SYSTEMATIC REVIEW article
Front. Neurol.
Sec. Experimental Therapeutics
Efficacy of Acupuncture in the Management of Ankylosing Spondylitis: A Systematic Review and Meta-Analysis with Insights
Provisionally accepted
- 1Graduate School of Beijing University of Chinese Medicine, Beijing, China
- 2Department of Traditional Chinese Medicine Rheumatology, China-Japan Friendship Hospital, Beijing, China
- 3Beijing University of Chinese Medicine, Beijing, China
- 4Beijing University of Chinese Medicine Dongfang Hospital, Beijing, China
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Background: Ankylosing spondylitis (AS) is a chronic, progressive autoimmune disease characterized by inflammation of the axial skeleton. Although acupuncture has been investigated as a potential therapeutic option for symptom relief, its efficacy in AS remains inconclusive. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of acupuncture for patients with AS, aiming to generate evidence to inform clinical practice. Methods: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. A literature search was performed across 7 databases to identify articles published up to December 25, 2024. Only randomized controlled trials (RCTs) that met the eligibility criteria were included. The methodological quality of the included trials was assessed using the Cochrane Risk of Bias Tool (RoB 2.0), and meta-analyses were conducted with RevMan 5.4 software. If high heterogeneity was observed among the included studies, a random-effects model was used for data synthesis. Subgroup analyses and sensitivity analyses were performed when necessary. Results: A total of 35 randomized controlled trials (RCTs) met the inclusion criteria of this study. We used 6 indicators to estimate the results of the meta-analysis, all outcomes showed statistically significant improvements, including BASDAI score, BASFI score, ASDAS, VAS score, CRP level, and ESR level. Specifically, the BASDAI score (MD = -1.55, 95% CI: -1.97 to -1.13, P < 0.0001), BASFI score (MD = -1.47, 95% CI: -1.76 to -1.19, P < 0.0001), and ASDAS (MD = -0.57, 95% CI: -0.82 to -0.33, P < 0.0001). VAS score (MD = -1.30, 95% CI: -1.54 to -1.06, P < 0.0001), CRP level (MD = -7.12, 95% CI: -8.68 to -5.56, P < 0.0001), and ESR level (MD = -7.22, 95% CI: -9.13 to -5.32, P < 0.0001) all decreased significantly. Conclusion: Acupuncture (including electroacupuncture, warm acupuncture, and fire acupuncture, etc.) is an effective and safe treatment for AS. Future research should focus on high-quality multicenter studies and comparative analyses of different acupuncture modalities to optimize the evidence for acupuncture in AS treatment. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42025633263.
Keywords: Acupuncture, ankylosing spondylitis, Complementary and Alternative Therapy, rct, Systematic review
Received: 01 Oct 2025; Accepted: 22 Dec 2025.
Copyright: © 2025 Zhang, Sun, Bai, Yin, Chen and Kong. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Weiping Kong
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