EFFICACY OF ACUPUNCTURE ON PAIN RELIEF IN PATIENTS WITH RHEUMATOID ARTHRITIS
EFFICACY OF ACUPUNCTURE ON PAIN RELIEF IN PATIENTS WITH RHEUMATOID ARTHRITIS

Summary/Abstract: Rheumatoid arthritis is probably the most universal of all diseases affecting practically everyone at some time or another of one's life in all parts of the globe. It has been known as a chronic and autoimmune disease characterized with symmetrical and persistent synovitis and destructive polyarthritis. The treatment of RA has always been a challenge. The mainstream of the management regarding RA is the use of nonsteroid anti-inflammatory drugs, antirheumatic drugs and biological agents. But the concerns may arise when taking accompanying side effects and toxicity into consideration. Given the fact of the expanding awareness of unwanted side effects of pharmaceutical treatment, there has been an increased utilization of acupuncture as a contemporary healthcare option which has been reported as a kind of safe management.According to traditional Chinese medicine, Rheumatoid arthritis belongs to the Painful Obstruction Syndrome, also called "Bi", which evokes the idea of "obstruction". In Chinese medicine it means pain, soreness or numbness of muscles, tendons and joints due to obstruction in the circulation of Qi and Blood in the channels caused by invasion of exterior Wind, Cold or Dampness.The invasion of external climatic factors is due to a pre-existing and temporary deficiency of the body's Qi and Blood which allows the Wind, Cold and Dampness to penetrate.There are five main types according to causative factor:1. Wind Painful Obstruction Syndrome: pain moving from joint to joint2. Damp Painful Obstruction Syndrome: fixed pain with soreness, heaviness, numbness and swelling of the joints3. Cold Painful Obstruction Syndrome: severe pain in one joint4. Heat Painful Obstruction Syndrome: very severe pain, hot-red-swollen joints5. Bony Painful Obstruction Syndrome: painful joints with swelling and bone deformities.Treatment: The aim of the treatment is simply to expel the pathogenic factors which have invaded the channels, and eliminate the resulting local stagnation of Qi and Blood in the channels.Acupuncture treatment: In general, the treatment is based on the choice of points from four possible groups:1. distal points; 2. local points (including Ah Shi points); 3. adjacent points; 4. points according to pattern; 5. general points. The aim of this study is to systematically review the efficacy of acupuncture on pain relief in patients with rheumatoid arthritis (RA). Methods of research: To answer the question of efficacy of acupuncture on pain relief in patients with RA, we used western and Chinese databases (PubMed, EMBASE, Cochrane, AMED, MEDLINE, CNKI (China National Knowledge Infrastructure) of systematic reviews, by screening multiple information sources, to identify systematic reviews and their included primary studies. Results: We extracted data from the identified reviews and reanalyzed data from primary studies included in those reviews: Alexis Ramos, José Domínguez, Soledad Gutiérrez (2018) used Epistemonikos, the largest database of systematic reviews in health. They found seven systematic reviews that included twenty primary studies, of which all were randomized trials. However, this table and the summary in general are based on only two randomized trials that answer the question posed. Both trials evaluated traditional Chinese acupuncture and analgesia intervention. The trials evaluated multiple outcomes, which were grouped by the systematic reviews as follows: Wang C, de Pablo P, Chen X, Schmid C, McAlindon T. (2008), performed a comprehensive search of 12 western and Chinese databases and reference lists. They included randomized controlled trials with pain as an end point, measured by tender joint count (TJC) or a pain scale. They also reviewed the effect of acupuncture on morning stiffness and joint mobility. Study quality was assessed by Jadad score. Differences between treatment groups were pooled as mean or median change (P value). Pei-Chi Chou1 and Heng-Yi Chu2 searched the PubMed, EMBASE, Cochrane, AMED (Allied and Complementary Medicine), NCCAM (The National Center for Complementary and Alternative Medicine), and CNKI (China National Knowledge Infrastructure) databases to identify relevant monographs and related references from 1974 to 2018. Chinese journals and theses/dissertations were hand searched. 43 studies were recruited. Each research was analyzed for study design, subject characteristics, intervention, selected acupoints, assessment parameters, proposed mechanisms, and results/conclusions.Discussion: Western medicine doesn‘t recognize the concepts of qi and meridians. However, scientific evidence suggests alternate explanations for why acupuncture might provide pain relief. Research offers limited, but in some cases promising, evidence that acupuncture can help with arthritis symptoms. There‘s a lot of research that says when we put an acupuncture needle into the body, a number of physiological mechanisms occurs. A well-placed needle sets off a cascade of events, producing a signal that travels along the spinal cord to the brain, triggering a release of neurotransmitters called endorphins and enkephalins, which scientists believe reduce the sensation of pain. Research also shows that inserting an acupuncture needle induces the production of cortisol, a hormone that helps control inflammation. Acupuncture may stimulate activity of other pain-relieving chemicals in the body as well.Conclusion: Even though patients offer anecdotal evidence that acupuncture has helped them, some studies have found acupuncture offers minimal pain and stiffness relief for osteoarthritis (OA). A 2018 Cochrane review of six studies evaluating acupuncture for hip OA concluded acupuncture probably has little or no effect in reducing pain or improving function compared to sham acupuncture in people with hip osteoarthritis. On the other hand, a much larger number of studies concluded that acupuncture alone or combined with other treatment modalities is beneficial to the clinical conditions of RA and can improve function and quality of life, and is worth trying. The review cites several possible ways acupuncture effects RA, including its anti-inflammatory effect, antioxidative effect and regulation of immune system function. However, the review acknowledges that there is still inconsistency among trial findings and that further research is needed to evaluate the effects of acupuncture and how it works.

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