Meta-analysis and trial sequential analysis on blood uric acid and joint function in gouty arthritis treated with fire needling therapy in comparison with western medication

Objective: To conduct the meta- analysis and trial sequential analysis (TSA) on clinical trials of fire needling therapy in treatment of gouty arthritis and review systematically the clinical therapeutic effect of fire needling therapy on gouty arthritis so as to provide the medical evidences of the extensive application of this therapy in treatment of gouty arthritis. Methods: The relevant clinical trials of fire needling therapy for treatment of gouty arthritis were searched from China National knowledge Infrastructure, Wanfang Data Knowledge Service Platform, Chinese Science and Technology Journal Database, American Medical Online, Dutch Medical Literature Database and International Evidence-Based Medical library. Using Review Manager 5.3 software, the quality of the included trials was assessed and meta-analysis was performed. With TSA v0.9 software, the trial sequential analysis was conduced on the appropriate outcomes. Results: A total of 10 trials were included with 775 patients involved. The analysis results showed that compared with the western medication, the total effective rate (RR = 1.14' 95%CI [1.09,1.20]), the curative rate (RR = 1.59' 95%CI [1.33,1.89]), the reduced VAS score (MD = -1.44' 95%CI [-1.93,-0.95]) and the reduced incidence of adverse reaction (RR = 0.27'Y 95% CI [0.09,0.76]) of the fire needling therapy were different significantly (all P < 0.05). Regarding the reduction of blood uric acid (MD = -40.47' 95%CI [80.21,-0.72]) and the score of symptoms and physical signs (MD = -1.38' 95% CI [-3.71, 0.95]), the effect of fire needling therapy was similar to that of western medication group (both P = 0.05). The trial sequential analysis suggested that the result was reliable, in which, the total effective rate of fire needling therapy was much higher than the western medication. But, it was potentially a false-positive finding, in which, fire needling therapy was much more advantageous at reducing blood uric acid as compared with the western medication. Conclusion: Based on the analytic results, it can be determined that fire needling therapy, as an effective approach to the treatment of gouty arthritis, has a certain advantage as compared with western medication. Given the low overall quality of trials, it still needs high-quality clinical trial to verify the findings of this study results. (C) 2021 Published by Elsevier B.V. on behalf of World Journal of Acupuncture Moxibustion House.