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| Authors and year | Study design | Subject characteristics | Interventions | Acupuncture points applied | Outcome assessment | Possible mechanisms proposed | Results and conclusions |
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| Meng et al. 2018 [23] | RCT | 160 RA patients | Acupuncture (once daily for 4 weeks) + herbs versus medication | ST36, BL18, BL20, BL23, RN6, RN4, ST36, DU14, LI11, SJ4, ST5, LI4, GB34, GB31, ST34, KI6, BL60, SP10, GB33, EX-LE4, EX-LE5, SI11, SI9, LI15, SJ14, BL36, GB30, BL54, GB40, BL62 | RA symptoms, ESR, RF, CRP, IL-1, IL-6, TNF-α, ICMAM-1 | Inhibiting the inflammatory reaction and improving immune function | (1) Acupuncture + herbs had significantly better effect on RA symptoms
(2) Significant differences in all parameters between 2 groups |
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| Adly et al. 2017 [24] | Clinical trial | 30 elderly RA patients | Laser acupuncture versus reflexology (12 sessions in 4 weeks for both groups) | LR3, ST25, ST36, SI3, SI4, LI4, LI11, SP6, SP9, GB25, GB34, HT7 | RAQoL, HAQ, IL-6, MDA, ATP, and ROM at wrist and ankle joints | (1) Anti-inflammatory effect
(2) Radiation absorption by the respiratory chain components inducing electronic excitation
(3) Antioxidative | Significant improvement in each group but acupuncture seems to be better |
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| Jie et al. 2017 [25] | Animal study (RCT) | 60 rabbits | Body versus buccal acupuncture (needling for 15 s then needle retaining for 30 min in buccal group) | ST36, LE5 “Xi” in buccal region | Pain threshold, cholecystokinin-8 (CCK-8), α-EP (α-endorphin) | Upregulation of α-EP and CCK-8 contents in cerebrospinal fluid (central analgesic effect) | (1) The central analgesic effect of buccal acupuncture is better than body-acupuncture
(2) Both buccal acupuncture and body-acupuncture can effectively raise the pain threshold in acute arthritis rabbits |
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| Cai et al. 2017 [26] | Animal study (RCT) | 50 rats | Warm needle moxibustion (15 min, once daily for 21 days) | ST36, BL23, GB 39 | Swelling volume of the affected knee-joint, IL-1α, IL-6, and IL-8, expression of SIRT 1 (a class III histone/protein deacetylase) and NF-κB p 65 proteins in the synovial tissue | (1) Downregulating serum inflammatory cytokines and NF-κB p 65 expression
(2) Upregulating SIR T1 expression | Warm needle moxibustion can relieve inflammatory reactions of RA rats |
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| Du et al. 2017 [27] | Animal study (RCT) | 40 rabbits | Heat-reinforcing needling (HRN) versus reinforcing-reducing needling (RRN), twirling-reinforcing needling (TRN) (30 min, once a day for 7 days) | ST36 | Pain threshold, local skin temperature, endogenous metabolites in the serum (α-ketoglutaric acid, citric acid, succinic acid, glucose, inositol, d-ribose, and D-mannose) | The specific regulation for the Krebs cycle and glycometabolism | (1) The effect of HRN group was significantly better than RRN and TRN group
(2) HRN for RA with cold syndrome is effective |
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| Chi and Hsu 2016 [28] | Clinical trial | 42 RA patients | Acupuncture (once daily for 10 days, 8 sessions) + warm needle acupuncture | ST36, SP6, LI4, LR3, GB34, LI11, SJ5, SJ4, EX-UE9, EX-UE4, EX-LE5, EX-L E2, SP9, ST34, BL62, BL60, KI6, KI3, Ashi points | RA symptoms, RF, ESR | TCM theory | Total effective rate was 95.2% |
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| Fong and Chao 2016 [29] | RCT | 120 RA patients | Acupuncture (once daily for 15 days, 2 sessions) with herb steaming versus herb steaming only | LI11, LI5, SJ5, LI4, SP10, ST36, GB34, SP9, ST41 | RA symptoms | TCM theory | Acupuncture combined with herb steaming had a better effect on RA symptoms than herb steaming alone |
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| Zhou et al. 2016 [30] | RCT | 68 RA patients | Electroacupuncture (3 times a week for 12 weeks) + oral medication versus oral medication | BL18, BL 23, GB 39, ST36, LR 3, LI 4 | VAS, clinical symptoms, DAS 28, ACR 20, HAQ, TCM symptoms score, ESR, CRP | | (1) The effects of the EA + medication group was better than medication group in terms of symptoms and function
