Rédacteurs : Johan Nguyen, Olivier Goret, Henri Truong
Sommaire
Ankylosing Spondylitis
Spondylarthrite ankylosante : évaluation de l'acupuncture
1. Systematic Reviews and Meta-Analysis
| ☆☆☆ | Evidence for effectiveness and a specific effect of acupuncture. |
| ☆☆ | Evidence for effectiveness of acupuncture. |
| ☆ | Evidence for effectiveness of acupuncture mais limitées qualitativement et/ou quantitativement. |
| Ø | No evidence or insufficient evidence. |
1.1. Generic Acupuncture
1.1.1. Xuan 2020
Xuan Y, Huang H, Huang H, Liu D, Hu X, Geng L, The Efficacy and Safety of Simple-Needling Therapy for Treating Ankylosing Spondylitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.Evid. Based Complementary Altern. Med.2020. 4276380. [211869]. doi
| Background | Clinical investigators have found that the use of needling in the treatment of ankylosing spondylitis (AS) has a good clinical application prospect in recent years. However, these studies were insufficient to provide evidence for the efficacy and safety of simple-needling for AS. So, we performed a systematic review and meta-analysis to evaluate the efficacy and safety of simple-needling for treating AS. |
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| Methods | We searched the PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Wangfang database (Wanfang), Chinese Science and Technology Periodical Database (VIP), and any other gray literature sources for randomized controlled trials (RCTs) that used simple-needling to treat AS before June 2019 with the language restriction of Chinese and English. Researchers evaluated the retrieved literature studies and extracted valid data according to relevant requirements and used RevMan5.3 software for meta-analysis. |
| Results | A total of 10 studies were included, all of which were Chinese literature studies, involving 729 patients. Compared with the control groups, simple-needling groups had a better effect on the clinical effective rate (RR = 1.20, 95% CI (1.11, 1.29), ), TCM syndrome score (MD = −5.26, 95% CI (−5.99, −4.53), ), symptom score (MD = −8.08, 95% CI (−10.18, −5.97), ), and Schober test outcome (MD = 0.39, 95% CI (0.15, 0.64), ). Sensibility analysis was based on the leave-one-out cross-validation procedure, and the results showed no significant changes. Most studies did not describe adverse reactions. The funnel plot suggested publication bias on clinical effectiveness. |
| Conclusion | This systematic review and meta-analysis demonstrated that simple-needling was effective as an intervention for AS. However, due to the low quality of the methodology of included studies, the designs of clinical trials were not rigorously standardized. Therefore, it is necessary to carry out multiquality RCTs for verification. |
1.1.2. Li 2019
Li Ping, Wang Yinjie, Tian Jigang. [Meta Analysis of the Randomized Controlled Trial of Acupuncture for Ankylosing Spondylitis]. Rehabilitation Medicine. 2019;Issue 3:66-72. [201714].
