Rheumatoid arthritis (RA) is a multisystemic inflammatory autoimmune disease involving mainly peripheral joints, with an incidence of about 0.3%-1% (1), and its underlying cause is still unknown. The disease mainly involves small joints such as wrist, metacarpophalangeal and interphalangeal joints. There are few large joints such as the knee (2), and the disease can eventually lead to varying degrees of functional impairment and, in severe cases, disability. From December 2005 to May 2008, 30 cases of knee arthropathy caused by rheumatoid arthritis were treated by acupuncture release in our hospital, and more satisfactory results were achieved, which are reported as follows.
Clinical data
Case collection
Diagnostic criteria: The cases were selected to meet the 1987 RA diagnostic criteria of the American College of Rheumatology. (1) morning stiffness lasting at least 1 h (daily) with a disease duration of at least 6 weeks; (2) having 3 or more arthrogryposis for at least 6 weeks; (3) wrist, metacarpophalangeal, and proximal phalangeal arthrogryposis for at least 6 weeks; (4) symmetrical arthrogryposis for at least 6 weeks; (5) having subcutaneous nodules; (6) hand X-ray changes (at least osteoporosis and narrowing of the joint space); and (7) positive rheumatoid factor (RF) (titer >1:20). Rheumatoid arthritis was diagnosed if four of the above seven items were present.
Inclusion criteria: meeting the above diagnostic criteria; age 18-65 years; with knee osteoarthritis symptoms and RA severity grade 2-3; knee score and functional score of the American Knee Society Score (KSS score) were less than 70.
Exclusion criteria: with significant organic diseases of heart, liver, lung and kidney; history of acupuncture sickness and allergy to anesthetic drugs; coagulation dysfunction; use of 2nd-line drugs within 3 months.
General information All 60 observation cases were obtained from patients in the outpatient clinic of the Department of Orthopedics and Traumatology and the outpatient clinic of the Department of Special Needs at Shanghai Guanghua Hospital of Integrative Medicine. They were grouped according to the order of consultation numbers and divided into treatment and control groups. Among the 30 cases in the treatment group, 11 were male and 19 were female, the oldest was 58 years old, the youngest was 28 years old, the average was 42.1 years old, the longest duration of the disease was 15 years, the shortest was half a year, the average was 3.4 years; among the 30 cases in the control group, 9 were male and 21 were female, the oldest was 60 years old, the youngest was 22 years old, the average was 41.6 years, the longest duration of the disease was 11 years, the shortest was 3 months, the average was 3.1 years. There was no significant difference in age and duration of disease between the two groups by t-test (P>0.05), which was comparable.
Treatment method
Treatment group: Patients were positioned at 60 degrees of knee flexion, and the pressure and pain points of the joint capsule, internal and external patellar support band, and medial and lateral collateral ligaments of the knee were used as the entry points, and each entry point was epidermally anesthetized with 1% lidocaine. Patients have obvious soreness and swelling is appropriate, the depth can reach the bone surface, loosen the needle in situ for 15 minutes, after the needle out of the sterile gauze compression needle hole to stop bleeding and cover the needle hole. The treatment was given once a week, with three times as a course of treatment.
Control group: oral Fotarine 25mg, 3 times a day, 3 weeks as a course of treatment.
Both groups were treated for one course of treatment, and the results were observed uniformly after the course of treatment.
Observation index
The American Knee Society Score (KSS score) criteria and adverse effects were observed. The KSS score criteria were divided into knee score (including pain, mobility and stability), and function score (including walking and walking up and down stairs), and the full score was 100 for normal people. Both groups were evaluated before treatment and at the end of the course of treatment.
Statistical analysis
SPSS13.0 software was used for statistical processing, and the results obtained from the scores of each item were expressed as x±s, and t-tests were performed.
Results
The results of KSS scores before and after treatment in the two groups are shown in Tables 1 and 2.
Table 1 Comparison of knee scores before and after treatment between two groups (x±s, n = 100 points)
Subgroup
Before treatment
After treatment
Pain
Mobility
Stability
Total score
Pain
Activity
Stability
Total score
Treatment group
±
±
± ±
± ± ±
± ±
±1.67 * △
±1.42* △
±1.72**△
Control group
±
±
± ±
± ± ±
± ± ±
±
±
± ±
Note: Compared with this group before treatment, *P<0.05, ** P<0.01; compared with the control group, △P<0.05, △△P<0.01. There was a significant difference in knee pain degree between the treatment group and the control group before treatment compared with after treatment (P<0.01), and there was no significant difference between groups after treatment. There was a difference in mobility and stability before and after treatment in the treatment group (P<0.05), no significant difference in the control group, and a difference in the comparison between groups (P<0.05). In terms of total score comparison, there was a significant difference between the treatment group before and after treatment (P<0.01), a difference in the control group (P<0.05), and a difference between groups (P<0.05).