(2) Adverse reactions can be reduced by EA therapy coordinated with western medicine |
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| Dong et al. 2016 [31] | Animal study (single case study) | 1 rat | Electroacupuncture (30 min daily for 28 days) | ST36, BL60 | Arthritis index, paw swelling, TLR4, MYD88, NF-κB | Anti-inflammatory by reducing the expression of TLR4, MYD88, and NF-κB | Acupuncture may play an important role in treatment of adjuvant arthritis rat |
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| Zhang et al. 2016 [32] | Animal study (RCT) | 32 rats | Electroacupuncture (30 min, once daily for 10 days) versus medication (prednisolone) | ST36, BL60 | Rats’ left ankle diameter, serum TNF-α, IL-1α, and ICAM-1 | Downregulating the levels of serum TNF-α, IL-1α, and ICAM-1 | (1) EA intervention is effective in relieving RA rats’ inflammatory reaction
(2) No significant differences between the medication and EA groups |
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| Du et al. 2016 [33] | RCT | 60 RA patients + 30 healthy subjects as control | Heat-reinforcing needling (HRN) versus uniform reinforcing-reducing needling (URN) (once daily, 5 days a week, two weeks) | CV4, CV6, ST36 | TCM symptom scoring system, the expression of plasma ATP synthase subunit O (Atp5 O) mRNA and lysosomal V 1 subunit B 2 (At p 6 V 1 B 2) mRNA | Upregulating expressions of plasma Atp 5 O mRNA and Atp 6 V 1 B 2 mRNA | Both HRN and URN can improve RA patients’ clinical symptoms while HRN was better |
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| Attia et al. 2016 [34] | RCT | 30 RA patients and 20 healthy subjects | Laser acupuncture (3 days/week for 4 weeks) | LI4, TE5, LI 11, DU 14, LIV3, SP6, GB34, and ST36 | SOD, GR, catalase, GSH, plasma ATP concentration, plasma MDA, serum nitrate and nitrite, serum CRP, plasma IL-6, GPx activity, ESR, DAS28 score | Alleviating oxidative stress and inflammation, improving antioxidant and energy metabolic status | (1) The study group revealed significantly increased plasma SOD, GR, GSH, and plasma ATP concentrations
(2) Significantly reduced plasma MDA, serum nitrate and nitrite, CRP, IL-6 GPx activity ESR |
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| Chen 2015 [35] | RCT | 78 RA patients | Group A = western medication;
B = A + herb;
C =A + B + acupuncture (once daily for 7 days, 24 sessions) | ST35, EX-LE2, ST36, SP10, Ahi points | RA symptoms | Not mentioned | Total effect in group C was significantly better than groups A and B |
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| Shetty et al. 2015 [36] | Single case study | 1 RA subject | EMMS (electroacupuncture, massage, mud, and sauna therapies) (15–45 min for 3 weeks) | GV20, LI4, LI11, BL11, GB4, SP6, KI3, ST44, EX28, and EX36 | VAS, 10-meter walk test, isometric hand-grip test, The Pittsburgh Sleep Quality Index, Depression Anxiety and Stress Scales, SF-36, health survey, blood and urine analysis | Not mentioned | The EMMS therapy might be considered as an effective treatments in reducing pain, depression, anxiety, and stress with improvement in physical functions, quality of sleep, and QOL in patient with RA |
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| Liu et al. 2015 [37] | RCT | 180 RA subjects with peptic ulcer | Ginger-partitioned acupoint stimulation (15 min, twice daily for 2 months) versus antirheumatic drugs (ARD) versus combination treatment | ST36 | RA symptoms, gripping strength, self-reported pain score, DAS-28 RA disease activity score, HAQ, RF, anticyclic citrullinated peptide (anti-CCP), ESR, and CRP | TCM theory/anti-inflammatory effect | Combination treatment with ginger-partitioned acupoint stimulation, oral sanhuangwuji powder, and ARDs had a better clinical effect for RA with complicated peptic ulcer |
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| Li et al. 2015 [38] | Animal study (RCT) | 60 rats | Acupuncture (15 min daily for 3 weeks) versus sham acupuncture | ST36, GB39, BL23 | Arthritis index, the expression levels of TNF-α and NF-κB (p65) in synovial cells, and the content of serum inflammatory cytokines | Acupuncture mediates the anti-inflammatory NF-kB pathway | (1) Parameters were lower for the acupuncture group than for the model group
(2) No statistically significant difference between the model and sham acupuncture group |
