Evaluation of the effect of acupuncture on hand pain, functional deficits and health-related quality of life in patients with rheumatoid arthritis—A study protocol for a multicenter, double-blind, randomized clinical trial

The effect of eucalyptus inhalation on pain and the quality of life in rheumatoid arthritis

Problem considered

Pain is one of the most significant symptoms of rheumatoid arthritis that reduce the quality of life. The purpose of the study was to determine the effect of eucalyptus on pain and the quality of life in patients with rheumatoid arthritis.

Methods

In this randomized clinical trial, 70 patients with rheumatoid arthritis were selected by random sampling. In the eucalyptus group, 1 mL of eucalyptus oil was inhaled for 5 min, 3 times a day, for one month. The control group received placebo inhalation. Both groups used routine treatments. Data were collected using a questionnaire of demographics, the numerical pain rating scale (NRS), and Quality of Life (SF-12). Statistical analysis was done using 19th edition SPSS software and applied on paired t-test, chi-square, Fisher's exact test, and analysis of covariance.

Results

The mean score of pain severity in the eucalyptus group significantly decreased in comparison with the control group (P < 0.001). The severity of pain there was no statistical difference in both groups before, the first, and the second weeks after the intervention, (p > 0.05); however, in the third and fourth weeks after the intervention, the mean severity of pain in the eucalyptus group was lower than in the control group, and these differences were statistically significant between the two groups (p < 0.05). Also, the patients' quality of life in the eucalyptus group was increased significantly (P < 0.001).

Conclusion

The eucalyptus leads to pain reduction, and consequently, improves the quality of life of patients with rheumatoid arthritis.

Trial registration

IRCT20160110025929N15 Registration date: 2018-10-07; https://en.irct.ir/trial/33573.

Clinical Efficacy of Acupuncture for the Treatment of Rheumatoid Arthritis: Meta-Analysis of Randomized Clinical Trials

Objective

Acupuncture has been used by rehabilitation specialists as an adjunctive treatment for the symptomatic treatment of rheumatoid arthritis (RA). This meta-analysis aims to evaluate the efficacy of acupuncture in treating patients with RA.

Methods

A comprehensive search was conducted in CBM, CNKI, PubMed, CENTRAL, Web of Science, and Embase from their inception up to March 2022. All randomized controlled trials (RCTs) without the language restriction, concerning the patients with RA treated with acupuncture, were included. Two reviewers independently assessed the risk of bias with the Cochrane Risk of Bias Assessment tool. Weight mean difference (MD) and 95% CI were calculated, and data were pooled with random effects model.

Results

A total of eleven RCTs involving 796 patients with RA met the established inclusion criteria. This systematic review indicated the efficacy of acupuncture as an adjunctive treatment for patients with RA. Invasive acupuncture could reduce significantly in pain (MD = -1.00, 95% CI: -1.96 to -0.05, P=0.040), health assessment questionnaire (HAQ, MD = -0.20, 95% CI: -0.30 to -0.11, P < 0.001), physician global assessment (PhGA, MD = -0.98, 95% CI: -1.23 to -0.72, P < 0.001), tender joint count (TJC, MD = -1.24, 95% CI: -2.11 to -0.37, P=0.005), C-reactive protein (CRP, MD = -1.81, 95% CI: -3.32 to -0.29, P=0.019), and erythrocyte sedimentation rate (ESR, MD = -3.03, 95% CI: -5.80 to -0.26, P=0.032), while compared to control group. Laser acupuncture could reduce HAQ (MD = -0.15, 95% CI: -0.28 to -0.01, P=0.034), the RA quality of life questionnaire (RAQoL, MD = -2.32, 95% CI: -4.40 to -0.25, P=0.028), CRP (MD = -35.24, 95% CI: -36.49 to -33.99, P < 0.001), and interleukin-6 (IL-6, MD = -29.63, 95% CI: -49.34 to -9.92, P=0.003), while compared to control group. No adverse events associated with acupuncture were reported.

Conclusion

Available evidence suggests that acupuncture is beneficial for relieving pain and ameliorating quality of life and health index in patients with RA; thereby, it should be available as an adjunctive nonpharmacological treatment in rehabilitation programmes.

Impact of socio-demographic and clinical characteristics on functional disability and health-related quality of life in patients with rheumatoid arthritis: a cross-sectional study from Palestine

BACKGROUND

Rheumatoid arthritis (RA) is a chronic autoimmune disorder, which has a significant impact on patients' health-related quality of life (HRQoL), and limits physical function as well as increases pain and fatigue. Therefore, this study aimed to evaluate the HRQoL and functional disability profile of patients with RA in Palestine to determine the socio-demographic and clinical features associated with low HRQoL and functional disability in patients with RA and to investigate the impact of drugs used on functional disability and HRQoL.

