Arthritis and acupuncture: the evidence for effectiveness
This briefing paper presents a summary of the evidence for the effectiveness of acupuncture in the treatment of arthritis based on a review of the published literature. It is concluded that whilst the evidence for effectiveness is sparse, acupuncture can be helpful in alleviating pain in both osteo- and rheumatoid arthritis. There is also some evidence to suggest that acupuncture can influence the inflammatory aspect of rheumatoid arthritis.
The Evidence Series of Briefing Papers aims to provide a review of the key papers in the literature which provide evidence of the effectiveness of acupuncture in the treatment of specific conditions. The sources of evidence will be clearly identified ranging from clinical trials, outcome studies and case studies. In particular this series of briefing papers will seek to present, discuss and critically evaluate the evidence.
Introduction to Arthritis
Arthritis is not a single disorder but a generalised name for joint disease from a number of causes. This review covers both osteo- and rheumatoid arthritis. Osteoarthritis is a disease essentially confined to the joint capsule.
The cartilage lining the bone surfaces becomes roughened and thinned and the synovial lining in the capsule becomes inflamed. In severe cases the bone ends touch and start to wear away, and bony growths form that can change the shape of the joint. Osteoarthritis usually starts after the age of 40 and is more prevalent and severe in women. Hard repetitive activity and joint injury are common causes. Symptoms are pain and stiffness of the joint. About 8 million people in the UK are affected and of these about one million ask for treatment (ArthritisResearch Campaign Booklet-Osteoarthritis).
Treatment includes pain killers, anti-inflammatory drugs, physiotherapy, losing weight, and in severe cases joint replacement. Puett & Griffin (1994) refer to the 'considerable (gastrointestinal) risks' associated with the use of non-steroidal anti-inflammatory drugs in older populations. Moreover these authors point out that it is uncertain whether the efficacy of anti-inflammatory drugs is superior to safer, pure analgesics. They quote clinical trials of anti-inflammatory drugs that show only a 30% reduction in pain and 15% improvement in function. Rheumatoid arthritis is a completely different disease except in that it also affects the joints of the body. It is an autoimmune illness that causes inflammation of the lining of the joint capsule. Tendons can also be affected, and the lungs and blood vessels may become inflamed. The disease may be accompanied by anaemia causing fatigue. In Britain about 3% of the population are affected; of those about five in a hundred people develop severe symptoms with extensive disability (Arthritis Research Campaign Booklet – Rheumatoid Arthritis). Most sufferers experience symptoms that come and go with no apparent pattern. The most common age for the disease to start is between 30 and 50; again women are more at risk than men. Treatment includes painkillers, anti- inflammatory drugs, anti- rheumatic drugs, and joint replacement. In Chinese medicine all forms of arthritis are covered by Bi syndromes, also known as painful obstruction syndrome, with further differentiation according to the signs and symptoms. Chinese disease patterns and Western disease categories do not always match. According to Legge (1990) trying to equate the various Bi syndromes with different forms of arthritis is not helpful or possible.
Literature Search
A search was made of the ARRCBASE database using the terms acupuncture and rheumatoid and osteoarthritis. From an initial 82 references articles were excluded if they were in a foreign language, related predominantly to treatment only, or were primarily concerned with TENS not acupuncture. This reduced the number to a total of 18 papers (10 osteo- and 8 rheumatoid) which form the basis of the following review.
Additional Info
Rheumatoid Arthritis
A total of eight papers are reviewed in this section, three overview papers and five trial papers
Terms and conditions:
Terms and conditions The use of this fact sheet is for the use of British Acupuncture Council members and is subject to the strict conditions imposed by the British Acupuncture Council details of which can be found in the members area of its website www.acupuncture.org.uk.