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| Guo et al. 2015 [39] | Animal study (RCT) | 32 rats | Electroacupuncture (EA; once daily for 5 days and rest for 2 days, 3 sessions) versus prednisolone | ST36, BL60 | Rats’ ankle diameter, IL-17, and IL-23 | Downregulating serum and knee-joint IL-17 and IL-23 levels | (1) EA can reduce inflammatory reaction of the ankle-joint in RA rats
(2) No obvious differences were found between the EA and prednisolone groups except IL-17 protein expression level |
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| Zhang et al. 2013 [40] | Animal study (RCT) | 40 rats | Fire needling (once every 3 days, 8 times) versus medication (MTX) | ST36, EXB2 | Weight, swelling rate of foot, joint pain score and polyarthritis index of rats, pathological change of liver tissue | Not mentioned | The fire needling has significant efficacy for rats with adjuvant arthritis without any damage to the liver and seems to be better than MTX treatment |
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| Han et al. 2012 [41] | Animal study (RCT) | 40 rats | Fire-needle acupuncture (once every 3 days, 8 times) versus MTX | ST36, EXB2 | Rat’s right hind paw swelling volume, serum IL-1 and TNF-alpha, pathological changes of synovium tissue of the right knee-joint | Downregulating serum IL-1 and TNF-alpha contents | (1) No significant differences were found in the swollen paw volumes on day 12
(2) Both groups showed better pathological observation |
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| He et al. 2011 [22] | Animal study (RCT) | 75 rats | Electroacupuncture (15 min, once every other day for 15 days) versus sham | ST36, GB39, BL23 | Body weight, paw volume, histologic inflammation scoring, VIP | Partially through the induction of VIP expression | EA markedly decreased the paw swelling and the histologic scores of inflammation in the synovial tissue and reduced the body weight loss |
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| Gao 2011 [42] | RCT | 114 RA patients | Group A = Western medication, B = A + acupuncture (once daily, 5 times a week for 3 months) | RN6, RN4, ST36, BL18, BL20, BL23 | RA symptoms | TCM theory | Group B had much better clinical effect than group A |
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| Ouyang et al. 2011 [43] | RCT | 63 RA patients | Electroacupuncture (EA) versus simple needling (SN) once every other day for 10 times, 3 sessions | Acupoints were selected mainly from yang-meridian and local Ashi points (pain-point) | TNF-α, VEGF in peripheral blood and joint synovia | Lowering TNF-α and VEGF in peripheral blood and joint synovia | (1) EA and SN could both reduce the TNF-α and VEGF
(2) The lowering of VEGF was more significant in the EA group |
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| Ouyang et al. 2010 [44] | RCT | 63 RA subjects | Electroacupuncture (EA) versus simple needling (SN) (once every other day for 20 times, 3 sessions) | GV20, GB20, LI11, TE5, CV4, ST36 | IL-1, IL-4, IL-6, and IL-10 in peripheral blood and joint fluid | Decreasing the proinflammatory cytokine of IL-1 and IL-6 and increasing the inhibition cytokine of IL-4 and IL-10 | (1) Both groups reduced the interleukins
(2) EA group had a greater effect than SN group |
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| Liu 2009 [45] | RCT | 57 RA patients | Acupuncture (once daily for 15 days, 2 sessions for consecutive 2-3 years) versus medication | SP6, SP9, ST36 | Functional assessment | TCM theory | Acupuncture group had significantly better ADL function (81.5% compared with 50.0%) |
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| Sato et al. 2009 [46] | Clinical trial | 6 female RA patients | Acupuncture (10 acupuncture treatments in 2 months) | ST34, ST35, ST36, SP9, SP10, BL39, BL40, BL56, KI10, GB31, and GB34 | VAS, ROM, face scale (mood), MHAQ, FDG-PET images, ESR, CRP | Not through reduction of regional inflammation | VAS, ROM, face scale and MHAQ improved in all patients and significantly after acupuncture, but no significant change in ESR, CRP, and PET images |
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| Kim et al. 2009 [47] | Clinical trial | 21 RA patients: responders (at least 50% reduction in swollen joint counts) or nonresponders (less than 50% reduction in swollen joint counts) | Acupuncture (14 sessions in 6 weeks) | Not mentioned | TAS in the serum, the SOD, catalase | The increased activities of SOD and catalase in the serum | (1) The responders showed significantly greater changes in the activity of SOD
