Comparative Effectiveness Research of Electroacupuncture and TENS in Patients With Rheumatoid Arthritis

Study Overview
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Brief Summary
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The aim of this pilot study is to compare the effectiveness of electroacupuncture or transcutaneous electrical nerve stimulation in reducing the tenderness in the patients with rheumatoid arthritis. The study adopted a pragmatic, randomized, patient-centered approach to investigate the effectiveness of clinical symptoms and quality of life.

Detailed Description
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A total of 80 volunteers of patients with rheumatoid arthritis will be recruited from the Chinese medicine or Western medicine clinics in China Medical University Hospital and Dalin Tzu-Chi Hospital. These patients will be randomized to receive electroacupuncture (40 participants) or transcutaneous electrical nerve stimulation (40 participants) treatment two sessions per week and for 10 treatments in total. The investigators expect that electroacupuncture or transcutaneous electrical nerve stimulation can reduce the severity of pain in the patients with rheumatoid arthritis. The effectiveness of electroacupuncture or transcutaneous electrical nerve stimulation can be detected by visual analogue scale, simplified disease activity index, and disease activity score and be used to improve the clinical symptoms and quality of life.

Official Title
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Comparative Effectiveness Research of Electroacupuncture and Transcutaneous Electrical Nerve Stimulation in Patients With Rheumatoid Arthritis: A Pragmatic Randomized Clinical Trial

Conditions
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Arthritis, Rheumatoid

Intervention / Treatment
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* Device: electroacupuncture
* Device: TENS


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 20-70 years old Met the American College of Rheumatology criteria (2010) for RA Classification of X-ray : Stage I III The participants' RA medication regimen (DMARD, NSAID, steroid)were eligible if they were on a stable dose for at least 3 months before entry into and throughout the study. All patients were instructed not to make any changes in their background therapies during the study. Intra-articular or pulse steroid were not permitted during the study Exclusion Criteria: Be treated with biological agents, such as antagonist of TNF-alpha, IL-6, Jak, and CD20 mono antibody in the last 3 months Having history of serious drug allergy Pregnancy or breastfeeding Bleeding or coagulation disorders Localized skin infections Uncontrolled or ill-controlled blood pressure with diastolic pressure≥110 mmHg Any other acupuncture treatment or herbal medication for RA within 2 weeks before screening needle phobia Intra-articular corticosteroid or pulse steroid within 4 weeks preceding the study Any severe chronic or uncontrolled comorbid disease

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: electroacupuncture<br>The needles remained in situ for 30 minutes, during which time the acupuncturist returned to stimulate the needles once to re-elicit the de qi sensation. Participants have 2 sessions per week, with total 5 weeks and 10 sessions. The body points included LI4, LI11, SP6 and ST36. The individual specific points protocol are as follows: GB20, TE5, SP10, GB34, LV3, ba xie, ba fen, Ashi). The acupuncture protocol consists of the body points and some of the individual specific points depending on subjects' condition. | Device: electroacupuncture<br>* Electroacupuncture used to reduce the inflammation was proved previously.<br>|
| Experimental: Transcutaneous electrical nerve stimulation<br>The protocol consisted of first swabbing all points with alcohol, then pads of TENS were sticked on the proper location of acupoints included LI4, LI11, SP6 and ST36. Electrical output of one channel was administered to the surface of body via a combination of two pads. LI4 and LI11, ST36 and SP6 are combination of acupoints, respectively. Participants had 2 sessions per week, with total 5 weeks and 10 sessions. Each session lasted 30 minutes. | Device: TENS<br>* Patients who unlike needles would like to choose TENS as treatment for pain relief.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Morning stiffness(scoring range 0 10 and lasting time : min/day) | Changes from baseline to end of intervention and 4 weeks after intervention completed | baseline, week 5, and week 9 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Simplified disease activity index (scoring range 0.0   86.0) | Changes from baseline to end of intervention and 4 weeks after intervention completed | baseline, week 5, and week 9 | 
| Disease Activity Score 28 (scoring range 0.0   9.4) | Changes from baseline to end of intervention and 4 weeks after intervention completed | baseline, week 5, and week 9 | 
| Erythrocyte sedimentation rate | Changes from baseline to end of intervention and 4 weeks after intervention completed | baseline, week 5, and week 9 | 
| Clinical Disease Activity Index (scoring range 0.0   76.0) | Changes from baseline to end of intervention and 4 weeks after intervention completed | baseline, week 5, and week 9 | 
| Pain Visual Analogue Scale (scoring range 0   10) | Changes from baseline to end of intervention and 4 weeks after intervention completed | baseline, week 5, and week 9 | 
| C-reactive protein | Changes from baseline to end of intervention and 4 weeks after intervention completed | baseline, week 5, and week 9 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Comparative effectiveness research, electroacupuncture, transcutaneous electrical nerve stimulation, rheumatoid arthritis:, randomized clinical trial