular injection of MSU crystal suspension (1.25 mg/site) was administered to the tibiotarsal joint of the hind paw of Sprague Dawley rats to induce MSU crystal-induced gouty arthritis. Colchicine (30 mg/kg) was orally administered 1 h before MSU crystal injection as a positive control, and BV (0.5 mg/kg) was injected into the tibiotarsal joint immediately after MSU crystal injection. The ankle thickness, mechanical allodynia, and expression of proinflammatory cytokines (TNF-α, IL-1β, IL6, COX2 and iNOS) and chemokines (MIP-1α, MIP-1β, MCP-1, GRO-α, MIP-2α) were then evaluated. BV reduced the expression of proinflammatory cytokines and chemokines, which are important mediators of MSU crystal-induced inflammatory responses. This anti-inflammatory effect was also confirmed histologically to attenuate synovitis and neutrophil infiltration. We demonstrated that BV markedly ameliorated ankle edema and mechanical allodynia in gouty rats. These results suggest that BV acupuncture is a potential clinical therapy for acute gouty management.