(2) No significant differences in the changes of the catalase activity and TAS between the groups |
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| Chen et al. 2009 [48] | RCT | 60 RA patients | Muscular acupuncture (once daily for 3 months) versus medication | L11, SP6, and scarring moxibustion on GV14, ST36 | RA symptoms, ESR, RF | Not mentioned, possible anti-inflammatory effect | (1) Both groups were effective but with no significant differences
(2) Acupuncture caused less adverse effects |
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| Zanette et al. 2008 [49] | Pilot double-blinded RCT | 40 RA patients | Acupuncture (AC) versus sham (control AC) (5–10 treatment sessions, followed up at 1 month) | EX 1, PC6, IG4, EX 28, CV 12, CV 6, ST 36, SP 6, LV 3, UB 20, UB 22, UB 23, GV 4, GV 14, UB 11, UB60 | ACR20, DAS, VAS, HAQ, ESR, CRP | Not through anti-inflammatory effect | (1) A trend for better efficacy in the AC group (ACR20)
(2) Other variables did not differ in both groups |
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| Pang et al. 2008 [50] | RCT | 86 RA patients | Acupuncture (once daily for 20 days, 2 sessions) + medication versus medication | DU14, LI11, LI4, SP6, DU3, BL20, RN4, Ashi points | RA symptoms, ESR, CRP, RF, IgG, IgA, IgM | Anti-inflammatory effect | Medication combined with acupuncture group with better clinical effects in terms of each parameter |
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| Lee et al. 2008 [51] | Pilot clinical trial | 25 RA patients | Acupuncture (14 sessions for 6 weeks) | HT8, KI10, ST36, SP3, LR8, LR2, SP2, LR1, SP1, SI5, ST41, GB41, ST43, SI3, BL66, SI2, LU8, KI7, SP3, KI3 | ACR 20, 50, and 70, DAS28, swollen joint count, SF-36, ESR | Anti-inflammatory effects | (1) At 6 weeks, 44%, 20%, and 12% of patients achieved ACR 20, 50, and 70 responses, respectively
(2) Acupuncture also produced statistically significant improvements in DAS28, pain and global activity, swollen joint count, SF-36, and ESR |
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| Bernateck et al. 2008 [52] | RCT | 44 RA patients | Auricular electroacupuncture (EA) versus autogenic training (AT) (once weekly for 6 weeks, follow-up at 3 months) | NA | VAS, DAS28, the use of pain medication, the pain disability index (PDI), the clinical global impression (CGI), and proinflammatory cytokine levels | Anti-inflammatory effect | (1) Both EA and AT resulted in significant short- and long-term effects
(2) The treatment effects of auricular EA were more pronounced |
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| Wang et al. 2007 [53] | Clinical trial | 47 RA patients | Acupuncture: 3 courses versus 6 courses | ST36, CV8, EXUE9, EXLE5, SI3, SI8, LI3, LI4, LI5, LI10, LI11, TE4, TE5, PC7, LU5, LR2, BL62, KI3, KI6. ST41, GB34, SP10 | Morning rigidity, swelling, and pain of joints as well as RF, ESR, CRP | Not mentioned, possible anti-inflammatory effect | 6 courses had greater effect on parameters than 2 courses of acupuncture treatment |
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| Tam et al. 2007 [54] | Pilot double-blinded RCT | 36 RA patients | Electroacupuncture (EA) versus traditional Chinese acupuncture (TCA) and sham acupuncture (Sham) (20 sessions for 10 weeks) | LI11, TE5, LI4, ST36, GB34, GB39 | Pain score, changes in the ACR core disease measures, DAS 28 score, and the number of patients who achieved ACR 20 at week 10, ESR, CRP | Not mentioned, possible anti-inflammatory effect | (1) The number of tender joints was significantly reduced for the EA and TCA groups
(2) Physician’s global score was significantly reduced for the EA group and patient’s global score was significantly reduced for the TCA group |
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| Fan and Xia 2007 [55] | RCT | 96 RA patients | Acupuncture (heat electroacupuncture instrument with Chinese herb iontophoresis plus medicine) versus control (medicine only) (followed up at one month) | LI11, GB33, GB34, ST34 | RA symptoms, CRP, RF, ESR, WBC, platelet | Anti-inflammatory effect | (1) The effective rate was 79.2% in the treatment group and 52.1% in the control group
