Acupuncture, Herbs and Nutrients for Arthritis

by Barbara Connor, M.Ac., L.Ac.

I thought I would write a little bit today about how acupuncture, herbs and nutrients can help in the treatment of arthritis. So I have put together a little summary below about how acupuncture, herbs and nutrients can help in this regard.  I hope it is helpful.

Rheumatoid arthritis is a chronic inflammatory disease that primarily affects the joints. The cause of the disease is unknown to a large extent. In addition to genetic factors, smoking, overweight, and nutrition contribute to the risk of disease. (Boeing et al 2012)

Acupuncture for Arthritis

1. Acupuncture relieves joint pain and improves joint function obviously.The effect of acupuncture is still sustainable in 4 weeks after terminating the treatment. (Dai et al 2014)
2. For the 42 cases in the acupuncture group, acupuncture at shu-stream points on the three yang meridians of the hand including Sanjian (LI 3), Zhongzhu (TE 3), Houxi (SI 3) and fire needle at Ashi points were applied, the treatments were given once every other day, 15 times as a treatment course. Shu-stream point acupuncture combined with fire needle therapy achieves a significant efficacy in the treatment of hand osteoarthritis. (Li et al 2013)
3. The combined therapy of acupuncture and moxibustion achieves the safe and effective therapeutic effect with less adverse reactions in the treatment of knee osteoarthritis. The immediate effect in the combined therapy group is not so obvious as compared with the western medication, but the long-term efficacy is remarkably superior to western medication. (Xu et al 2013)
4. The different acupuncture methods at the three stages improve obviously the clinical effect and are highly targeted. The mechanism of the three stages on “meridian muscle region pathology” and the treatment based on the disease stages can be the effective approach to knee osteoarthritis. (Cheng et al 2013) 
5. Acupuncture provided significantly better relief from knee osteoarthritis pain and a larger improvement in function than sham acupuncture, standard care treatment, or waiting for further treatment. (Cao et al 2012)
6. Acupuncture that meets criteria for adequate treatment is significantly superior to sham acupuncture and to no additional intervention in improving pain and function in patients with chronic knee pain. Due to the heterogeneity in the results, however, further research is required to confirm these findings and provide more information on long-term effects. (White et al 2007)

Botanicals and Nutrients for Arthritis

• Boswellia extracts and boswellic acids exert positive effects in such chronic inflammatory diseases as rheumatoid arthritis, bronchial asthma, osteoarthritis, ulcerative colitis and Crohn’s disease. (Ammon et al 2010)

• Boswellia serrata extract – was shown to reduce pain rapidly, as early as after 1 week of treatment.  It reduces levels of the cartilage degrading enzyme MMP-3 in synovial fluid, and, most importantly it is safe for human consumption, even long term.  (Sengupta et al 2008)  

• Boswellia – Researchers identified 522 genes induced by TNFalpha, with 113 of those genes proved sensitive to boswellia, as 5-Loxin®. The highlight of the study was the regulatory effect of boswellia on TNFα inducible of VCAM-1 and ICAM-1 gene expression. Other research on boswellia has shown various preparations inhibit leukotriene activity and have reduced inflammation in rheumatoid arthritis patients. (Tripathi et al 2004) (Ammon et al 2002) 

• Bromelain – has anti-inflammatory properties. (Akhtar & Haqqi 2012) Experimental evidence suggests that bromelain’s action as an anti-inflammatory is mediated via decreasing levels of PGE2, thromboxane A2 and through modulation of certain immune cell surface adhesion molecules, which play a role in the pathogenesis of arthritis [Hale et al. 2002; Kumakura et al. 1988]. 

• Bromelain – Another study showed there was no real difference between Phlogenzym [a combination of bromelain, trypsin and rutin] and diclofenac, implying an equal benefit-risk relation between the substances. Phlogenzym may well be recommended for the treatment of patients with osteoarthritis of the hip with signs of inflammation as indicated by a high pain level. (Klein et al 2006) 

• Cat’s Claw (Uncaria tomentosa) – was found to be an effective treatment for osteoarthritis. (Piscoya et al 2001)  Three studies support cat’s claw alone or in combination for osteoarthritis. (Rosenbaum et al 2010) 

• Curcumin – is known to possess potent antiinflammatory and antiarthritic properties. In this pilot study of patients with rheumatoid arthritis the curcumin group showed the highest percentage of improvement in overall Disease Activity Score  (DAS) and American College of Rheumatology (ACR) scores (ACR 20, 50 and 70) and these scores were significantly better than the patients in the diclofenac sodium group. More importantly, curcumin treatment was found to be safe and did not relate with any adverse events. (Chandran & Goel 2012)

