针灸治疗难治性类风湿关节炎的疗效随机双盲对照研究

目的：观察针灸治疗难治性类风湿关节炎的疗效,探讨针灸作为一种辅助手段治疗难治性类风湿关节炎。方法：这个研究是前瞻性、随机、双盲、安慰对照临床试验研究。采用随机、双盲、安慰针对照的方法来评估电针组（第1组）、手针组（第2组）和假针组（第3组）治疗难治性类风湿关节炎的疗效。所有的患者在10个星期接受共20次治疗。所有的患者都选择同样的6个穴位。主要观察指标是疼痛评分的改善,其次观察美国风湿病学会（ACR）标准评估,DAS28关节评估,在10周达到ACR20评分标准的患者。总计36例患者（其中男7例、女29例）平均年龄（58±10）岁,平均患病时间（9.3±6.4）年。每组随机分配12位患者。结果：在第10周,疼痛评分3个组都没有明显改善。3例、2例和2例患者达到ACR20标准分别在12、、3组。电针组和手针组的关节压痛和医生全面评估分数显著降低;手针组的关节肿胀和患者全面评估分数大大降低;而所有结果保持不变的是假针组。结论：电针组和手针组同假针组相比疼痛评分没有显著改善;然而针灸仍然为难治性关节炎患者提供一种辅助治疗方法可以减轻关节压痛和肿胀。

Acupuncture in Treatment of Refractory Rheumatoid Arthritis：a Double-Blind Controlled Pilot Study

Objective：This study is the observation of acupuncture treatment of refractory rheumatoid arthritis,to explore acupuncture as an adjunct to the treatment of refractory rheumatoid arthritis.Methods：The study employs a randomized,prospective,double-blind,placebo-controlled trial to evaluate the effect of electroacupuncture（EA）,traditional Chinese acupuncture（TCA）and sham acupuncture（Sham）in patients with RA.All patients received 20 sessions over a period of 10 weeks.Six acupuncture points were chosen.Primary outcome is the changes in the pain score.Secondary outcomes included the changes in the ACR core disease measures,DAS 28 score and the number of patients who achieved ACR 20 at week 10.Results：From 80 eligible patients,36 patients with mean age of（58±10）years and disease duration of（9.3±6.4）years were recruited.Twelve patients were randomized to each group.Twelve,10 and 7 patients from the EA,TCA and Sham group respectively completed the study at 20 weeks（P0.03）;all except one of the premature dropouts were due to lack of efficacy.At week 10,the pain score remained unchanged in all 3 groups.The number of tender joints was significantly reduced for the EA and TCA groups.Physician＇s global score was significantly reduced for the EA group and patient＇s global score was significantly reduced for the TCA group.All the outcomes except patient＇s global score remained unchanged in the Sham group.Conclusion：EA and TCA group compared with the sham acupuncture group there was no significant improvement of pain score;However,acupuncture still refractory rheumatoid arthritis patients an adjuvant therapy can reduce joint tenderness and swelling.This pilot study has allowed a number of recommendations to be made to facilitate the design of a large-scale trial,which in turn will help to clarify the existing evidence base on acupuncture for RA.