(2) The decreases of blood CRP, ESR, PLT in the treatment group were more significantly as compared with the control group |
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| Chen and Guo 2006 [56] | RCT | 137 patients | Acupuncture (once a day for 10 days, 3 sessions) + moxibustion versus acupuncture | SI4, LI5, LI11, SJ5, LI4, ST36, GB34, Sp6, LR3, GB41, EX-UE9, ST41 | RA symptoms | TCM theory | Total effective rate was better in group with acupuncture and moxibustion (88.51% versus 64.0%) |
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| Gao et al. 2006 [57] | RCT | 98 RA patients | Acupuncture (once daily for 10 days) and moxibustion versus herbs | LI11, SJ5, EX-UE9, EX-LE4, EX-LE5, BL40, GB34, ST36, SP6, GB40, EX-LE10 | RA symptoms | TCM theory | Total effective rate was better in group with acupuncture and moxibustion (94.3% versus 80.0%) |
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| Shuain and Hsu 2006 [58] | Clinical trial | 20 RA patients | Acupuncture and herbs | LI11, ST36, ST40, AP6, GB39, GB30, PC7, LU5, LI4, SJ5, ST34, GB33, BL60 | RA symptoms and ESR | TCM theory and anti-inflammatory effect | Total effective rate was 95% |
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| He et al. 2006 [59] | RCT | 50 RA patients | Needle-sticking method versus routine filiform needle therapy (2 sessions) | Not mentioned | RA symptoms (painful and swollen joints), RF, CRP, ESR | Possible anti-inflammatory effect | Both groups had an apparent therapeutic effect on RA, but needle-sticking method was better in terms of RF and symptoms |
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| Ai et al. 2005 [60] | RCT | 146 RA patients at active stage | Electroacupuncture versus medication | LI4, LI11, GB34 | RA symptoms | Not mentioned | Effective rate was 79.73% in the treatment group and 51.39% in the control group with a significant difference |
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| Usichenko et al. 2003 [61] | Double-blinded RCT | 12 RA patients | Electromagnetic millimeter waves (MW) applied to acupuncture points versus sham versus MW exposure 40 min | Not mentioned | RA symptoms | Not mentioned | Patients from MW group reported significant pain relief and reduced joint stiffness during and after the course of therapy. MV may be an adjuvant therapy for RA |
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| David et al. 1999 [62] | Double-blinded RCT | 56 RA patients | Acupuncture versus sham
(5 treatments at weekly interval for 5 weeks/2 sessions and one 6-week washout period in between) | LI3 | ESR, CRP, VAS, global patient assessment, DAS28, GHQ | Not through anti-inflammatory effect | No significant effect of treatment or period and no significant interaction between treatment and period for any outcome variable |
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| Li et al. 1999 [63] | Clinical trial | 55 RA patients | Acupuncture + needle warming by moxibustion (once daily for 2 months) | LU9, P7, H7, SP3, LI3, K3, L3, SI3, SJ3, ST43, GB41, UB65, ST36, GB34. GB39, RN4 | RA symptoms, ESR, RF, X-rays of hands | TCM theory | (1) The total effective rate was 9 0.9%
(2) No changes found in X-rays |
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| Guan and Zhang 1995 [64] | Clinical trial | 12 RA patients | Acupuncture (once daily for 10 days, 1–3 sessions) | Ex17, UB12, UB13, LI4, LU7, REN22, LU6, ST36, ST40, LU5, LU9, REN4, REN17 | Serum IgG, IgM, IgA | The reinforcement of the immunological function | IgG, IgA, and IgM decreased, while IgE did not change evidently |
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| Liu et al. 1993 [65] | Clinical trial | 54 RA patients | Warm needling versus point injection | | NK activity and IL-2 | Regulatory effect on the cellular immunological function | The NK activity and IL-2 value in RA patients were found to be lower than those of normal individuals; both increased after treatment |
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| Xiao et al. 1992 [66] | RCT | 41 RA patients and 16 healthy subjects as control | Acupuncture with moxibustion versus point injection | Not mentioned | IL-2 levels | An influence on the immunity system through neuroendocrine system to improve the IL-2 production | The IL-2 level in control group was unchanged but increased considerably in two RA groups |
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