• Curcumin – Recent studies have shown that curcumin ameliorates multiple sclerosis, rheumatoid arthritis, psoriasis, and inflammatory bowel disease in human or animal models. Curcumin inhibits these autoimmune diseases by regulating inflammatory cytokines such as IL-1beta, IL-6, IL-12, TNF-alpha and IFN-gamma and associated JAK-STAT, AP-1, and NF-kappaB signaling pathways in immune cells. (Bright JJ 2007) 

• Curcumin and resveratrol combined may be a useful strategy in osteoarthritis therapy as compared with separate treatment with each individual compound. (Csaki et al 2009) 

• DIM – could reduce the expression of several inflammatory cytokines, which was, however, not adequate to prevent the development of the arthritis. On the other hand, DIM was shown to effectively inhibit the expression of nuclear factor kappa B ligand (RANKL), leading to the blockade of osteoclastogenesis and consequently an alleviation of experimental arthritis. Further in vitro and in vivo studies confirmed the inhibition of RANKL by DIM. DIM has shown anti-arthritis activity in animal models via inhibiting the expression of RANKL, and thus may offer potential treatments for arthritis and associated disorders. 3,3′-Diindolylmethane (DIM) is a natural compound formed during the autolysis of glucobrassicin present in Brassica food plants. (Dong et al 2009)

• Emodin – The anti-inflammatory effects of emodin have been exhibited in various in vitro as well as in vivo models of inflammation including pancreatitis, arthritis, asthma, atherosclerosis and glomerulonephritis. As an anti-cancer agent, emodin has been shown to suppress the growth of various tumor cell lines including hepatocellular carcinoma, pancreatic, breast, colorectal, leukemia, and lung cancers. Emodin is a pleiotropic molecule capable of interacting with several major molecular targets including NF-κB, casein kinase II, HER2/neu, HIF-1α, AKT/mTOR, STAT3, CXCR4, topoisomerase II, p53, p21, and androgen receptors which are involved in inflammation and cancer. (Shrimali et al 2013)

• Eicosapentaenoic acid (EPA) was the most effective, followed by docosahexaenoic (DHA) and then alpha-linolenic (ALA) acid – These omega-3 (n-3) PUFAs cause a reduction in the mRNA levels for various proteins known to be important in the pathology of osteoarthritis. The relative efficacy of EPA suggests that this omega-3 PUFA may be especially useful for dietary supplementation in patients with osteoarthritis. (Zainal et al 2009) 

• Eleutherococcus senticoccus, Panax notoginseng and Rehmannia glutinosa – were found to be safe, tolerable and effective for symptomatic improvement of pain and physical function of knee osteoarthritis patients.  (Park et al 2009) 

• Honokiol – Our data showed that IL-1β markedly stimulated the expressions of iNOS and COX-2 and the productions of NO, PGE2 , and IL-6, which could be significantly reversed by honokiol. Honokiol could also suppress the IL-1β-triggered activation of IKK/IκBα/NF-κB signaling pathway. Moreover, honokiol significantly inhibited the IL-1β-induced MMP-13 production and collagen II reduction. Taken together, the present study suggests that honokiol may have a chondroprotective effect and may be a potential therapeutic choice in the treatment of osteoarthritis patients. (Chen et al 2014) 

• Mediterranean diet – A Mediterranean-type diet rich in fish, fruit and vegetables and low in saturated fats has been associated with health benefits, including improved cardiovascular profile and benefit in rheumatoid arthritis (RA). Results demonstrate that a 6 week intervention can improve consumption of healthier foods. If implemented more widely it may prove a popular, inexpensive and useful adjunct to other RA treatment. (McKellar et al 2007)

• Mediterranean diet – It has been shown that the Mediterranean diet can reduce disease activity, pain and stiffness in patients with inflammatory arthritis and may thus constitute a valuable support for patients suffering from these diseases. (Sales et al 2009)

• Omega 3 Fatty Acids -two studies support omega-3 fatty acids for the treatment of rheumatoid arthritis. (Rosenbaum et al 2010)