METHODOLOGY

A cross-sectional, observational study conducted at rheumatology clinics in Northern West-Bank, Palestine (Alwatani Hospital-Nablus, Khalil Suleiman Hospital-Jenin, Thabet Thatbet Hospital-Tulkarem, and Darweesh Nazzal Hospital-Qalqilia). EuroQoL-5 Dimension scale (EQ-5D-5L) was used to evaluate HRQoL, Health Assessment Questionnaire, Disability Index (HAQ-DI) to evaluate the functional disability, and the Health Assessment Questionnaire pain visual analog scale (HAQ-VAS) to evaluate pain.

RESULTS

300 patients were included in the study, 229(76.3%) were females, the mean ± standard deviation age was 49 ± 13.10 years, and the median RA duration (lower-upper quartiles) was 6 (4-12) years. The median EQ-5D-5L index value and Euro QOL visual analogue scale (EQ-VAS) scores were 0.56 and 60, respectively. There was a significant strong positive correlation (R = 0.773; p < 0.001) between the EQ-5D-5L index values and the reported EQ-VAS scores. The median HAQ-DI and HAQ-VAS were 0.94 and 40, respectively. The results of multiple linear regression showed that treatment with biological DMARD (Etanercept), having work, higher income, absence of night pain, and absence of comorbid diseases were significantly associated with higher EQ-5D-5L index score (better HRQoL) and lower HAQ-DI scores (less disability). On the other hand, older age and the presence of morning stiffness were significantly associated with higher HAQ-DI scores (more disability).

CONCLUSIONS

This study revealed the impact of treatment, clinical variables, and socio-demographic factors on disability and HRQoL in RA patients. Healthcare providers should be aware of the association between treatment with biological DMARD and improved HRQoL and functional status to make early interventions that reduce disability and improve HRQoL in susceptible patients.

Intradermal acupuncture for rheumatoid arthritis: study protocol for a randomised controlled trial

Background

Rheumatoid arthritis (RA) is a common autoimmune disease that severely impacts quality of life. Currently available medications for the treatment of RA have adverse side effects. Emerging evidence suggests that intradermal acupuncture (IA) is feasible and safe for patients, but its application in RA patients has not been examined. Our study aims to explore the efficacy and safety of IA for the treatment of RA.

Methods

This study is a randomised, sham-controlled, patient-outcome assessor-statistician blind trial that aims to evaluate the effects of IA in patients with RA. We will recruit 132 patients aged ≥ 18 years with a diagnosis of RA. Patients will be randomly allocated with a 1:1 ratio to IA or sham IA groups. Both groups will receive basic treatment and nursing routines for RA. The experimental group will receive actual IA treatment, whereas the control group will receive sham IA treatment. All patients will receive one course of treatment (i.e., four consecutive treatment sessions with an intervening 1-day interval). Primary outcomes will be traditional Chinese medicine (TCM) syndromes before and after a treatment course and Health Assessment Questionnaire (HAQ) scores. Secondary outcomes will be disease activity score 28 (DAS28) and levels of serum C-reactive protein (CRP). Outcome measures will be collected pre- and post-treatment.

Discussion

This study aims to provide high-quality evidence for the efficacy and safety of IA for treating RA. In addition, the results will provide references for selection of acupoints for other syndromes in clinical practice.

Trial registration

Chinese Clinical Trial Registry ChiCTR2000038028. Registered on 8 September 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05416-0.

A novel approach utilizing laser acupuncture teletherapy for management of elderly-onset rheumatoid arthritis: A randomized clinical trial

INTRODUCTION

Rheumatoid arthritis (RA) disease is a systemic progressive inflammatory autoimmune disorder. Elderly-onset RA can be assumed as a benign form of RA. Until recently, face-to-face therapeutic sessions between health professionals and patients are usually the method of its treatment. However, during pandemics, including coronavirus disease 2019 (COVID-19), teletherapeutic sessions can extensively increase the patient safety especially in elderly patients who are more vulnerable to these infections. Thus, the aim of this randomized clinical trial was to evaluate a novel teletherapy approach for management of elderly patients suffering from RA by utilizing laser acupuncture.

METHODS

A teletherapy system was used for management of elderly patients suffering from RA. Sixty participants were allocated randomly into two groups and the ratio was 1:1. Patients in the first group were treated with laser acupuncture and telerehabilitation sessions, which consisted of aerobic exercise and virtual reality training. Patients in the second group received telerehabilitation sessions, which consisted of aerobic exercise and virtual reality training. Evaluation of patients was done by using the Health Assessment questionnaire (HAQ), the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire, and the analysis of interleukin-6 (IL-6), serum C-reactive protein (CRP), plasma adenosine triphosphate (ATP) concentration and plasma malondialdehyde (MDA).