Table 2 Comparison of functional scores between the two groups before and after treatment (x±s, n=100 points)
Subgroup
Before treatment
After treatment
Walking
Going up and down stairs
Total score
Walking
Up and down stairs
Total score
Treatment group
±
±
± ±
± ± 1.59 **△
±1.67 * △
±1.63* △
Control group
±
±
± ±
± ± ±
± ± ±
± ±
Note: Compared with this group before treatment, *P<0.05, ** P<0.01; compared with the control group, △P<0.05, △△P<0.01. There was a significant difference in walking scores before treatment compared with after treatment in the treatment group (P<0.01) and in the control group (P<0.05). There was a difference between groups after treatment (P<0.05). In terms of stair going up and down scores, there was a difference before and after treatment in the treatment group (P<0.05) and no significant difference in the control group, with a difference in the comparison between groups (P<0.05). In terms of total score comparison, there was a difference between the treatment group before and after treatment within group comparison (P<0.05) and between group comparison (P<0.05).
Adverse reactions
No serious adverse reactions interrupted observation in either group. No significant adverse reactions were found in the treatment group, and 2 patients in the control group experienced mild gastric discomfort, which improved after treatment with gastric mucosa-protective drugs.
Discussion
Rheumatoid arthritis has been recorded in traditional Chinese medicine for a long time, and is mostly classified as “paralysis”, which is similar to the ancient Chinese medical records of “calendar joints”, “nagging paralysis”, “tendon paralysis”, and “tendon paralysis”. “It is the same as the ancient Chinese medical records of “tendon paralysis”, “bone paralysis”, “crane knee wind”, “Dong bath barium ≈ hao hi beer! 端省け月邸II胺又粒隙砸病痹蛱隽吮災さ牟∫虿±恚笫酪郊宜凇! The theoretical basis for the treatment of paralysis by acupuncture is laid in the theory of “the treatment is in the burnt-needle robbery, with knowledge as the number, and pain as the Yu” as well as the theory of “where the acupuncture has twelve sections, in order to respond to the twelve meridians” in the chapter of “The official acupuncture chapter of the Ling Shu”.
Although modern acupuncture therapy has been used in clinical practice for only thirty years, its prototype is already available in the “Nine Needles and Twelve Principles of the Ling Shu”. A little shaking and deep, to the needle bone” and other records, it can be seen that similar to the needle knife needles and manipulation techniques for the treatment of rheumatoid arthritis in the motherland medicine already existed. Therefore, we can consider the needle knife is a special needle tool, is an extension and development of the traditional acupuncture method.
From the point of view of modern medicine, the knee joint lesion caused by rheumatoid arthritis is the main cause of walking dysfunction and loss of lower limb function in rheumatoid arthritis patients, and the basic pathological change of rheumatoid arthritis is synovitis. In the early stage, the synovial membrane is characterized by exudative inflammatory reactions, and later vascular proliferation and invasion of cartilage to form granulomatous vascular opacities. In addition to cartilage lesions, adhesions, scars, and contractures of the muscles, ligaments, and joint capsule surrounding the joint will further aggravate the deformity and loss of function of the joint. In addition to the mechanism of therapeutic regulation of immune function, microcirculation, free radical damage, and cortisol secretion in rheumatoid arthritis (3), acupuncture has a certain role in relieving the high pressure in the joint capsule, changing the force lines around the joint, and preventing deformity changes in knee osteoarthritis. Clinical practice has also demonstrated that the treatment of wind-like guan with trigeminal needle scattering has also achieved good clinical results (4). In addition, a study showed that IL-1 and TNF-α have a very important role in the onset and development of inflammation (5), and acupuncture has a significant reduction effect on IL-1 and TNF-α in animal experiments (6).
The efficacy of acupuncture for the treatment of rheumatoid arthritis-induced knee lesions and even the whole rheumatoid arthritis is reliable and without significant adverse effects, and it is worth to be promoted as a new acupuncture method in the treatment of rheumatoid arthritis for trial application.