Acute gouty arthritis (AGA) severely affects the quality of life of patients due to its persistent, recurrent, and debilitating characteristics. Acupuncture holds a pivotal role as a classical alternative therapy in managing gouty arthritis. This study aimed to assess the clinical effectiveness of various acupuncture methods used in conjunction with conventional medications for treating acute gouty arthritis. We conducted a search of seven English and Chinese databases up to February 10, 2024, and analyzed the data using R software version 4.4.0.The study included a total of 37 randomized controlled trials(RCT), encompassing 2,801 patients. The network meta-analysis (NMA) results are as follows: Fire acupuncture demonstrated the highest effectiveness in improving cure rates. Acupuncture combined with conventional medication was found to be the most effective for reducing VAS scores. Additionally, Acupuncture combined with conventional medication proved most effective in lowering uric acid levels. For reducing ESR, the combination of blood-letting therapy and conventional drugs showed the greatest efficacy. No statistically significant differences were found among the different interventions regarding the reduction of TCMSS and CRP levels. In conclusion, fire acupuncture showed the greatest overall effectiveness. Acupuncture with conventional medication best reduced VAS scores and uric acid levels, while blood-letting therapy combined with conventional drugs was most effective in lowering ESR.

The authors have declared no competing interest.

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Registration of Systematic Review: This study has been registered with PROSPERO under registration number CRD42021278233. Detailed information can be accessed at PROSPERO.