Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
Rheumatoid Arthritis is a chronic inflammatory disorder, primarily affecting the joints in the body. It can have a pattern of relapses and remissions, and pain and inflammation are some of the primary symptoms that patients are looking to address.
About the research: It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. Below we have a selection of the available research, which does include some larger RCTs, and reviews of the literature alongside smaller studies. The n= figure tells you how many people were participants in the study.
The British Acupuncture Council (BAcC) reviewed eight research papers on Rheumatoid Arthritis and acupuncture in their review paper. They conclude that the quality of the evidence has improved over the years since the earlier of the papers, and that the more recent papers such as MacPherson and Blackwell (1994) tend to support acupuncture for pain relief and control of inflammation, although with caveats as to the quality of some of the trials reviewed, further trials are warranted to corroborate this.
Mechanisms of Action:
A review article (Kavoussi & Ross, 2007) suggests that the anti-inflammatory actions that have been demonstrated to be brought about by acupuncture may be mediated via activation of the vagus nerve, alongside deactivation of inflammatory macrophages and other proinflammatory cytokines. The researchers concluded that “The use of acupuncture as an adjunct therapy to conventional medical treatment for a number of chronic inflammatory and autoimmune diseases seems plausible and should be validated by confirming its cholinergicity”.
Other studies (Zijlstra et al, 2003) have revealed that acupuncture some of the pain modulating and anti-inflammatory effects seen in acupuncture trials may be due to the fact that it has been shown to stimulate certain substances in the body which act as vasodilators, neurotransmitters and painkillers (beta-endorphins, CGRP and substance P) and further stimulate cytokines and nitric oxide, all of which play roles in inflammatory states.
Acupuncture has also been shown in human research trials, to downregulate the areas of the brain associated with sensitivity to pain and stress, which may also contribute to its contribution to addressing pain issues (Hui et al, 2010).
Electroacupuncture has been shown to alleviate symptomatic knee pain in rheumatoid arthritis (Casimiro et al 2005; Cochrane review).
Specifically acupuncture in an animal model has also demonstrated improvement in inflamed synovium which is characteristic of Rheumatoid Arthritis (He et al, 2010),
British Acupuncture Council evidence based factsheet about Rheumatoid Arthritis including specific research, trials and mechanisms of action for acupuncture in this condition.
In addition, there is also a BACC review paper on the evidence for effectiveness of acupuncture in arthritis (including a section on Rheumatoid Arthritis), which is aimed at medical professionals.
Casimiro, L., Barnsley, L., Brosseau, L., Milne, S., Welch, V., Tugwell, P. and Wells, G.A., 2005. Acupuncture and electroacupuncture for the treatment of rheumatoid arthritis. Cochrane Database of Systematic Reviews, (4).
Kavoussi B, Ross BE. The neuroimmune basis of anti-inflammatory acupuncture. Integr Cancer Ther 2007; 6: 251-7.
He, T.F., Zhang, S.H., Li, L.B., Yang, W.J., Zhu, J. and Chen, Y.F., 2010. Effects of acupuncture on the number and degranulation ratio of mast cells and expression of tryptase in synovium of rats with adjuvant arthritis. Zhong xi yi jie he xue bao= Journal of Chinese integrative medicine, 8(7), pp.670-677.
Hui, K.K., Marina, O., Liu, J., Rosen, B.R. and Kwong, K.K., 2010. Acupuncture, the limbic system, and the anticorrelated networks of the brain. Autonomic Neuroscience, 157(1-2), pp.81-90.
MacPherson H, Blackwell R, 1994. Rheumatoid Arthritis and Chinese Medicine: a Review.
European J of Oriental Medicine 1(3) 17-29
Zijlstra, F.J., van den Berg-de Lange, I., Huygen, F.J. and Klein, J., 2003. Anti-inflammatory actions of acupuncture. Mediators of inflammation, 12(2), pp.59-69.