The Effects and Potential Mechanisms of Moxibustion for Rheumatoid Arthritis-Related Pain: A Randomized, Controlled Trial

Abstract

Purpose

To investigate the effects of moxibustion in relieving pain, and other clinical symptoms for patients with rheumatoid arthritis (RA), and explore the potential mechanism of moxibustion treatment for RA.

Patients and Methods

Seventy qualified RA patients were randomly assigned in a 1:1 ratio to the moxibustion group or the routine group. The routine group only took oral methotrexate tablets and folic acid tablets. The moxibustion group was treated with moxibustion based on oral pharmaceutical. Moxibustion was performed two times weekly for 8 weeks, a total of 16 sessions. Patients scored their pain on a visual analog scale (VAS). The American College of Rheumatology improvement criteria of 20%, 50% and 70% (ACR20, ACR50 and ACR70) after treatment were investigated. Clinical symptoms, a disease activity score using 28 joint counts (DAS28), simplified disease activity index (SDAI), clinical disease activity index (CDAI), health assessment questionnaire (HAQ), interleukin 1β (IL-1β), tumor necrosis factor-alpha (TNF-α), and vascular endothelial growth factor (VEGF) of RA patients were analyzed before and after treatment.

Results

After treatment, the VAS scores, tender and swollen joint counts, morning stiffness scores, disease activity scores (DAS28, SDAI, CDAI), HAQ scores in the two groups were both improved, and the effects of moxibustion group were more obvious (P < 0.05). The ACR20 and ACR50 of the moxibustion group were greater than that of the routine group (P < 0.05), no significant difference of the ACR70 existed between the two groups (P > 0.05). In addition, the decreases of IL-1β, TNF-α, VEGF of the moxibustion group were better than that of the routine group (P < 0.05).

Conclusion

Moxibustion could effectively relieve pain, ameliorate the clinical symptoms, and decrease the disease activity of RA. The potential mechanism may be the decrease in the level of serum inflammatory factors.

Keywords:

• moxibustion
• rheumatoid arthritis
• pain
• inflammatory factor

Abbreviations

RA, rheumatoid arthritis; QoL, quality of life; DMARDs, disease-modifying antirheumatic drugs; NSAIDs, non-steroidal anti-inflammatory drugs; CDUTCM, Chengdu University of Traditional Chinese Medicine; DAS28, a disease activity score using 28 joint counts along with other components; VAS, visual analog scale; ACR20, ACR50 and ACR70, the American College of Rheumatology improvements criteria of 20%, 50% and 70%; SDAI, simplified disease activity index; CDAI, clinical disease activity index; HAQ, health assessment questionnaire; IL-1β, interleukin 1β; TNF-α, tumor necrosis factor-alpha; VEGF, vascular endothelial growth factor; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; BMI, body mass index.

Data Sharing Statement

All data generated or used during the study appear in the submitted article. No further data will be shared.

Ethics Approval and Informed Consent

The study was performed according to the principles of the Declaration of Helsinki, approved by the Ethics Committee of the Affiliated Hospital of CDUTCM (NO.2015KL-015), and registered at the Clinical Trial Registry (registration number: ChiCTR-IOR-17012282). Only patients signed the informed consent form were included.

Consent for Publication

Written informed consent for publication was obtained from all participants.

Acknowledgments

The authors would like to thank all study participants. The authors were grateful their colleagues from CDUTCM and The Affiliated Hospital of CDUTCM, who provided insight and expertise that greatly assisted the research.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This study was supported by The National Natural Science Foundation of China (81373738) and the Education Department of Sichuan Province (2017JY0016 and 2022YFS0386).