Rheumatoid Acupuncture

Rheumatoid arthritis (RA) is the most common chronic inflammatory joint disease. It is classified as an autoimmune disorder, which is a condition that occurs when the immune system mistakenly attacks and destroys healthy body tissue. I find it fascinating that our immune system, which protects us from so many pathogens on a day to day basis, would attack itself. Essentially what happens is that our body designates one of its own cells as a foreign cell. How could this happen? Throughout our lifetime, and even before we are born, we accumulate environmental toxins, hormone disruptors, and other agents that have become part of what it means to live in a modern society. It is practically unavoidable. With all these components of non-self that are now integrated into our bodies, it is understandable why the body would be confused! These toxins don’t belong there but have become part of our inner landscape none the less. Thus, when managing cases of rheumatoid arthritis, we not only need to regulate pain levels, but we need to support the proper functioning of the immune system and try to uncover what has caused it to wage war on our own tissues.
It is believed that the tendency to develop rheumatoid arthritis may be genetically inherited. It is also believed that certain infections caused by bacteria, fungi, or viruses (i.e. Epstein–Barr virus, parvovirus and bacteria such as Proteus and Mycoplasma) or environmental factors may trigger the activation of the immune system in susceptible individuals. Other risk factors include smoking, obesity, and in women, an adverse pregnancy outcome or never having children. It is more prevalent in female populations, which suggests a hormonal component. Factors supporting this hypothesis include the observed protective effect of the oral contraceptive pill, the increased risk in women who are nulliparous (never having given birth to a child), and the increased susceptibility to disease during the first three months postpartum. More research is needed on the role of hormones and genetics, but some of the risk factors for developing RA are preventable with proper health education and good choices.

Rheumatoid arthritis is characterized by inflammation of the same joints on both sides of the body, which results in progressive destruction of the joints and surrounding tissues.  Often symptoms appear suddenly, and include tenderness and stiffness in the joints, early afternoon fatigue, low-grade fever, deformities and rheumatoid nodules.

Western medicine approaches treatment with rest and passive exercise until the inflammation is controlled. There are numerous pharmacological interventions. NSAIDs are generally the first option. Gold sodium thiomalate and penicillamine are used to block the inflammatory process. Hydroxychloropuine is an antimalarial medication that blocks inflammation by an unknown mechanism. Sulfasalazine blocks the activity of certain enzymes that release inflammatory compounds. Corticosterioids have dramatic short-term relief, but their benefit diminishes over time and they do not prevent the progressive destruction of the joints (see Acupuncture versus Cortisone Injection for the Treatment of Pain).
From a more natural perspective, it is important to take the diet into consideration, as there may be food allergies. Food allergies can cause inflammation in the gut which allows food particles to pass through the intestinal lining and into the blood stream, where they can travel all over the body and cause more inflammation. Vegetables in the nightshade family, including potatoes, peppers, and eggplant, are inflammatory and should be avoided. Plant and fish oils that are high in omega-3 fatty acids help control inflammation, as do carotenoids, which give fruits and vegetables their color.
Acupuncture has received wide spread attention for its ability to decrease pain. In fact, the proportion of chronic pain relieved by acupuncture is generally in the range of 55-85%. This compares favorably with that of potent drugs, such as morphine, which helps in 70% of cases, and far outweighs the placebo effect, which is demonstrated in about 30-35% of cases. (WHO; Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials) However, since its therapeutic actions are achieved by mobilizing the patients’ own potential for healing, acupuncture does not produce adverse effects like many drug therapies. Instead, it is believed that acupuncture decreases pain by increasing endorphin levels, which block pain. This makes it an excellent treatment option, especially in chronic conditions, because most people do not want to take a pill for the rest of their life. In addition, drug interactions are potent causes of illness in our modern society, so keeping the number of medications to a minimum is a high priority.
Rheumatoid arthritis is referred to as Bi (Bee) Syndrome in Chinese Medicine. Most pain conditions fall into this syndrome, including osteoarthritis, rheumatic fever, gout and sciatica. ‘Bi’ means obstruction or blockage. Bi syndrome describes a set of syndromes in which the invasion of external pathogens such as Wind, Cold, Damp, and Heat obstruct the flow of energy and blood in the body. This affects the tendons, bones, muscles and joints, presenting symptoms of pain, soreness, heaviness, numbness, limited range of motion, redness or swelling. Depending on the symptom presentation, Bi syndrome will be classified as heat, cold, wind, or damp dominant. In heat dominant Bi, there will be more redness and burning. Cold dominant will present with limited range of motion with severe fixed pain that is alleviated by warmth. Wind dominant is primarily in the upper half of the body and presents with fairly mild pain that changes location. Damp dominant pain will usually feel heavy and swollen. Each of these will be aggravated by their respective environmental condition. For example, arthritis that is worse in the cold months is usually a Cold dominant Bi.
Acupuncture points, modalities, and Chinese herbs will be selected depending on which syndrome type predominates. If the diagnosis is Cold dominate Bi, moxibustion is an excellent choice. Moxibustion involves burning Mugwort, Artemisia Vulgaris, either directly on the skin or indirectly over acupuncture points.  Doing so decreases inflammation by increasing white blood cell count in the area. Research by Xiao et al. (1992) has shown that moxibustion increases interleukin-2, an immune modulator, which in turn stimulates the proper functioning of the immune system. Thus, not only does acupuncture and moxibustion decrease pain, but they also treat the root cause of the pain, which in the case of RA, is a dysfunction of the immune system. Another study by Li et al. (2006) demonstrated a significant difference between a control group using methotrexate and NSAIDs to treat RA and a treatment group using the same protocol as the control group plus acupuncture and moxibustion. The effectiveness in the treatment group was 60% higher than the control group with less side effects. Thus, attempting to decrease the inflammation and subsequent pain by using natural methods before heading to pharmaceutical intervention is an excellent option.
In conclusion, the use of acupuncture and Chinese medicine is a viable option for people suffering from rheumatoid arthritis. Supporting the proper functioning of the immune system while decreasing inflammation will produce more lasting results than simply masking the pain with NSAIDs. In addition, a thorough health history and dietary education may provide insight for the patient on how their actions contribute to their health and vitality, thereby giving them the power to take their healing into their own hands.