• Omega 3 Fatty Acids – By virtue of their anti-inflammatory action, omega-3 polyunsaturated fatty acids (PUFA) may be beneficial in inflammatory diseases. A large body of evidence supports a protective effect of omega-3 PUFA in experimental animal and ex-vivo models of Crohn’s disease (CD), Ulcerative colitis (UC) and rheumatoid arthritis (RA). Although fish oil supplementation in patients with IBD results in omega-3 PUFA incorporation into gut mucosal tissue and modification of inflammatory mediator profiles, the evidence of clinical benefits of omega-3 PUFA is weak. On the other hand, more convincing data support the efficacy of omega-3 PUFA in reducing pain, number of tender joints, duration of morning stiffness, use of non-steroidal anti-inflammatory drugs and improving physical performance in RA patients. (Ruggiero et al 2009) 

• Omega 3 Fatty Acids – There have been a number of clinical trials assessing the benefits of dietary supplementation with fish oils in several inflammatory and autoimmune diseases in humans, including rheumatoid arthritis, Crohn’s disease, ulcerative colitis, psoriasis, lupus erythematosus, multiple sclerosis and migraine headaches. Many of the placebo-controlled trials of fish oil in chronic inflammatory diseases reveal significant benefit, including decreased disease activity and a lowered use of anti-inflammatory drugs. (Simopoulos 2002)

• Panax notoginseng – In a double-blind, randomized, placebo-controlled study researchers found that a water soluble extract of panax notoginseng, rehmannia glutinosa and eleutherococcus senticosus was safe, tolerable and effective for symptomatic improvement of pain and physical function in patients with knee osteoarthritis. (Park et al 2007)

• Panax notoginseng – Another study showed that panax notoginseng saponins can significantly improve the condition of patients and enhance the therapeutic effect in treating rheumatoid arthritis, through regulating the disordered immunity and improving the anti-inflammatory and analgesic effect. (Zhang et al 2007)

• Probiotics – Lactobacillus casei 01 supplementation improved the disease activity and inflammatory status of patients with rheumatoid arthritis. Further studies are warranted to confirm these results, and such confirmation may lead to the introduction of probiotics as adjunctive therapy for this population. (Vaghef-Mehrabany et al 2014)

• Red raspberry fruit extract – showed pharmacological activity and was able to significantly reduce the development of clinical signs of arthritis and markedly reduce the degree of bone resorption, soft tissue swelling and osteophyte formation, preventing articular destruction in treated animals. (Figueira et al 2014)

• Resveratrol – prevented IL-1β-induced inflammation in human articular chondrocytes at least in part by inhibiting the TLR4/MyD88/NF-κB signaling pathway suggesting that resveratrol has the potential to be used as a nutritional supplement to counteract osteoarthritis symptoms. (Liu et al 2014)  

• Scutellaria – was tested along with another natural compound called catechin and the combination was found to be as effective as naproxen in controlling the signs and symptoms of osteoarthritis of the knee. (Levy et al 2009)  

• Vitamin D – Low dietary vitamin D intake increases the risk of progression of knee radiographic osteoarthritis. Particularly in subjects with low baseline bone mineral density, vitamin D status seems to influence the incidence and progression of knee radiographic osteoarthritis . Thus, improving the vitamin D status in the elderly could protect against the development and worsening of knee osteoarthritis, especially in those with low bone mineral density. (Bergink et al 2009)  
• Vitamin D – We observed a significant positive association between serum 25(OH)D and bone mineral density in individuals with primary knee osteoarthritis, independent of sex, age, BMI, knee pain, physical activity, and disease severity. Given the high prevalence of low 25(OH)D status in persons with knee osteoarthritis and the positive association between 25(OH)D and BMD, vitamin D supplementation may enhance bone mineral density in individuals with osteoarthritis. (Bischoff-Ferrari et al 2005)

• Willow Bark – In one study, the effectiveness of a willow bark extract providing 240 mg of salicin a day was compared to placebo in a 2-week randomized controlled trial in 78 people with osteoarthritis. After two weeks, the willow bark patients’ pain scores were reduced by 14% compared to the placebo group, which had a 2% increase in pain scores. (Schmid et al 2001) 

Foods to Avoid:

Sugar-sweetened soda – Regular consumption of sugar-sweetened soda, but not diet soda, is associated with increased risk of seropositive rheumatoid arthritis in women, independent of other dietary and lifestyle factors. (Hu et al 2014)

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Compassionate Acupuncture and Healing Arts, providing craniosacral acupuncture, herbal and nutritional medicine in Durham, North Carolina. Phone number 919-475-1005.