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Explore This IssueSeptember 2013
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Pain and functional impairment are hallmarks of rheumatoid arthritis (RA). Given the complexity and cost of the therapeutic armamentarium used in RA, nonpharmacological therapies are becoming increasingly attractive. Recently, complementary and alternative medicine therapies for arthritis have been heavily advertised with broad, attractive claims. Clinical trials and observational studies have provided encouraging evidence that acupuncture, mind–body therapy, and Tibetan medicine have some benefits for patients with RA. This overview synthesizes the current body of knowledge on the therapeutic benefits of several types of complementary and alternative medicine approaches to relieving pain and other symptoms of RA to better inform clinical decision making for our patients.
In the past two decades, the literature has consistently recognized the potential therapeutic benefits of Tai Chi mind–body exercise for chronic conditions.
Acupuncture for RA
Originating in China more than 3,000 years ago, acupuncture is one of the most popular sensory stimulation therapies. It is an ancient technique of inserting and manipulating fine needles to stimulate specific anatomic points, also known as acupuncture points or meridian points. Acupuncture is often used for the treatment of conditions associated with pain relief and is supported by evidence of biological mechanisms. Although a recent systematic review of two trials of acupuncture on measures of disease activity in RA reported that acupuncture had no effect, another narrative review including 63 Chinese studies concluded that acupuncture was helpful in treating RA. Since many prior studies have methodological concerns that limit their interpretation, my colleagues and I performed an updated review of all currently available data to determine the efficacy of acupuncture for pain relief in patients with RA.
A comprehensive search of 10 Western and Chinese databases and reference lists was performed, and included all clinical trials with pain as an endpoint measured by tender joint count (TJC) or a pain scale. Eight studies—four placebo-controlled and four active-controlled trials—with a total of 536 patients met eligibility criteria. Average study duration was 11 weeks. The mean (standard deviation [SD]) number of acupuncture points and sessions were 11 (8) and 42 (62), respectively. Average duration of needle insertion was 24 minutes. Collectively, seven studies reported a decrease in pain for patients who received acupuncture compared with controls, and five showed a statistically significant improvement in treated patients.1-5 Compared with controls, the mean or median changes of acupuncture-decreased TJC pain ranged from 1.5 to 6.5. In addition, patients in four studies reported a significant reduction in morning stiffness (mean change –29 minutes), but the difference was not significant compared with controls.3-6 With regard to inflammatory markers, five studies observed a reduction in patients’ erythrocyte sedimentation rate (ESR) (mean –3.9 mm/hour), and three noted a reduction in patients’ levels of the C-reactive protein (CRP) (mean –2.9 mg/dl); but only one study showed a significant difference for both ESR and CRP.1-5