| Objective | To evaluate the clinical effect of acupuncture in the treatment of ankylosing spondylitis and provide evidence-based medical evidence for clinical practice. |
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| Methods | Randomized controlled trials(RCT) about acupuncture(trial group)compared with medicines(control group) in the treatment of ankylosing spondylitis were collected from five major databases at home and abroad(CNKI, VIP database, Chinese Biomedical Database, Wanfang database, PubMed) from January 2000 to February 2018.Two independent reviewers screened the articles, extracted data and assessed the risk of bias. The evaluation of the quality was performed using Cochrane Risk of Bias evaluation criterion and Modified Jadad Scales; besides the data was analyzed by using RevMan5.3 software. Bi-categorized variables were represented by risk rate(RR) or odds ratio(OR) and its 95% confidence interval(CI) and continuous variables were represented by weighted mean difference(MD) and its 95% CI. |
| Results | Finally, 11 clinical randomized controlled trials were included. All of them were Chinese literatures. A total of 767 participants involving 395 patients were included in the trial group and 372 patients in the control group. According to meta-analysis, the total effective rate of acupuncture in the treatment of ankylosing spondylitis was higher than that of the control group [RR=1.26, 95%CI(1.17, 1.35), P<0.000 01], and the difference was statistically significant(P<0.05). Thoracic distance [MD=0.41, 95%CI(0.26,0.56), P<0.000 01], finger distance [MD=-4.97, 95%CI(-9.06,-0.89), P=0.02], erythrocyte sedimentation rate [MD=-8.46, 95%CI(-14.00,-2.92), P=0.003], C-reactive protein [MD=-23.20,95%CI(-40.68,-5.73), P=0.009] of the trial group were significantly improved better than those of the control group, and the differences were statistically significant(P<0.05). However, there were no significant differences in improving the disease activity index of ankylosing spondylitis score [MD=-5.36, 95%CI(-12.99,-2.26), P=0.17], the functional index of ankylosing spondylitis score [MD=-4.25,95%CI(-8.81, 0.31), P=0.07] and the adverse reaction rate [OR=0.12, 95%CI(0.01, 1.64), P=0.11] between the two groups(P>0.05).The sensitivity analysis of the total effective rate was carried out by removing one of them one by one and then merging the effect quantity analysis. Meta-analysis results showed that the difference of total effective rate had statistical significance(P<0.05) after eliminating one of the documents in turn. The merging effect was determined by RR and the obtained RR was relatively stable. Sensitivity analysis showed that the research was homogeneous and the results of the meta-analysis were stable. |
| Conclusion | Acupuncture has certain advantages in the treatment of ankylosing spondylitis, and it is helpful to improve the activity of thoracic spine, the activity of lumbar spine and the inflammatory markers(erythrocyte sedimentation rate, C-reactive protein) in patients with ankylosing spondylitis as a result. So acupuncture in the treatment of ankylosing spondylitis is worthy of clinical use. However, this study is based on literature data; the quality and quantity of literature maybe have significant influence on the final results. Therefore, it is necessary to conduct more high-quality and large-sample studies, so as to provide a more reliable evidence-based basis for the treatment of ankylosing spondylitis by acupuncture. |
1.1.3. Zhang 2018 ☆
Zhang Zhu-Heng, Wang Jing, Fu Yu, et al. [Meta Analysis of Clinical Randomized Controlled trials [Research Literature on Acupuncture and Moxibustion Treatment of Ankylosing Spondylitis]. Chinese Journal of Basic Medicine in TCM. 2018;24(12):1743. [193195].
| Objective | Evaluate the clinical efficacy and safety of acupuncture in the treatment of ankylosing spondylitis (AS) , and provide evidence for the application of acupuncture in the treatment of ankylosing spondylitis. |
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| Methods | Collect clinical randomized controlled trials ( RCTs) of acupuncture treatment of AS. Search the medical electronic bases including PubMed, Embase, Cochrane library retrieval, China CNKI, Wanfang Data and VIP data by computer to find the application of acupuncture and Western medicine in the treatment of ankylosing spondylitis. Retrieval time were from inception to December 2016. The data were extracted independently by 2 researchers, and the data were extracted and evaluated independently according to the Cochrane system evaluation methodology. The Meta analysis was made by Revman 5. 3 software. |
| Results | A total of 21 studies were included, involving a total of 1820 patients (950 in treatment group, 870 in control group). The results of Meta analysis showed that the effects of acupuncture was superior to western medicine in terms of the efficiency rate(RR = 3. 25, 95% CI 2. 52 to 4. 20) , thoracic expansion degree (SMD =0. 32, 95% CIO. 09 to 0. 54) , finger ground distance ( SMD = - 1. 01 , 95% CI - 1. 27 to 0. 76) , pillow wall distance (SMD = -0.73,95% CI -1. 19 to 0.27), Schober test( SMD = 0.37,95% CIO. 22 to 0.53) , erythrocyte sedimentation rate (ESR) (SMD = -0.80, 95% CI - 1.21 to -0.40). |
| Conclusion | The acupuncture treatment of AS has certain advantages compared with western medicine, but it still needs more high-quality, low-risk randomized controlled literature to verify and support. |
1.1.4. Zhang 2018 ☆
Zhang Xiao, Luo Xiaozhou, Cao Qiuyu, Deng Gan, Tang Chunzhi. [Efficacy of Acupuncture and Sulfasalazine for Ankylosing Spondylitis: A Network Meta-analysis]. Chinese Archives of Traditional Chinese Medicine. 2018;10:. [182494].
