Acupuncture and Rheumatoid Arthritis

Summary of a presentation at the Living with RA Workshop at HSS

Jeffrey Y.F. Ngeow, MD
Jeffrey Y.F. Ngeow, MD
Associate Attending Anesthesiologist, Hospital for Special Surgery
Clinical Associate Professor of Anesthesiology, Weill Cornell Medical College
Understanding Acupuncture

The underlying principles of acupuncture date to the Stone Ages, when Neolithic man discovered that hitting the body with sticks or pressing points on the body with stones could get pain to go away. Over time, certain points were found to be particularly effective. Based on thousands of years of practical observation and clinical experience, the Chinese developed this into acupuncture, which involves stimulating specific points on the body to treat disease or decrease pain.

Acupuncture may be accomplished by stimulating the points with:

  • Pressure - applied with the finger, fruit seeds, stones, or other methods
  • Hitting - gentle tapping
  • Insertion of needles, and twirling them with the fingers, applying electricity, light bloodletting; or heating with moxibustion (burning herbs attached to the stem of the needle), lamps, or lasers
  • Cupping - placing small, heated glass jars, which form a vacuum, over the points to bring energy to the surface

Traditional Chinese Medicine Theory

The traditional Chinese understanding of how acupuncture works relates to qi (pronounced chee). Qi is the life energy, contained in every part of the body. Some qi determines nutrition, helps defenses, or helps the blood and circulation, for example. Qi must flow around the body harmoniously.

A related concept is yin and yang, the positive and negative aspects or opposing forces in the body, which must be in balance. Qi conducts the energy in order to balance the opposing forces throughout the body. A modern corollary for this concept is the sympathetic and parasympathetic nervous system - yielding positive and negative feedback. If qi is in deficiency or excess in any one organ, you get a yin or yang predominant state.

You may have seen drawings showing the meridian lines on the body, depicting where the acupuncture points fall. Each line has a beginning and end but is linked to another meridian, with the qi flowing in a definite direction. All the meridians are ultimately connected. When the flow is interrupted due to a lack of qi or lack of energy to propel this flow, a pathological condition occurs.

Each meridian line relates to a particular organ, such as the stomach or lungs. Stimulating points along that meridian will help to treat diseases of the organ. The surface acupuncture point on the body is where the internal organ manifests its function. An example of how meridians flow relates to heart attacks, which may cause not just chest pain but a radiation of pain into the left arm; this arm pain falls precisely along the heart meridian line.

Why does needling at a distant point from the problem help? Traditional Chinese medicine theorizes that any one part of the body reflects the entire body. A modern understanding of this might relate to our DNA; every single cell of our bodies carry the entire set of DNA codes, thus representing our entire body.

Acupuncture for Rheumatoid Arthritis

Because rheumatoid arthritis is an inflammatory and painful condition, it falls into the realm of interruption of qi . Inflammatory conditions reflect an excess of qi ; however, dull pains and stiff joints are indicative of a deficiency of qi . This probably mirrors the evolution of rheumatoid arthritis, from an early stage when it is highly inflammatory to a chronic, late stage where there is more atrophy, stiffness, and dull aching. The treatment of course has to be appropriate for each stage. So the clinician must examine you to determine the stage in order to use the appropriate acupuncture points. However, rheumatoid arthritis can be helped.

Questions and Answers

How long does acupuncture take to work?

Acupuncture effects last 48 to 72 hours in animals, which translates to 2 to 3 days in humans. Thus, for acupuncture to be effective, treatment sessions should not be more than 2 to 3 days apart. Once a week is not sufficient. You don't get cumulative benefits. And don't expect to see much benefit before 5 or 6 treatments.

If you have an acupuncturist working under the supervision of another doctor, the two have to agree on the cause of your problem and the approach must be planned out. If the two don't agree, the plan is different and the effects will be different. When expectations are different, you cannot gauge the results of the treatment.

Does acupuncture help inflammation?

Yes, it can help control acute inflammation in conditions, such as fever, laryngitis, and sinusitis. Acupuncture also has an effect on autoimmune reactivity and chronic inflammation, such as that seen in rheumatoid arthritis, but the treatment has to be maintained because the condition is chronic and we cannot totally eliminate the reactivity. However, we can alleviate it to some extent.

If you have cortisone shots for knee pain, could acupuncture replace those shots?

Probably. In the clinic here, a primary concern is back pain, often caused by spinal stenosis, which is an anatomical problem. It cannot be eliminated without surgery to eliminate the bone. But the pain can be alleviated, such as with cortisone shots. If the shots do not relieve pain for a specific time period of several months, acupuncture is offered as an alternative. In my experience, about 55 to 65% of patients respond to such treatment. However, a research study is underway to clearly define the level of benefit.

Can acupuncture replace surgery?

That depends on the reason for the surgery. If it's for pain, acupuncture may be an alternative. If it's for deformity, acupuncture cannot undo the deformity. Acupuncture is a symptomatic treatment, not an anatomical changing modality.

Can ulnar deviation of the hand be treated with acupuncture?

Ulnar deviation is due to joint erosion and, because the joint is damaged unevenly, the forces on the muscles on either side of the joint are uneven. Prevention requires relaxation of the muscle. Treatment must be prolonged and involve an acupuncture technique to relax those muscles. When trying to achieve relaxation, extra stimulation (such as electricity) should not be used. But once muscle shortening has become permanent, such as in a bunion, it is almost impossible to correct without lengthening or cutting loose the muscle in some way.

What can be done about fainting when the needle is inserted?

This is more common in men than women. Reclining eliminates 90% of fainting attacks. Be sure to have something to eat and drink beforehand, which also helps prevent fainting. Further, it helps to get used to the sensation of the needles in your hands or feet before applying needles to other parts of the body.

Is acupuncture covered by health insurance?

Some insurers cover it, but Medicare does not.

About the Living with RA Workshop at HSS

Summary written by Diana Benzaia.

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