Rheumatoid arthritis is a chronic condition that can cause pain, stiffness, progressive joint destruction and deformity, and reduce physical function, quality of life and life expectancy. The condition involves synovial joint inflammation.(Smolen 2003); both T- and B-cells are implicated in the underlying immune pathology, as is the over-production of pro-inflammatory cytokines, including tumour necrosis factor alpha (TNF-?), interleukin-1 (IL-1) and IL-6.(NICE 2008; Panayi 2005; Smolen 2003)
The course of rheumatoid arthritis is variable, following a pattern of relapses and remissions.(Masi 1983) However, within about 2 years of diagnosis, patients usually have moderate disability and, after 10 years, around 30% are severely disabled (NICE 2008).
The cause of rheumatoid arthritis is, as yet, unknown. Infection with a micro-organism in those genetically susceptible, hormonal influences, obesity, diet, and cigarette smoking have all been implicated as risk factors.(Silman 2004)
The aim of treatment is to control pain and inflammation, reduce joint damage, disability and loss of function, achieve low disease activity or remission, and improve quality of life.(NICE 2008; Smolen 2007). A variety of drugs are used, including NSAIDs, analgesics, corticosteroids, disease-modifying anti-rheumatic drugs (DMARDs) like methotrexate, and ‘biologic’ drugs that block tumour necrosis factor-alpha (TNF) such as etanercept, infliximab or adalimumab.(NICE 2008) None-drug treatments such as physiotherapy may also be used.(NICE 2008).
In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body’s homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress (Hui 2010) It has also be shown to reduce inflammation, by promoting release of vascular and immunomodulatory factors.(Zijlstra 2003; Kavoussi 2007) Acupuncture treatment may help to relieve pain and improve function in patients with rheumatoid arthritis by:
decreasing the proinflammatory cytokines IL-1 and IL-6 and increasing the inhibitory cytokines IL-4 and IL-10 (Ouyang 2010);
inducing vasoactive intestinal peptide expression, an anti-inflammatory neuro-peptide (He 2011);
inhibiting the function of synovial mast cells (which are substantially involved in the initiation of inflammatory arthritis) (He 2010);
upregulating plasma adrenocorticotropic hormone, downregulating serum cortisol levels and synovial nuclear factor-kappa B p 65 immunoactivity, and restoring the hypothalamus-pituitary-adrenal axis (HPAA).(Gao 2010);
stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz 1987; Han 2004; Zhao 2008; Cheng 2009);
increasing local microcirculation (Komori 2009), which aids dispersal of swelling.