| Objective | To evaluate the clinical efficacy of acupuncture and moxibustion in the treatment of ankylosing spondylitis by using the random effects model based on Bayesian theory. |
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| Methods | A computer-controlled search of Google Scholar, Pub Med, Cochrane Library, CNKI, VIP, CBM and Wanfang database were published from the publication to October 2017. Randomized controlled trials/acombined randomized controlled trials on acupuncture for ankylosing spondylitis( RCT/CCT) literature were assessed the risk of quality and bias by two researchers in accordance with the Cochrane Handbook 5. 1. 0. Stata 14. 0 was used to draw the network structure diagram and Ge MTC 0. 14. 3 to do the statistics. |
| Results | The final 25 studies met the inclusion criteria, a total of 2208 cases, involving sulfasalazine, acupuncture, moxibustion, bee acupuncture, acupuncture + moxibustion, acupuncture + moxibustion + cupping, moxibustion +bee needle and other 9 kinds of interventions. The results of network Meta-analysis showed that the combination of sulfasalazine and acupuncture, sulfasalazine and moxibustion, sulfasalazine and acupuncture + moxibustion, sulfasalazine and acupuncture + moxibustion + canister, sulfasalazine and acupuncture + canister, sulfasalazine and acupuncture + bee needle, sulfasalazine and moxibustion + bee needle, needle and needle + moxibustion, acupuncture and acupuncture +moxibustion + cupping, moxibustion and acupuncture + moxibustion, moxibustion and acupuncture + moxibustion + cupping. The total effective rate between bee needle and acupuncture + moxibustion + cupping was statistically significant. According to the best possible curative effect, the order from high to low is acupuncture + moxibustion + cupping, acupuncture + moxibustion + bee, moxibustion + bee acupuncture, acupuncture + moxibustion, acupuncture + cupping, moxibustion, acupuncture, bee acupuncture, Sulfapyridine. |
| Conclusion | The existing research evidence shows that acupuncture and moxibustion is superior to monotherapy and sulfasalazine, acupuncture + moxibustion + cupping, acupuncture +moxibustion + bee, moxibustion + bee acupuncture for the best treatment of this disease. But the exact conclusion still needs a lot of high-quality RCTs to be confirmed. |
1.1.5. Lv 2015 (vs Disease-modifying Antirheumatic Drugs) ★
Lv ZT, Zhou X, Chen AM. [Acupuncture Therapy versus Disease-modifying Antirheumatic Drugs for the Treatment of Ankylosing Spondylitis–a Meta-analysis]. Forsch Komplementmed. 2015;22(6):395-402. [190122]
| Objectives | We conducted a meta-analysis evaluating the efficacy and safety of acupuncture compared to disease-modifying antirheumatic drugs in patients with ankylosing spondylitis. |
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| Methods | Four databases including Pubmed, EMBASE, Cochrane library, and ISI Web of Science were searched in December 2014, taking also the reference section into account. Randomized controlled trials that aimed to assess the efficacy of acupuncture therapy were identified. The inclusion criteria for the outcome measurements were the clinical effect, ESR, occipital wall test, chest expansion, CRP and finger ground distance. Finally, six studies met these inclusion criteria. Two reviewers screened each article independently and were blinded to the findings of each other. |
| Results | We analyzed data from 6 RCTs involving 541 participants. Acupuncture therapy could further improve the clinical effect (OR = 3.01; 95% CI, 1.48-6.13; P = 0.002) and reduce ESR level (SMD = -0.77; 95% CI, -1.46 to -0.08; P = 0.03) compared to DMARDs; a combination of acupuncture and DMARDs could further improve clinical effect (OR = 3.20, 95% CI, 1.36-7.54; P = 0.008), occipital-wall distance (SMD = -0.84; 95% CI, -1.37 to -0.31; P = 0.002), chest expansion (SMD = 0.38; 95% CI, 0.16-0.60; P = 0.0009), and finger-ground distance (SMD = -0.48; 95% CI, -0.87 to -0.09; P = 0.02) as compared to DMARDs treatment alone. |
