Syndrome de Sjögren : évaluation de l'acupuncture

1. Revues systématiques et méta-analyses

☆☆☆ Preuves en faveur d’une efficacité et d’un effet spécifique de l’acupuncture
☆☆ Preuves en faveur d’une efficacité de l’acupuncture
Preuves limitées en faveur d’une efficacité de l’acupuncture
Ø Absence de preuve ou preuves insuffisantes

1.1. Al Hamad 2019 Ø

Al Hamad A, Lodi G, Porter S, Fedele S, Mercadante V. Interventions for dry mouth and hyposalivation in Sjögren's syndrome: A systematic review and meta-analysis. Oral Dis. 2019;25(4):1027-1047. [204003]. DOI

Objectives Systematic review with meta-analysis of interventions for dry mouth symptoms and hyposalivation of Sjögren's syndrome (SS).
Materials and methodsWe searched MEDLINE, Cochrane Central and EMBASE up to February 2018 for randomized trials of interventions for dry mouth and hyposalivation of SS. The primary outcome was the mean change in xerostomia symptoms. The secondary outcomes included changes in salivary flow and quality of life. We used the Cochrane risk of bias tool for individual studies and the GRADE method to summarize the quality of evidence across studies for the included outcomes.
ResultsThirty-six studies (3,274 patients) were included in the systematic review. Results from the meta-analyses showed high-quality evidence that pilocarpine was superior to placebo in reducing dry mouth symptoms. We found moderate quality of evidence that pilocarpine, rituximab and interferon-alpha were more effective than placebo in increasing salivary flow, with the relevant effect size being large for pilocarpine, and notably smaller for rituximab and interferon-alpha.
ConclusionClinicians should be very confident in the beneficial effects of pilocarpine upon dry mouth symptoms of SS and moderately confident that pilocarpine, rituximab and interferon-alpha can have beneficial effects upon salivary flow. Adverse events are common. The use of other treatment modalities cannot be supported on the basis of current evidence.
Acupuncture the present systematic review suggests that there is no evidence that the use of DMARDs, acupuncture, laser acupuncture, infliximab, etanercept and other interventions (gamma‐linolenic acid, dehydroepiandrosterone, omega‐3/vit E, nizatidine, a traditional chinese medicine compound) can reduce symptoms of dry mouth or increase salivary flow in individuals with SS.

1.1.1. Hackett 2015 Ø

Hackett KL, Deane KH, Strassheim V, Deary V, Rapley T, Newton JL, Ng WF. A systematic review of non-pharmacological interventions for primary Sjögren's syndrome. Rheumatology (Oxford). 2015;54(11):2025-32. [169450].

ObjectiveTo evaluate the effects of non-pharmacological interventions for primary SS (pSS) on outcomes falling within the World Health Organization International Classification of Functioning Disability and Health domains.
MethodsWe searched the following databases from inception to September 2014: Cochrane Database of Systematic Reviews; Medline; Embase; PsychINFO; CINAHL; and clinical trials registers. We included randomized controlled trials of any non-pharmacological intervention. Two authors independently reviewed titles and abstracts against the inclusion/exclusion criteria and independently assessed trial quality and extracted data.
ResultsA total of 1463 studies were identified, from which 17 full text articles were screened and 5 studies were included in the review; a total of 130 participants were randomized. The included studies investigated the effectiveness of an oral lubricating device for dry mouth, acupuncture for dry mouth, lacrimal punctum plugs for dry eyes and psychodynamic group therapy for coping with symptoms. Overall, the studies were of low quality and at high risk of bias. Although one study showed punctum plugs to improve dry eyes, the sample size was relatively small.
ConclusionFurther high-quality studies to evaluate non-pharmacological interventions for PSS are needed.

2. Recommandations de bonne pratique

⊕ recommandation positive (quel que soit le niveau de preuve annoncé)
Ø recommandation négative, absence de preuve ou non conclusif

2.1. The British Society for Rheumatology (BSR, UK) 2017 ⊕

Price EJ, Rauz S, Tappuni AR, Sutcliffe N, Hackett KL, Barone F, Granata G, Ng WF, Fisher BA, Bombardieri M0, Astorri E, Empson B, Larkin G, Crampton B, Bowman SJ; British Society for Rheumatology Standards, Guideline and Audit Working Group. The British Society for Rheumatology guideline for the management of adults with primary Sjögren's Syndrome. Rheumatology (Oxford). 2017;56(10):1828. [197096].

There is some experimental evidence for both acupuncture and mild electrical stimulation improving salivary flow rates. Published studies are generally small, usually observational and are not specifically looking at patients with SS. There were adverse effects reported with the use of acupuncture, but these were mild and of short duration. There were no reported adverse effects from electrostimulation, with some evidence for improved salivary flow