RESULTS

A statistically significant difference was found in CRP, RAQoL, IL-6 and MDA between the pre- and post-treatments in the first group (p < 0.05) favouring the post-treatment group, while the HAQ showed a statistically significant difference between pre- and post-treatments (p < 0.05) in both groups. Statistically significant post-treatment differences were also observed between the two groups (p < 0.05) in RAQoL, CRP, ATP and MDA, favouring the first group.

DISCUSSION

Laser acupuncture teletherapy could be suggested as a reliable treatment method for elderly patients suffering from RA, as it can provide a safe and effective therapeutic approach. Teletherapy provided safer access to health professionals and patients while giving a high patient satisfaction value with a relatively lower cost (ClinicalTrials.gov Identifier: NCT04684693).

Effects of laser acupuncture tele-therapy for rheumatoid arthritis elderly patients

Rheumatoid arthritis (RA) is a progressive common autoimmune disorder and is one of the most functional limiting diseases in elderly. Until recently, its treatment is mainly based on physical locations and meetings while being face to face. However, laser acupuncture tele-therapy approaches can significantly provide the patient with safety during the COVID-19 pandemic as well as changing the disorder’s prognosis. Sixty patients were assigned randomly into 2 groups with 1:1 ratio. Patients in group A are treated remotely by laser acupuncture in addition to methotrexate and a tele-rehabilitation program in the form of aerobic exercise training. Patients in group B are treated by methotrexate and a tele-rehabilitation program in the form of aerobic exercise. There was a statistically significant difference in health assessment questionnaire (HAQ) pre- and post-treatment in group A (p < 0.05). The C-reactive protein (CRP) and interleukin-6 (IL-6) inflammatory markers as well as the malondialdehyde (MDA) oxidative marker showed a significant reduction pre- and post-treatment in group A (p < 0.05). Additionally, there was a significant increase in the adenosine tri-phosphate (ATP) antioxidant marker pre- and post-treatment in group A (p < 0.05). The comparison between groups A and B showed a statistically significant post-treatment difference in RAQoL, CRP, IL-6, ATP, and MDA in group A than group B. Considering the significant improvement that was found in the laser acupuncture group, it can be concluded that the use of laser acupuncture as adjunctive was effective in the treatment of elderly patients with RA. ClinicalTrials.gov Identifier: NCT04758689

Problems of scientific methodology related to placebo control in Qigong studies: A systematic review

INTRODUCTION

Qigong is widespread in the West and used for preventive care, stress-induced conditions, emotional and vegetative symptoms like migraine and hypertension, as well as for better coordination in the elderly and quality of life enhancement in severe disease such as cancer. Adequate controls for Qigong research are lacking, compromising the level of efficacy evidence. Adequate Qigong placebo control exercises should match clear and standardized criteria.

METHODS

Three computerized databases were assessed in January 2018 (Scopus, Web of Science and MEDLINE on PubMed) using the following keywords or their combinations: (Qigong OR Qi Gong OR Gong Qi OR Chi Kung OR Kung Chi OR Kiko OR Ki Gong OR Ki Kong) AND placebo. In addition, all reference lists were scanned for further relevant articles. Literature was examined for the effects of Qigong as compared to a control intervention.

RESULTS

110 articles were found, 78 of which were excluded after examining the title and abstract, and 16 because they were duplicates. Four more articles were found by searching in the bibliographies of published papers. A total of 20 studies were included in this systematic review. We found that, to the best of our knowledge, no criteria for placebo controls have been published in peer-reviewed journals so far.

CONCLUSION

Placebo controls should be developed by the usage of vegetative functional assessments such as heart rate variability, thermography, and electrophysiological measurements, thus excluding major vegetative effects of the exercise, as well as by the usage of psychometric tests and other quantitative evaluations.

Moxibustion for rheumatoid arthritis: Protocol for a systematic review

BACKGROUND

Rheumatoid Arthritis (RA) is a serious chronic disease which will result in serious syndrome such as joints stiffness, disability, and death. The major medications treating RA usually make sense and side effects, while moxibustion is known as a safe and effective treatment for RA. This review aims to systematically evaluate the effect and safety of moxibustion for treating RA.

METHODS

The following databases will be searched from their inception to March 2019: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Wan-Fang Databases, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Citation Information by National Institute of Informatics, Chinese Scientific Journal Database (VIP Database). Two reviewers will search these databases, select data and measure the quality of studies independently. The methodological quality will be assessed by the Cochrane risk of bias tool. Data will be synthesized by either the fixed-effects or random-effects model according to a heterogeneity test. The primary outcome is symptom evaluation including morning stiffness, pain and joint swelling. The number of joints affected by RA, adverse effects, quality of life, erythrocyte sedimentation rate (ESR), C reactive protein (CRP), and Rheumatoid factor (RF) will be evaluated as secondary outcomes. Risk ratio for dichotomous data and mean differences with a 95% confidence interval for continuous data will be adopted to express the effect and safety of acupuncture for RA.

