Poking needles under your skin doesn’t exactly sound soothing, but some people swear by the use of acupuncture for their rheumatoid arthritis (RA). Such anecdotal evidence suggests this therapy might be effective in relieving RA discomfort. Yet with few good-quality studies available, proving acupuncture’s safety and benefit has been a challenge.
Many reviews of studies done so far have not found a statistically significant benefit on pain, swollen joints or other measures of disease when compared to a control treatment. Many of the studies that did find positive outcomes weren’t well conducted. Yet there has been enough potential noted for this therapy that researchers say it warrants further study.
Acupuncture’s Effect on Inflammatory Markers
Acupuncture involves inserting tiny needles into a person’s skin. A version known as electro-acupuncture adds a mild electric current. The needles are inserted at some of the 2,000 mapped points along what are called meridians or channels.In Chinese terms, acupuncture restores the optimal flow of energy – called Qi (pronounced chee) – in the body.
In a 2011 Chinese study looking at electro-acupuncture and traditional acupuncture, both significantly lowered tumor necrosis factor-α (TNF-α) and vascular endothelial growth factor (VEGF). “Both TNF-α and VEGF are associated with chronic inflammation,” explains Nathan Wei, MD, director of the arthritis treatment center in Frederick, Md. “In particular, TNF-α appears to play a pivotal role in the chronic inflammation and joint destruction that characterizes RA. That’s why so many of the biologic medications target TNF-α.”
In a 2008 Arthritis & Rheumatism review of eight acupuncture studies involving a total of 536 patients with RA, five studies reported a reduction in erythrocyte sedimentation rate (ESR), three saw a reduction in C-reactive protein (CRP), and one study described a significant drop in both. Both ESR and CRP are markers of inflammation in the body. Several of the studies also reported decreased pain and a reduction in morning stiffness.
How acupuncture affects inflammatory markers like TNF-α is unknown. “No one has figured out one single mechanism for acupuncture’s effects,” says Jeffrey I. Gold, PhD, director of the pediatric pain management clinic at Children’s Hospital in Los Angeles.
Gold explains that MRI studies show that acupuncture sites specifically induce responses in various portions of the brain. Acupuncture can possibly effect any organ or system: immunological, neurological, hormonal and psychological. “It doesn’t only block pain signals,” he says.
Experts do know that acupuncture relieves pain by stimulating the release of endorphins, the body’s own natural painkillers, says Jamie Starkey, lead acupuncturist for the Tanya I. Edwards, MD Center for Integrative and Lifestyle Medicine at Cleveland Clinic. “We’re activating the peripheral nervous system, which then activates the central nervous system, so that the brain begins to release endorphins.” Acupuncture may relieve pain locally, she says, by not only releasing neurotransmitters, but also by having an anti-inflammatory effect. “How exactly it happens, we are still researching.”
Taking the Acupuncture Route
“The more studies that come in showing the drop in inflammatory markers through acupuncture treatments, the more rheumatologists will take note,” says Starkey. In a 2010 Mayo Clinic survey, 54% of rheumatologists said they would recommend acupuncture as an adjunct treatment.
Here are some things to consider if you’re thinking of jumping on the acupuncture bandwagon:
“Find an acupuncturist who comes highly recommended by your rheumatologist or physician, family friends, and colleagues so you know firsthand what their experience was like,” says Starkey. If you don’t know anyone to ask, search The National Certification Commission for Acupuncture website for a certified clinician in your area.
Acupuncturists have to be licensed by their state medical board, so you can check there as well. “Ideally, try to find someone who has experience working with RA patients,” says Starkey.
Know What’s Covered
Some insurance companies cover acupuncture for certain diagnoses, but others do not. Prices for acupuncture vary, depending on your area and can run $75 to $200 per treatment.
Expect Several Treatments
“We tend to see substantial results within three to six treatments,” says Dr. Gold. But each patient responds differently and treatments vary depending on the stage of the disease.
Understand the Limit
Acupuncture doesn’t work on everyone, says Starkey. “In my clinical work, we see a 20% non-response rate.” But,acupuncture has many styles and practitioners. “If it doesn’t work right away, don’t dismiss the whole field of acupuncture,” says Dr. Gold. “Try a different style.”