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Acupuncture is more effective for treating rheumatoid arthritis and improving markers of oxidative stress than pharmaceuticals. This was discovered in a recent study conducted at Gansu University of Traditional Chinese Medicine Affiliated Hospital. [1]
This study compared treatments of hot-filling acupuncture to pharmacology for 68 patients presenting with wind-cold-damp type rheumatoid arthritis. Outcomes were determined by measuring both pain relief by VAS (visual analog scale) and oxidative stress markers such as GSH-Px (glutathione peroxidase), SOD (superoxide dismutase), and MDA (malondialdehyde). Oxidative stress describes increased levels of ROS (reactive oxygen species), which damage cells and are believed to be participatory in the pathology of rheumatoid arthritis.
Following treatment, the total effective rate in the acupuncture group was 91.2%. The control group measured at 76.5%. At the 3 month follow-up, the acupuncture group continued to experience greater improvements with an effective rate of 88.3% while the control group measured lower at 70.6%.
Introduction
Patients were recruited and randomly assigned to the acupuncture or control group. The acupuncture group was comprised of 16 male and 18 female participants 41–70 years old with a mean age of 56. This group’s disease duration spanned 9–75 months, with a mean duration of 30.5 months. The control group was comprised of 18 male and 16 female participants 42-69 years old with a mean age of 54. This group’s disease duration spanned 10–72 months, with a mean duration of 32.3. There were no statistically significant differences between the two groups in terms of gender, age, disease severity, or pain scores (p>0.05) at the onset of the study.
Rheumatoid arthritis severity was assessed with the DAS-28 (Disease Activity Score 28), where a combination of examination, global pain scores, inflammatory markers, questionnaires, and medical imaging are all considered; total scores are calculated using a complex formula. Scores of >5.1 indicate active disease, scores of <3.2 indicate low disease activity, and scores of <2.6 indicate remission.
TCM diagnostic criteria include primary symptoms of severe joint pain in a fixed location, stiffness in the morning, and limited ability to bend and stretch. Secondary symptoms include heavy limbs, reduced joint mobility, numb skin or muscle, a white and greasy tongue coating, and a taut or bowstring pulse.
In addition to meeting the above criteria, participants were also required to be 40–70 years old with a disease duration of 5–80 months and a DAS-28 score of >2.6. They were also required to be able to give informed consent and not be participatory in glucocorticoid or DMARD (disease modifying anti-rheumatic drug) therapy.
Exclusion criteria included concurrent respiratory, hemopoietic, psychological, or other primary disease, suspected or confirmed lesions or skin disease in knee joints or surrounding areas, other immune disorders, pregnancy or lactation, and poor treatment compliance.
Treatment
Acupuncture group patients received hot-filling acupuncture administered at the following primary acupoints:
- Hegu (LI4)
- Zusanli (ST36)
- Sanyinjiao (SP6)
- Guanyuan (CV4)
- Qihai (CV6)
According to each patient’s most severely affected joints, additional acupoints were selected:
- For the elbow, Chize (LU5), Quchi (LI11), and Shousanli (LI10) were added.
- For the wrist, Yangchi (TB4), Wangu (SI4), Yangxi (LI5), and Waiguan (TB5) were added.
- For the knee, Yinlingquan (SP9), Yanglingquan (GB34), Heding (MLE27), Dubi (ST35), Xiyangguan (GB33), Liangqiu (ST34), and Xiyan (MNLE16) were added.
- For the ankle, Jiexi (ST41), Kunlun (BL60), and Xuanzhong (GB39) were added.
Stainless steel, disposable, filiform needles (0.30 × 40 mm) were inserted bilaterally using the following technique: Following standard procedure, the selected points were disinfected while the patient was in a supine position. The researcher then applied pressure to the selected acupoint with their left thumb or forefinger. Next, they used their right hand to insert the needle 30–40mm deep. After achieving deqi, the needle was pressed and rotated forward 5 times using the right hand while continuous pressure was applied with the left finger or thumb.
