The efficacy and safety of acupuncture-related therapy in the treatment of rheumatoid arthritis: A protocol for systematic review and network meta-analysis

Attenuation of immobilization stress-induced hypertension by temperature-controllable warm needle acupuncture in rats and the peripheral neural mechanisms

Introduction

We and others have shown that electrical stimulation of the PC-6 acupoint over the wrist relieves hypertension by stimulating afferent sensory nerve fibers and activating the central endogenous opioid system. Warm needle acupuncture has long been utilized to treat various diseases in clinics.

Methods

Here, we developed a temperature-controllable warm needle acupuncture instrument (WAI) and investigated the peripheral mechanism underlying the effect of warm needle acupuncture at PC-6 on hypertension in a rat model of immobilization stress-induced hypertension.

Results

Stimulation with our newly developed WAI and traditional warm needle acupuncture attenuated hypertension development. Such effects were reproduced by capsaicin (a TRPV1 agonist) injection into PC-6 or WAI stimulation at 48°C. In contrast, PC-6 pretreatment with the TRPV1 antagonist capsazepine blocked the antihypertensive effect of WAI stimulation at PC-6. WAI stimulation at PC-6 increased the number of dorsal root ganglia double-stained with TRPV1 and CGRP. QX-314 and capsaicin perineural injection into the median nerve for chemical ablation of small afferent nerve fibers (C-fibers) prevented the antihypertensive effect of WAI stimulation at PC-6. Additionally, PC-6 pretreatment with RTX ablated the antihypertensive effect of WAI stimulation.

Conclusion

These findings suggest that warm needle acupuncture at PC-6 activates C-fiber of median nerve and the peripheral TRPV1 receptors to attenuate the development of immobilization stress-induced hypertension in rats.

Semi-automated socio-anthropologic analysis of the medical discourse on rheumatoid arthritis: Potential impact on public health

BACKGROUND

The debilitating effects of noncommunicable diseases (NCDs) and the accompanying chronic inflammation represent a significant obstacle for the sustainability of our development, with efforts spreading worldwide to counteract the diffusion of NCDs, as per the United Nations Sustainable Development Goals (SDG 3). In fact, despite efforts of varied intensity in numerous directions (from innovations in biotechnology to lifestyle modifications), the incidence of NCDs remains pandemic. The present work wants to contribute to addressing this major concern, with a specific focus on the fragmentation of medical approaches, via an interdisciplinary analysis of the medical discourse, i.e. the heterogenous reporting that biomedical scientific literature uses to describe the anti-inflammatory therapeutic landscape in NCDs. The aim is to better capture the roots of this compartmentalization and the power relations existing among three segregated pharmacological, experimental and unstandardized biomedical approaches to ultimately empower collaboration beyond medical specialties and possibly tap into a more ample and effective reservoir of integrated therapeutic opportunities.

METHOD

Using rheumatoid arthritis (RA) as an exemplar disease, twenty-eight articles were manually translated into a nine-dimensional categorical variable of medical socio-anthropological relevance, relating in particular (but not only) to legitimacy, temporality and spatialization. This digitalized picture (9 x 28 table) of the medical discourse was further analyzed by simple automated learning approaches to identify differences and highlight commonalities among the biomedical categories.

RESULTS

Interpretation of these results provides original insights, including suggestions to: empower scientific communication between unstandardized approaches and basic biology; promote the repurposing of non-pharmacological therapies to enhance robustness of experimental approaches; and align the spatial representation of diseases and therapies in pharmacology to effectively embrace the systemic approach promoted by modern personalized and preventive medicines. We hope this original work can expand and foster interdisciplinarity among public health stakeholders, ultimately contributing to the achievement of SDG3.

Effects of Warm Needle Acupuncture plus Xitong Waixi Lotion in Patients with Knee Osteoarthritis: A Randomized Controlled Trial

Objective

To evaluate the effect of warm needle acupuncture plus Xitong Waixi lotion on the levels of IL-1, TNF-α, and MMP-3 in patients with knee osteoarthritis.

Methods

Eighty patients with knee osteoarthritis admitted to our hospital from October 2019 to June 2021 were recruited and assigned via the random number table method at a ratio of 1 : 1 to receive either Xitong Waixi lotion (conventional group) or warm needle acupuncture plus Xitong Waixi lotion (combined group). Outcome measures included clinical efficacy, inflammatory cytokine level, Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, visual analogue scale (VAS) score, Hospital for Special Surgery (HSS) knee score, and adverse reactions.

