Moxibustion with Artemisia argyi H.Lév. & Vaniot in rheumatoid arthritis animal models: A meta-analysis linking clinical efficacy to inflammasome and cytokine signaling mechanisms

Clinical Snapshot

Key Findings

• P Value: Not explicitly reported but confidence intervals suggest p<0.001

• Effect Size: Arthritis index SMD -3.72, paw volume SMD -4.59, histopathological score SMD -2.24

• Primary Outcome: Arthritis severity significantly reduced across all measures

• Nnt Or Sensitivity: Large effect sizes (SMD >2.0) suggest clinically meaningful differences in animal models

• Confidence Interval: All outcomes showed non-overlapping confidence intervals excluding null effect

Clinical Application

Moxibustion is already practiced in traditional Chinese medicine clinics but evidence base for RA remains preclinical Not currently covered by PBS; would require TGA evaluation and RACGP guideline consideration following human trials. Some practitioners may offer as complementary therapy Currently limited to research settings; requires human clinical trials before patient application

Abstract

ETHNOPHARMACOLOGICAL RELEVANCE: Moxibustion, a traditional Chinese healing method, uses mugwort (Artemisia argyi H.Lév. & Vaniot) to apply heat to specific points, treating conditions like "Bi Zheng", which is akin to rheumatoid arthritis (RA). According to traditional theory, its therapeutic actions are attributed to warming the meridians and regulating the flow of Qi and blood. AIM OF THE STUDY: To quantitatively evaluate the therapeutic efficacy of moxibustion and to map its anti-arthritic mechanisms in animal models of RA. MATERIALS AND METHODS: The protocol was registered with PROSPERO (CRD42024503829) and reported according to PRISMA 2020. Eight databases were searched through 28 July 2025 for randomized controlled animal studies comparing moxibustion with the control in RA models. The primary outcome was arthritis severity, assessed by the arthritis index, paw volume, and histopathological score. Secondary endpoints included serum or tissue levels of pro-inflammatory cytokines (IL-1β, TNF-α, IL-6), immunomodulatory cytokines (IL-10, IL-4), and key signaling proteins (NF-κB, NLRP3, TLR4, MyD88). The SYRCLE tool was used to assess the risk of bias. RESULTS: Seventy-three studies were included. Meta-analysis showed that moxibustion significantly reduced arthritis severity (arthritis index: SMD -3.72, 95% CI -4.25 to -3.20; paw volume: SMD -4.59, 95% CI -5.54 to -3.63; histopathological score: SMD -2.24, 95% CI -2.80 to -1.67). Moxibustion also lowered the levels of pro-inflammatory cytokines: IL-1β (SMD -3.52, 95% CI -4.19 to -2.86), IL-6 (SMD -3.17, -4.17 to -2.16), and TNF-α (SMD -3.38, -3.97 to -2.79) and suppressed key signaling pathways, including NF-κB (SMD -2.29, 95% CI -3.20 to -1.37), NLRP3 (SMD -1.74, 95% CI -2.49 to -0.99), TLR4 (SMD -6.72, 95% CI -12.54 to -0.90), and MyD88 (SMD -9.16, 95% CI -15.28 to -3.04). CONCLUSION: This meta-analysis suggests that moxibustion alleviates arthritis severity and histopathological damage in RA animal models, potentially through modulating inflammatory networks and inhibiting key pathways such as NF-κB and NLRP3. These findings provide preclinical evidence supporting the rationale for future clinical investigation of moxibustion as a potential adjunct therapy for RA.

References

1. 1.Ma, J., Zhao, Y., Liu, S., Zhang, D., Lu, Z., Qiu, Y., Wang, Y., Qiu, G., & Sun, Z. (2026). Moxibustion with Artemisia argyi H.Lév. & Vaniot in rheumatoid arthritis animal models: A meta-analysis linking clinical efficacy to inflammasome and cytokine signaling mechanisms. Journal of Ethnopharmacology, 121302. https://doi.org/10.1016/j.jep.2026.121302