Evaluating the effectiveness of different types of acupuncture therapies in the treatment of rheumatoid arthritis.

This analysis compared the effectiveness of different acupuncture therapies combined with disease-modifying anti-rheumatic drugs (DMARDs) in the treatment of rheumatoid arthritis (RA). The data indicated that RA disease activity was most improved by combining electro-acupuncture and DMARDs while fire-needle or moxibustion plus DMARDs were most effective at improving pain and reducing inflammation.

RA is a chronic, inflammatory disease that affects multiple joints. This leads to pain, swelling, stiffness, joint deformities, and reduced mobility. RA is managed with steroidal and non-steroidal anti-inflammatory drugs and DMARDs. However, some patients can have unwanted side effects or become resistant to the effects of these medications.

Acupuncture is a type of alternative therapy that has been combined with DMARDs to treat RA. Previous studies indicated that a combined approach is better than DMARDs alone. There are many types of acupuncture.

Conventional acupuncture uses activated, solid, metallic needles to penetrate the skin. Warm needle acupuncture uses “moxa” cones made of dried plant material placed onto the handles of inserted needles. Electro-acupuncture uses a mild electric current that is passed between pairs of acupuncture needles. Fire-needle acupuncture uses heat to make acupuncture needles red-hot before insertion into body points. Moxibustion uses heated “moxa” placed on selected body points. The embedding of catgut sutures in acupuncture points instead of needles is called acupuncture embedding. Auricular acupoints involve ear acupuncture.

Direct comparisons of acupuncture techniques to determine the best combinations with DMARDs in patients with RA need to be investigated.

This analysis included 32 studies with 2,115 patients with RA. Studies reported on combinations with DMARDs such as moxibustion, conventional acupuncture, electro-acupuncture, acupoint embedding, fire needle, warm needle, auricular acupoints, or DMARDs alone. Studies were analyzed to determine the best combinations to improve RA disease activity (DAS 28 score), pain (VAS score), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) (inflammatory markers), and rheumatoid factor (RF).

Electro-acupuncture with DMARDs was shown to be most effective at improving the DAS 28 score. Fire needle with DMARDs resulted in the most effective improvement of the VAS score and reduced CRP and ESR most effectively. RF was most effectively reduced with moxibustion combined with DMARDs.

The study showed that electro-acupuncture combined with DMARDs was best for improving the DAS 28 score, and fire needle or moxibustion with DMARDs most effectively improved pain and inflammation.

The studies analyzed had small sample sizes and variations in the types and dosages of DMARDs used. This might have influenced the accuracy of the results. Some acupuncture therapies were not examined in this analysis.

Discuss with your doctor if acupuncture techniques can be used in your situation. Acupuncture should only be done by a certified practitioner, under the advice of your physician.