| Conclusions | Our findings support that acupuncture therapy could be an option to relieve symptoms associated with AS. These results should be interpreted cautiously due to the generally poor methodological qualities of the included trials. |
1.1.6. Gong 2007 ★
Gong XM, Ren K. [Acupuncture therapy in the rehabilitative treatment of ankylosing spondylitis a systematic review]. Chinese J Rehabil Med. 2007;22:537. [181461].
| 目的:系统评价针灸促进强直性脊柱炎的康复和减少其远期发病率的效果.方法:计算机互联网检索MEDLINE(1978-2006)、中国学术期刊全文数据库(1994-2006)、中国生物医学全文数据库(1995-2006)、Highwire 文献数据库,获取所涉及针灸治疗强直性脊柱炎的随机或半随机对照试验;而后选择符合纳入标准的临床试验,评价其方法学质量,并从中获取患者基本情况、干预措施、终点指标和结果等相关资料进行系统评价.结果:共有7个小规模的临床随机对照试验.合计555例患者符合纳入标准,但因其在试验设计、报道上存在明显缺陷,以及试验之问存存较大差异.不符合Meta分析条件,因而只能进行定性分析;结果显示针灸治疗强直性脊柱炎具有一定的疗效(P＜0.001).结论:针灸治疗强直性脊柱炎有效,但入选的7个随机对照试验规模小,质量不高,降低了这一结论的可靠性.开展高质量、内在真实性好的相关随机对照试验非常必要 | |
| Automatic translation | |
| Objective | To evaluate the promotion of acupuncture ankylosing spondylitis rehabilitation and long-term effect of reducing its incidence. |
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| Method | Computer Internet to retrieve MEDLINE (1978-2006), China Academic Journal Full-text Database (1994-2006), the full text of Chinese Biomedical Database (1995-2006), Highwire literature database, get involved in acupuncture and moxibustion treatment of ankylosing spondylitis randomized or quasi-randomized controlled trials; then select clinical trials met the inclusion criteria to evaluate methodological quality, and to obtain the basic condition of the patient, intervention and other measures, endpoints and results Info systematic evaluation. |
| Results | A total of seven small-scale randomized controlled trials in patients with a total of 555 cases met the inclusion criteria, but because there are obvious flaws in the experimental design, reports, and test it. Q. exist large differences exist does not meet the conditions of Meta-analysis, which can only qualitative analysis; results showed that acupuncture treatment of ankylosing spondylitis have a certain effect (P <0.001). |
| Conclusion | Acupuncture effective treatment of ankylosing spondylitis, but selected seven randomized controlled trials are small, the quality is not high, reducing the reliability of this conclusion. conduct high-quality, good internal validity relevant randomized controlled trials is necessary |
1.2. Special Acupuncture Techniques
1.2.1. Moxibustion
1.2.1.1. Dong 2020
Dong Li, Bin-Bin Yang, Min-Min Chang, Xin Yuan, … Shu-Jie Tang. Moxibustion for ankylosing spondylitis: A systematic review and meta-analysis. European Journal of Integrative Medicine. 2020;35. [212069]. doi
| Introduction | Both moxibustion and western medicine are widely used in the treatment of Ankylosing Spondylitis in China. However, which is better for the disease? Up to now, no review and meta-analyses have been published and the answer is still unclear. The aim of this research was to compare the effectiveness of moxibustion versus western medicine in the treatment of ankylosing spondylitis. |
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| Methods | The PubMed, Cochrane Library, EMBASE, China Biology Medicine Data, Web of Science, CNKI, VIP, and Wanfang database were searched from their inception through November 1st, 2019. A meta-analysis was performed using the RevMan 5.3 software and the evidence level was assessed using the GRADE system. |
