Acupuncture for Arthritis & Joints

Introduction

This is an introduction to acupuncture for joint problems, including osteoarthritis, rheumatoid arthritis, general stiffness, and rheumatic aches and pains.

Acupuncture in Exeter for arthritis: treatment of osteoarthritis of the knees

In 2013, Arthritis Research UK reported on the evidence for the effectiveness of twenty-five complementary therapies for musculoskeletal pain. Acupuncture was the most effective therapy for treating osteoarthritis. A large review funded by the National Institute for Health & Care Research in 2017, showed that acupuncture is better than standard care for osteoarthritis knee pain, and outperforms exercise and weight loss interventions. Acupuncture has been recommended for osteoarthritis of the knee in Germany, Scotland and America (1-3).

Arthritis and related conditions, are the most common long-term complaint in the UK. They affect more than nine million adults. In the 35 to 44 age group, 18% of people have experienced arthritis or joint pain. This rises to 49% in the 55 to 64 age group. Acupuncture has been found to be very effective in helping sufferers manage the condition. It can help with pain relief without the side-effects associated with drugs. It can also help stiffness and improve range of movement.

Osteoarthritis

Beginning with osteoarthritis, you might already have had a diagnosis from your GP, or an X-ray of the affected joint. I find osteoarthritis is usually responsive to acupuncture. Because it is a degenerative condition, the sooner you start treatment, the better the results tend to be. Acupuncture is unable to reverse significant joint damage which has already occurred.

Realistic objectives are to reduce pain, reduce your intake of painkillers and anti-inflammatories, and to slow further deterioration of the joint. Knees, hips and fingers present for treatment most commonly.

Rheumatoid arthritis

Moving to rheumatoid arthritis, patients I see are usually under the regular care of either their rheumatologist or GP. Acupuncture can work effectively alongside any medication which has been prescribed. Because a systemic disease process is at work here, there is a greater need to treat the underlying imbalances which Chinese medicine is capable of identifying, as well as attending to the most painful joints.

Other Joint Problems

Finally, we have general stiffness problems, conditions like reactive arthritis, and those rheumatic aches which might have defied clear diagnosis. Sometimes, the symptoms are focal at the site of an old injury. Other times, they are more widespread, and so we bear in mind possibilities such as the pains being menopausal, induced as side-effects of medication, or arising from other diseases. I need to fully examine the surrounding area and find out about your lifestyle. I will ask you about the influence of the weather on your joints. If it is a factor, patients are most likely to report damp, cold or sudden weather changes affect them.

Diet and lifestyle can be crucial when helping joint problems, and I will often give you some self-help measures to implement. These will usually be simple but effective. We might for example discuss a tilt towards the Mediterranean diet as a means of combating inflammation. Your gut microbiome is also often worth looking at.

Below you can read the results of some of the research which has been undertaken into acupuncture for joint problems. The trials vary in quality, but systematic reviews and randomised controlled trials are generally considered to provide the highest quality evidence. If you would like to read more about evidence quality, I would refer you to the British Acupuncture Council’s description of the evidence pyramid.

(1) GBA. Zusammenfassender Bericht des Unterausschusses “Ärztliche Behandlung” des Gemeinsamen Bundesausschusses über die Bewertung gemäߧ135 Abs.1 SGB V der Körperakupunktur mit Nadeln ohne elektrische Stimulation bei chronischen Kopfschmerzen chronischen LWS-Schmerzen chronischen Schmerzen bei Osteoarthritis: Gemeinsamer Bundesausschuss Akupunktur, 2007.

(2) SIGN. Management of chronic pain SIGN 136. A national clinical guideline: Scottish Intercollegiate Guidelines Network, 2019.

(3) Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care & Research, 2020.

