Rheumatoid Arthritis Treatment With Acupuncture
This blog post continues describing research studies showing how acupuncture treatment benefits rheumatoid arthritis. Edited and produced by the Acupuncture Research Resource Centre, Published by the British Acupuncture Council, June 1998.
A total of eight papers are reviewed in this section, three overview papers and five trial papers.
Review of Overview articles
Given that rheumatoid arthritis is a more complex disorder than osteoarthritis it can be expected that treatment and demonstration of effectiveness are more difficult. The three overview articles on rheumatoid arthritis (Table 2) confirm this. In 1985 Bhatt-Sanders concluded that, in view of the lack of high quality trials, acupuncture is not a treatment for rheumatoid arthritis, and this was probably the mainstream view in the UK for many years. However opinions may be changing.
Kenyon (1995) suggests that acupuncture can help with pain relief. MacPherson and Blackwell (1994) include evidence from China (albeit with considerable caveats) that support acupuncture for both pain relief and control of inflammation. This paper is extremely helpful in that it gives a treatment strategy for rheumatoid arthritis based on Chinese experience.
Review of Trials
Man and Baragar (1974), the single study undertaken in the West, gives impressive results, namely pain relief sustained over 2-3 months from one local treatment. They recorded no anti-inflammatory effect from the treatment. Surprisingly, in view of the results of the osteoarthritis studies, sham acupuncture gave only small and transient relief. This in spite of the fact that the sham acupuncture sites (above, in the middle of, and below the patella) would now be considered by some to be real acupuncture points.
All four remaining uncontrolled outcome studies are from China and specifically address the question of immune response along with ‘improvement’. Luo (1987) treated 65 patients with moxa and claims, along with an overall success rate of 86%, that ESR(see note) levels fell and negative rheumatoid factor (RF) increased. Wang (1993), reports on 650 patients given long term TCM treatment for rheumatoid arthritis and describes a range of positive symptomatic changes. He also reports significant reductions in ESR and RF levels. As with many such reports the methodology is unclear but he mentions that acupuncture is given in combination with (unspecified) drug administration. Obviously this makes accurate interpretation of results impossible.
Liu (1993) attributes changes in immune function of his 34 patients to the acupuncture treatment. All patients improved and his findings reflect those of the earlier authors in relation to RF and ESR. Guan (1995) focused upon measuring immunoglobulin (Ig) antibody levels in his small study and describes a statistically significant change after a course of 15 acupuncture treatments. He also confirmed others’ findings of positive changes in ESR and RF.
These are factors objectively recorded through serum tests and hence are significantly different from most results recorded in studies from China. However rheumatoid arthritis is a disease characterised by periodic flare-ups and without more explanation of how immune system parameters might be expected to vary in such patients, and in particular in the trial patients, these data must be considered as interesting and worthy of further research rather than categorical proof.
It is common for Chinese research relating to the treatment of Western disease categories with acupuncture to claim success rates of well over 80% with little or no information being provided on outcome measures. However in this review the Chinese evidence includes changes in immunological function as well as pain alleviation and the numbers of patients involved in studies make them difficult to ignore, especially in disorders where conventional treatment is limited.
Methodologically there are shortcomings from the point of view of what is scientifically acceptable, clearly, for example, one would need to have a far greater understanding of how the reported trials were carried out and assessed. However, they are more likely than many Western trials to use treatment protocols acceptable to practising acupuncturists, for example Man & Baragar (1974) gave one treatment at 3 points, whereas Liu (1993) gave 30 daily treatments on 22 points. If there is a mechanism whereby acupuncture can bring about an immune response it is hardly surprising that the Chinese treatments find the effect and the more limited Western studies do not.
Acupuncture has been shown to give some pain relief in rheumatoid arthritis and an anti-inflammatory response may also be present. Treatment early in the disease is preferable but age and duration of the disease should not be seen as barriers to treatment The research to date is limited and better trials, incorporating a diagnosis based on TCM differentiation along with pain scales and immune function measurements are advisable.
Acknowledgements are due to Leon Saunders, Alison Gould and Hugh MacPherson for
their work in preparing this briefing paper.
CLICK HERE to watch a short video describing how we treat arthritis at Acupuncture Associates of Denver.