Effectiveness of Yoga and Acupuncture in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis

Abstract

Introduction. Rheumatoid arthritis is a form of inflammatory joint disease; sometimes, patients need prolonged cycles of nonsteroidal anti-inflammatory drugs and/or glucocorticoids for symptomatology management in addition to traditional disease-modifying drugs and biologics. On some occasions, doses are increased without improvement of symptoms associated with side effects; this is why, on some occasions, patients seek other types of nonpharmacological therapies, such as alternative therapies. Objective. To establish the effectiveness of alternative therapies such as yoga and acupuncture in rheumatoid arthritis by measuring disease activity with the disease activity score 28. Methods. A systematic review of the literature and meta-analysis was performed; databases such as PubMed and Embase were used to find the best available evidence of randomized clinical trials from 2017 to 2021, two researchers independently screened and extracted the necessary data, and the methodological quality and the risk of bias were assessed through the Cochrane risk-of-bias tool. The articles that applied for meta-analysis were analyzed in Jamovi version 2.2 and EPIDATA version 3.1 software. Results. Eight studies were included for qualitative analysis of which seven were included in the meta-analysis, with 550 rheumatoid arthritis patients, predominantly female. The meta-analysis evidenced a significant effect of yoga and acupuncture interventions in decreasing DAS 28 in patients with rheumatoid arthritis (four RCTs; SMD −2.51 95% CI [−2.89, −2.14], $p\le 0.001$ , I2 25.9%); in the yoga subgroup analysis, there was also evidence of improvement in the evaluated outcome (three RCTs; SMD −0.51 95% CI [−0.71, −0.30], $p\le 0.001$ , I2 0%). Conclusion. It was demonstrated that the practice of yoga and acupuncture in patients with rheumatoid arthritis helped to decrease disease activity through the improvement of pain and joint inflammation; we recommend the implementation of this type of alternative intervention associated with conventional therapies for the management of patients diagnosed with rheumatoid arthritis.