| Results | Seventeen studies with 1235 patients were included. Pooled analysis showed a favorable effect of moxibustion in total effective rate (RR = 1.14, 95 % CI: 1.07–1.21; P < 0.0001), VAS (MD = −0.82, 95 % CI: −1.08 to −0.56; P < 0.00001), gastrointestinal reaction (RR = 0.11, 95 % CI: 0.03–0.44; P = 0.002), CRP (MD = −1.14, 95 % CI: −1.99 to −0.29; P = 0.008), TNF-α (MD = −1.32, 95 % CI: −2.21 to −0.43; P = 0.004), finger-to-floor distance (MD = −3.02, 95 % CI: −4.81 to −1.23; P = 0.0009; MD = −8.19, 95 % CI: −9.73 to −6.65; P < 0.00001) and Schober test (MD = 0.50, 95 % CI: 0.17–0.82; P = 0.003), while no significant differences were found in BASDAI (MD = 0.12, 95 % CI: −0.53 to 0.76; P = 0.72), abnormal liver function (RR = 0.20, 95 % CI: 0.02–1.66; P = 0.14), ESR (MD = −1.55, 95 % CI: −5.54 to 2.43; P = 0.45), occiput to wall distance (MD = −0.58, 95 % CI: −1.43 to 0.28; P = 0.19) and thoracic expansion (MD = 0.04, 95 % CI: −0.07 to 0.14; P = 0.50) between the two groups. |
| Conclusion | Compared with western medicine, moxibustion had a favorable effect in alleviating pain, improving lumbar activity and reducing inflammatory reaction in people with ankylosing spondylitis. However, considering the limitations of this study, the evidence is not conclusive and high quality trials are needed in the future to further confirm this conclusion. |
1.2.1.2. Hu 2020
Hu J, Mao Y, Zhang Y, Ye D, Wen C, Xie Z. Moxibustion for the treatment of ankylosing spondylitis: a systematic review and meta-analysis. Ann Palliat Med. 2020;9(3):709-720. [217488]. doi
| Background | To systematically evaluate the efficacy of moxibustion in the treatment of ankylosing spondylitis (AS). |
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| Methods | Seven electronic databases were systematically searched for relevant studies for inclusion from databases inception to December 31, 2018. Randomized controlled trials investigating the efficacy of moxibustion for AS treatment versus Western medicine (Wm) treatment were included for systematic review and meta-analysis. Effect estimates were pooled using the fixed or random-effects models. Between-study heterogeneity and publication bias were also assessed. Stratification analyses were further performed based on the treatment plan of experimental groups. |
| Results | Twenty-six studies were eligible for inclusion with a total of 1,944 AS patients. Meta-analysis showed that compared with those receiving Wm treatment alone, patients receiving moxibustion combined with Wm treatment or moxibustion alone had a higher clinical efficacy rate [odds ratio (OR) =4.21, 95% confidence interval (CI): 2.91 to 6.10, P<0.001 for moxibustion combined with Wm versus Wm; OR =2.43, 95% CI: 1.62 to 3.65, P<0.001 for moxibustion alone versus Wm]. In addition, patients receiving moxibustion combined with Wm treatment had lower levels of C-reactive protein [weighed-median difference (WMD) =-6.33, 95% CI: -9.64 to -3.01, P<0.001] and erythrocyte sedimentation rate (WMD =-7.86, 95% CI: -11.26 to -4.46, P<0.001) after treatment, respectively. Furthermore, moxibustion could also improve Schober test scores (WMD =0.85, 95% CI: 0.15 to 1.55, P=0.017), occipital-wall distances (WMD =-0.55, 95% CI: -0.92 to -0.19, P=0.003), and finger-ground distances (WMD =-3.64, 95% CI: -5.61 to -1.68, P<0.001) of AS patients. |
| Conclusions | This study suggests that moxibustion is an effective complementary treatment for AS patients. However, further large-scale multicenter clinical trials are needed to confirm these findings. |
1.2.1.3. Lu 2018 ☆
Lu Yang , Sun Shu-Ning , Chen Guo-Ming , et al. [Meta-analysis of the Clinical Efficacy of Moxibustion in Treating Ankylosing Spondylitis]. Shanghai Journal of Acupuncture and Moxibustion. 2018;37(5):583. [188158].