Results

Warm needle acupuncture plus Xitong Waixi lotion was associated with a significantly higher clinical efficacy versus Xitong Waixi lotion alone (P=0.006). Patients in the combined group had significantly lower levels of interleukin (IL)-1, tumor necrosis factor-α (TNF-α), and matrix metalloproteinase-3 (MMP-3) than those in the conventional group (P=0.020). Warm needle acupuncture plus Xitong Waixi lotion resulted in significantly lower WOMAC scores and VAS scores and higher HSS scores for the patients versus Xitong Waixi lotion (P=0.012). The two groups had a similar incidence of adverse events (P=0.068).

Conclusion

Warm needle acupuncture plus Xitong Waixi lotion effectively alleviates the inflammatory response and knee pain in patients with knee osteoarthritis, with significant clinical effects and a high safety profile.

Chrono-moxibustion adjusts circadian rhythm of CLOCK and BMAL1 in adjuvant-induced arthritic rats

OBJECTIVE

The clinical symptoms of rheumatoid arthritis (RA) have significant circadian rhythms, with morning stiffness and joint pain. Moxibustion is effective in the treatment of RA, while the underlying therapeutic mechanisms remain limited. Thus, we explored whether moxibustion could adjust the circadian rhythm of RA by modulating the core clock genes CLOCK and BMAL1 at the molecular level.

METHODS

144 Sprague Dawley rats were randomly divided into four groups: control group (group A), model group (group B), 7-9 am moxibustion treatment group (group C), and 5-7 pm moxibustion treatment group (group D). Each group was divided into 6 time points (0 am, 4 am, 8 am, 12 N, 6 pm, and 8 pm) with an equal number of rats at each time point. Except for group A, all rats were injected with Freund's Complete Adjuvant (FCA) 0.15 ml on the right foot pad to establish the RA model. The rats of the two moxibustion treatment groups were respectively subjected to moxibustion at 7-9 am and 5-7 pm. After 3 weeks of treatment, the tissues were collected at 6 time points during the next 24 hours. Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was used to test the mRNA expression of CLOCK and BMAL1 in the hypothalamus and synovial tissues. CLOCK and BMAL1 protein expression in synovial tissues were detected with western blot.

RESULTS

Compared to group A, group B showed significantly down-regulated expression levels of CLOCK and BMLA1 at synovial tissue (P < 0.05), while no statistically significant difference was found in the hypothalamus (P > 0.05). The expression levels of CLOCK and BMLA1 were up-regulated in the moxibustion treatment groups in different tissues, especially in synovial tissue (P < 0.05) compared to group B. Nevertheless, no difference was observed between groups C and D (P > 0.05).

CONCLUSIONS

Moxibustion could treat RA by modulating clock core genes CLOCK and BMAL1 to regulate the circadian rhythm. However, there was no significant difference between the 7-9 am moxibustion treatment group and the 5-7 pm moxibustion treatment group. This study provides a basis for research on moxibustion in the treatment of RA.

Needle-Warming Moxibustion plus Multirehabilitation Training to Improve Quality of Life and Functional Mobility of Patients with Rheumatoid Arthritis after Medication

Objective

Patients treated with medication for rheumatoid arthritis (RA) often improve but continue to have active diseases. The study aims to investigate whether needle-warming moxibustion (NWM) plus multirehabilitation training can improve quality of life (QoL) and functional mobility of RA patients after medication.

Methods

Eighty-four RA patients were selected as study participants, including 42 patients receiving medication (medication group) and 42 patients receiving NWM plus multirehabilitation training (NWM + MRT group). The scores of disease symptoms, pain (visual analogue scale (VAS)), sleep quality (Pittsburgh Sleep Quality Index (PSQI)), functional mobility (Fugl-Meyer assessment scale (FMAS)), self-rating anxiety scale (SAS), self-rating depression scale (SDS), and QoL (SF-36) were compared before and after treatment. When patients were discharged from the hospital, they were given a questionnaire for treatment satisfaction.

Results

After treatment, decreases in the scores of the VAS, PSQI, SAS, and SDS were observed in both cohorts, especially in the NWM + MRT group (P < 0.05). The FMAS scores of upper limbs and lower limbs were increased after treatment, which were higher in the NWM + MRT group in comparison with the medication group (P < 0.05). Of note, patients in the NWM + MRT group scored higher in various dimensions of the SF-36 scale (P < 0.05), showing better QoL. The satisfaction survey showed that the NWM + MRT group had a higher proportion of patients being satisfied and a lower proportion of patients being dissatisfied (P < 0.05).

Conclusion

NWM plus multirehabilitation training could significantly attenuate disease symptoms, improve QoL, recover functional mobility, and reduce the risk of anxiety and depression in RA patients.