Moxibustion for treating rheumatoid arthritis: A systematic review and meta-analysis of randomized controlled trials

IntroductionMoxibustion is widely used in China and other East Asian countries to manage the symptom of rheumatoid arthritis (RA) and to lessen the adverse effects of western medicine. The purpose of this systematic review was to evaluate the available evidence from randomized controlled trials (RCTs) of moxibustion for treating patients with rheumatoid arthritis (RA).MethodsSeven Chinese and English databases were searched to November 2013 from their inception. Eligible RCTs were included if moxibustion was used either alone or in combination with Western medicine for treating rheumatoid arthritis. Study selection, data extraction, and validation was performed independently by two reviewers. Cochrane criteria for risk of bias was used to assess the methodological quality of the trials.ResultsEight RCTs met the inclusion criteria, and most were of low methodological quality. Meta-analysis showed favorable effects of moxibustion on the response rate, either alone [RR = 1.18, 95%CI (1.03, 1.35), p = 0.02; heterogeneity: Chi2 = 1.11, p = 0.77, I2 = 0%] or the combination with Western medicine therapy [RR = 1.28, 95%CI (1.12, 1.47), p = 0.0004; heterogeneity: Chi2 = 1.96, p = 0.58, I2 = 0%]. When compared with Western medicine therapy, Western medicine plus moxibustion therapy showed a favorable statistically significant effect on a reduction on American College of Rheumatology (ACR) 50 [RR = 1.57, 95%CI (1.25, 1.99), p = 0.0001; heterogeneity: Chi2 = 2.87, p = 0.58, I2 = 0%], whereas it failed to do so on American College of Rheumatology (ACR) 20. Additionally, when compared with western medicine therapy alone, meta-analysis of three RCTs suggested favorable but no statistically significant effects of moxibustion plus western medicine on the control of disease activities of rheumatoid arthritis.ConclusionsIt is difficult to draw firm conclusions on whether moxibustion is an effective intervention for treating RA due to the small sample size of eligible RCTs and the high risk of bias among the available RCTs. Further rigorous RCTs are warranted but need to overcome methodological shortcomings of the existing evidence.