Acupuncture for Joint Pain in Breast Cancer Treatment

American research: Acupuncture for joint pain in breast cancer treatment. A team of American researchers lead by Columbia University Irving Medical Center, has shown acupuncture to have long-term benefits for joint pain in breast cancer treatment with aromatase inhibitor (AI) drugs. The drugs, such as anastrozole, letrozole, and exemestane, are prescribed for hormone-sensitive tumours, but joint pain and stiffness contribute to more than 50% of patients reducing or stopping their medication.

A group of 226 women with early stage hormone-sensitive breast cancer, and joint pain from taking AI medication, were randomised to true acupuncture, sham acupuncture or to waiting list control. Treatment was given across eleven academic and community sites. Acupuncture was given twice per week for 6 weeks then once per week for 6 further weeks. True acupuncture was partially individualised, and sham acupuncture consisted of needling at non-acupoints.

One year from the start of treatment, statistically significant improvements in pain scores were seen for the true acupuncture group compared with the other two groups. The researchers conclude that this study highlights the durability of the acupuncture response through one year, as well as the importance of having both sham and waiting list groups to fully evaluate the effect of the acupuncture intervention.

(Comparison of Acupuncture vs Sham Acupuncture or Waiting List Control in the Treatment of Aromatase Inhibitor-Related Joint Pain: A Randomized Clinical Trial. Journal of the American Medical Association Network Open, 11 November 2022.)

Acupuncture, Herbs & Qigong for Knee Osteoarthritis

In a Chinese study, a programme of acupuncture, herbs and qigong for knee osteoarthritis, outperformed conventional pain management interventions. A total of 722 patients recruited from 38 community clinics, were randomly allocated to one of two treatment arms. In the first, health education was combined with a programme of acupuncture, herbal washes and qigong exercises. Acupuncture was given three times a week for four weeks. In the second treatment arm, conventional rehabilitation therapy was administered, including physical therapy, joint movement training and muscle strength training.

A total of 696 patients completed the programmes. At all five time points, the acupuncture treatment group demonstrated significantly better outcomes than the conventional rehabilitation group, including for pain, lower limb muscle strength, knee swelling and quality of life measures.

(Chinese Medicine Involving Triple Rehabilitation Therapy for Knee Osteoarthritis in 696 Outpatients: A Multi-Center, Randomized Controlled Trial. Chinese Journal of Integrated Medicine, October 2021.)

Acupuncture Improves Recovery after Knee Replacement

Acupuncture improves recovery after knee replacement.

Electro-acupuncture in addition to conventional anaesthesia delivered during total knee replacement procedures, improves functional recovery, pain, circulation and swelling. In a Chinese trial of 200 participants, patients were randomly allocated to one of four groups: intravenous analgesia, femoral nerve block analgesia, or each of the foregoing plus electro-acupuncture.

Electro-acupuncture plus femoral nerve block was associated with a significantly lower incidence of deep vein thrombosis, compared with the other three groups. Seven days after surgery, blood flow in the two electro-acupuncture groups was significantly better than in the other two groups. With less post-operative pain, the electro-acupuncture plus femoral nerve block group, was able to participate in rehabilitation exercises sooner.

(The Preventive Effect of Computed Tomography Image-Guided Electroacupuncture Combined with Continuous Femoral Nerve Block on Deep Vein Thrombosis After Total Knee Arthroplasty Based on an Adaptive Algorithm. World Neurosurgery, May 2021.)

The Anti-Inflammatory Effects of Acupuncture

Researchers studying the anti-inflammatory effects of acupuncture, have found significant changes in biochemical markers associated with treatment for osteoarthritis of the knees. The Chinese clinical trial enrolled 60 patients who were assigned to eight weeks of either acupuncture or electro-acupuncture. By the end of the treatment period, pain and joint function had significantly improved in both groups. Both treatment modes were associated with significant reductions in serum levels of proinflammatory cytokines and cartilage degradation markers, plus significant increases in the anti-inflammatory cytokine IL-13.

(Effect of Electro-Acupuncture (EA) and Manual Acupuncture (MA) on Markers of Inflammation in Knee Osteoarthritis. Journal of Pain Research, 26 August 2020.)