| Objective | To evaluate the clinical efficacy of moxibustion in treating ankylosing spondylitis. |
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| Method | By computer retrieval, literatures about randomized controlled trial on moxibustion in treating ankylosing spondylitis were collected from Pubmed, Embase, China Biology Medicine disc (CBMdisc), China National Knowledge Infrastructure (CNKI), and WanFang database. After data extraction and quality evaluation by using Cochrane Review Handbook 5 . 1, the eligible clinical trials underwent meta-analysis by using RevMen5 .3 software. |
| Result | A total of 25 articles met the inclusion criteria, including 2 087 cases with 1 048 cases in the experiment group and 1 039 cases in the control group. The meta-analysis showed that the total effective rate of moxibustion in treating ankylosing spondylitis was superior to that of Western medicine [RR=1 . 1 7, 95%CI (1 .04, 1 .32), P=0.008]. Moreover, the total effective rate of moxibustion plus Western medicine in treating ankylosing spondylitis was superior to that of Western medicine [RR=1.14, 95%CI (1.09, 1.18), P<0.01]. |
| Conclusion | Compared to Western medicine alone, moxibustion and moxibustion plus Western medicine can produce a better clinical efficacy and less adverse reactions. But due to the relative low quality of the eligible clinical studies, more randomized double-blind clinical trials with multiple centers and high quality are expected for further verification. |
1.2.1.4. Sun 2018 ☆
Sun Shu-Ning , Lu Yang , Chen Guo-Ming , Chen Xing-Hua , Chen Xin-Lin. [Meta-analysis of Adjuvant Therapy with The Moxibustion in The Treatment of Ankylosing Spondylitis]. Journal of Basic Chinese Medicine. 2018;24(8):1122. [181093].
| 0bjective | To systematically review the effectiveness and safety of adjuvant therapy with the Moxibustion in the treatment of Ankylosing Spondylitis AS. |
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| Method | Such databases as Pubmed, Embase, CBM,CNKI, VIP database and WanFang Data are searched to collect randomized clinical trials on the effectiveness and safety of Moxibustion Combined with Western medicine contrast using Western medicine for Ankylosing Spondylitis. According to the inclusion and exclusion criteria, literature was screened, data were extracted, and the methodological quality of included studies was also assessed. Then, Meta-analysis was performed using RevMan 5. 3 software. |
| Results | 18RCTs were included eventually among a total of 1452 cases on Moxibustion combined with Western medicine in the treatment of Ankylosing Spondylitis. Compared with the control group, the effectiveness of Moxibustion combined with Western medicine in the treatment of AS is superior than using Western medicine. It can improve the ESR score, the CRP score and shorten the Lime of morning stiffness. And there are less untoward effect by using Moxibustion. |
| Conclusion | The clinical effects of Moxibustion Combined with Western medicine in the treatment of Ankylosing Spondylitis certain and the safety is superior to the western medicine group. But the existing researches need to be verified in more high-quality randomized and double-blind multicenter studies due to their poor quality. |
1.2.1.5. Dong 2018 (Moxibustion on Governor Vessel)☆
Dong Long-Cong, Deng Lu-Da, Lan Wei-Ya, Fu Ying-Yue, Pan Jian-Xiang, Xiang Kai-Wei. [Meta-analysis of Clinical Efficacy of Moxibustion on Governor Vessel in Treating Ankylosing Spondylitis]. Rheumatism and Arthritis. 2018;(9):30-5. [181201].