To elicit sensation in the surrounding area, needle depth was increased in 5 stages. The needle was then gently lifted in 5 stages before it was pressed and rotated 5 times more. This process was repeated continuously for 1 minute before allowing the needle to rest at an appropriate depth. Needles were retained for 30 minutes, and treatment was administered once daily. A total of 4 courses were administered. Each course was comprised of 5 consecutive treatments, separated by 2–day breaks. Control group patients received pharmacological intervention with the following drugs and dosages:
- Etoricoxib 60 mg daily, after food
- Leflunomide 20 mg daily, after food
- Methotrexate 5 mg twice weekly, after food
All pharmaceuticals were administered for a total of 4 weeks.
Outcomes and Discussion
Outcomes for this study were measured after 4 weeks of treatment and at a 3 month follow-up. These outcomes were measured by VAS for pain, serum GSH-Px, SOD, and MDA. Total effective rates were also calculated for each group.
Mean pretreatment VAS scores were 7.12 in the acupuncture group and 6.99 in the control group. Following treatment, these scores fell to 1.32 and 2.96 respectively. At the 3-month follow-up, they had risen to 2.97 and 3.98. Although both groups experienced significant improvements in pain scores, improvements were significantly greater in the acupuncture group (p<0.05).
Serum levels of the biomarkers GSH-Px, SOD, and MDA were also assessed before and after treatment. GSH-Px and SOD are enzymes with antioxidant properties, while MDA is a marker of oxidative stress.
Mean pretreatment levels of GSH-Px were 67.34 U/L in the acupuncture group and 67.40 U/L in the control group. Following treatment, these scores increased to 80.50 U/L and 77.70 U/L respectively. They fell to 76.98 U/L and 69.00 U/L at the three-month follow-up.
Mean pretreatment levels of MDA were 5.57 µmol/L in the acupuncture group and 5.66 µmol/L in the control group. Following treatment, these scores fell to 3.55 µmol/L and 3.94 µmol/L respectively. They increased to 4.88 µmol/L and 4.29 µmol/L at the three-month follow-up. Although both groups experienced improvements across all biomarkers, improvements were significantly greater in the acupuncture group (p<0.05).
Total effective rates were calculated for each group according to TCM syndrome scores. Patients with a ≥95% improvement in symptoms were classed as recovered. Treatment was classed as markedly effective for patients with a 70–90% improvement in symptoms, effective for patients with a 30–70% improvement in symptoms, and ineffective for patients with a ≤30% improvement in symptoms. Recovered, markedly effective, and effective scores were added together to calculate the total effective rate.
There were 12 recovered, 13 markedly effective, 6 effective, and 3 ineffective cases in the acupuncture group, giving a total effective rate of 31/34 (91.2%). There were 8 recovered, 7 markedly effective, 11 effective, and 8 ineffective cases in the control group, giving a total effective rate of 26/34 (76.5%).
At the 3-month follow-up, there were 9 recovered, 14 markedly effective, 7 effective, and 4 ineffective cases in the acupuncture group with a total effective rate of 30/34 (88.3%). There were 5 recovered, 8 markedly effective, 11 effective, and 10 ineffective cases in the control group with a total effective rate of 30/34 24/34 (70.6%).
The results indicate that acupuncture effectively relieves pain and improves biomarkers for rheumatoid arthritis patients, and is more effective than conventional, pharmacological treatment.
Reference:
1. Zhang Fengfan, Yuan Bo, Tian Liang, Wang Yixin, Qiao Xiang, Zhang Tingzhuo, Li Xinglan, Wang Jinhai, Tian Jiexiang, Du Xiaozheng (2019) “Clinical Efficacy of Hot Needling Acupuncture for Rheumatoid Arthritis and Its Effects on Oxidative Stress” Chinese Journal of Information on TCM Vol. 26 (2) pp. 26-30.