RESULTS

This study will provide a high-quality synthesis of current evidence of moxibustion for asthma from several aspects including morning stiffness, pain and joint swelling. The number of joints affected by RA, adverse effects, quality of life, erythrocyte sedimentation rate (ESR), C reactive protein (CRP), and Rheumatoid factor (RF).

CONCLUSION

The conclusion of our study will provide updated evidence to judge whether moxibustion is an effective and safe intervention for patients with RA.

ETHICS AND DISSEMINATION

As individuals will not be involved, the ethical approval will not be required. This review will be published in a peer-reviewed journal or at a relevant conference.

PROSPERO REGISTRATION NUMBER

CRD42019126685.

Clinical Efficacy of Acupuncture on Rheumatoid Arthritis and Associated Mechanisms: A Systemic Review

OBJECTIVE

The objective of this review is to investigate the detailed existing scientific information about the clinical efficacy of acupuncture on rheumatoid arthritis (RA) conditions and to reveal the proposed mechanisms.

METHODS

We searched the PubMed, EMBASE, Cochrane, AMED (Allied and Complementary Medicine), NCCAM (The National Center for Complementary and Alternative Medicine), and CNKI (China National Knowledge Infrastructure) databases to identify relevant monographs and related references from 1974 to 2018. Chinese journals and theses/dissertations were hand searched.

RESULTS

43 studies were recruited. Each research was analyzed for study design, subject characteristics, intervention, selected acupoints, assessment parameters, proposed mechanisms, and results/conclusions.

CONCLUSIONS

In our review, we concluded that acupuncture alone or combined with other treatment modalities is beneficial to the clinical conditions of RA without adverse effects reported and can improve function and quality of life and is worth trying. Several important possible mechanisms were summarized including anti-inflammatory effect, antioxidative effect, and regulation of immune system function. However, there is still inconsistency regarding the clinical efficacy and lack of well-designed human/animal double-blinded RCTs. Future discussion for further agreement on taking traditional Chinese medicine (TCM) theory into consideration as much as possible is a top priority.

Effect of Scutellarin inhibits collagen‑induced arthritis through TLR4/NF‑κB‑mediated inflammation

Scutellarin is the major effective constituent of the commonly used Chinese medicine Erigeron breviscapus. It has been applied in the clinic to treat various diseases, and is characterized by high content, a stable source, controllable quality, high efficiency and low toxicity. In addition, its potential pharmacological effects have been increasingly identified and elucidated. The present study was performed to examine the role of scutellarin on collagen‑induced arthritis (CIA). Mice were injected subcutaneously with bovine collagen type II and administered scutellarin for 2 weeks by gavage 20 mg/kg/day. ELISA kits were used to measure the levels of interleukin (IL)‑1β, IL‑6, tumor necrosis factor‑α (TNF‑α), oxidative stress markers [superoxide dismutase (SOD) and malondialdehyde (MDA)] and caspase‑3/-9 activity. Bax, Bcl‑2, toll like receptor 4 (TLR4) and nuclear factor (NF)‑κB protein expression was analyzed using western immunoblot analyses. The present study demonstrated that scutellarin prevented CIA, and inhibited the expression of inflammation factors, IL‑1β, IL‑6 and TNF‑α. In addition, scutellarin reduced the levels of oxidative stress markers, SOD and MDA, as well as intercellular adhesion molecule‑1 and monocyte chemoattractant protein 1 in CIA mice. Caspase‑3/-9, Bax/Bcl‑2, TLR4 and NF‑κB protein expression were reduced in CIA mice following scutellarin treatment. The results of the current study suggest a novel effect of scutellarin involving the inhibition of TLR4/NF‑κB‑mediated inflammation.

Calidad de vida, nivel de salud percibido y factores sociodemográficos en personas con artritis reumatoide

Objetivo: determinar la relación entre la calidad de vida, el nivel de salud y los factores sociodemográficos en personas con artritis reumatoide (AR). Materiales y método: estudio correlacional explicativo. Se realizó una entrevista directa en el momento de la consulta de enfermería antes del control médico de reumatología. A través de un muestreo intencional no probabilístico de sujetos tipo se contó con la participación de 635 personas. Resultados: se encontró una frecuencia de presentación de AR mayor en mujeres (87%). También se evidenció una correlación positiva (0,596; P<0,001) entre calidad de vida y nivel de salud. Sociodemográficamente, las mujeres con educación básica y bajo estrato socioeconómico presentan una menor percepción de calidad de vida y nivel de salud. Estas variables se sometieron a un proceso de prueba con el uso de un modelo Path de análisis de covarianza. Conclusiones: las condiciones sociales que viven las personas con AR son factores que determinan la puesta en marcha de acciones de intervención dirigidas a solucionar la problemática de la calidad de vida en esta población.