| Objective | To systematically evaluate the clinical efficacy of moxibustion on Governor Vessel in treating ankylosing spondylitis. |
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| Methods | Databases such as Pub Med, Embase, The Cochrane Library, CBM, CNKI, VIP and WANFANG DATA were retrieved by computer to find randomized controlled trials(RCT)of treating ankylosing spondylitis with moxibustion on Governor Vessel alone or combined with western medicine(from the establishment of the databases to March 2018).Two researchers independently screened the literature, extracted the literature and assessed the risk of bias, and analyzed the data using software Rev Man 5.3. |
| Results | A total of 10 RCT articles with 705 sample cases were included, including 352 experimental groups and 353 control groups. The results of Meta-analysis showed that the effective rate of moxibustion on Governor Vessel was higher in seven articles(RR = 1.23, 95%CI = [1.13, 1.35], P < 0.000 01), and their VAS(WMD =-1.35, 95%CI =[-2.16, 0.53], P = 0.001), morning stiffness time(WMD =-1.35, 95%CI =[-2.16, 0.53], P = 0.001), C-reactive protein(WMD =-10.36, 95%CI =[-17.48, -3.24], P = 0.004)and erythrocyte sedimentation rate(WMD =-8.80, 95%CI =[-12.11, -5.49], P < 0.000 01)were better than those of the control group. Six of them mentioned adverse reactions, and 4 of them didn’t. |
| Conclusion | Moxibustion on Governor Vessel has some advantages over other treatments with Western medicine alone. Higher-quality randomized controlled double-blind trials will be needed to verify the curative effect of moxibustion on Governor Vessel in treating ankylosing spondylitis. |
2. Clinical Practice Guidelines
| ⊕ positive recommendation (regardless of the level of evidence reported) Ø negative recommendation (or lack of evidence) |
2.1. Korean Society of Spondyloarthritis Research 2023 Ø
Seo MR, Yeo J, Park JW, Lee YA, Lee JH, Kang EH, Ji SM, Kwon SR, Kim SK, Kim TJ, Kim TH, Kim HW, Park MC, Shin K, Lee SH, Lee EY, Cha HS, Shim SC, Yoon Y, Lee SH, Lim JH, Baek HJ; Korean Society of Spondyloarthritis Research. Korean treatment recommendations for patients with axial spondyloarthritis. J Rheum Dis. 2023 Jul 1;30(3):151-169. https://doi.org/10.4078/jrd.2023.0025.
Seo MR, Yeo J, Park JW, Lee YA, Lee JH, Kang EH, Ji SM, Kwon SR, Kim SK, Kim TJ, Kim TH, Kim HW, Park MC, Shin K, Lee SH, Lee EY, Cha HS, Shim SC, Yoon Y, Lee SH, Lim JH, Baek HJ; Korean Society of Spondyloarthritis Research. Korean treatment recommendations for patients with axial spondyloarthritis. Korean J Intern Med. 2023 Sep;38(5):620-640. https://doi.org/10.3904/kjim.2023.194. Epub 2023 Jul 24. PMID: 37482652.
| Recommendation 17. We suggest that spa and acupuncture not be provided to patients with axSpA as therapies (GoE, low; SoR, weak; LoA, 80.6%) |
