Effect of Moxibustion on β-EP and Dyn Levels of Pain-Related Indicators in Patients with Rheumatoid Arthritis

Abstract

Background. Rheumatoid arthritis (RA) is a systemic immunodeficiency disease characterized by persistent synovial inflammation, pannus formation, and bone and cartilage destruction, resulting in joint malformations and function decline. Objective. The purpose of this study is to evaluate the effect of moxibustion on clinical symptoms and levels of pain-related indicators beta-endorphin (β-EP) and dynorphin (Dyn) in patients with RA and to explore the potential anti-inflammatory and analgesic mechanisms of moxibustion in RA treatment. Methods. A total of 64 patients with RA who met the inclusion criteria were randomly and equally classified into the control and treatment groups. The control group received conventional treatment (oral methotrexate, folate, or leflunomide prescribed for a long time). The treatment group was treated with moxibustion at ST36 (Zusanli), BL23 (Shenshu), and Ashi points with respect to the control group. Patients’ clinical symptoms and routine inspection indexes (rheumatoid factor [RF], erythrocyte sedimentation rate [ESR], and C-reactive protein [CRP]) were recorded before and after treatment. Serum levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), β-EP, and Dyn were determined by enzyme-linked immunosorbent assay (ELISA). The software SPSS24.0 was used for statistical analysis. Results. (1) Compared with the pretreatment result, both of the two groups’ clinical symptoms and routine inspection indexes (RF, ESR, and CRP) improved ( P < 0.05), and the improvement of clinical symptoms in the treatment group outperformed that in the control group ( P < 0.05). (2) TNF-α and IL-1β levels decreased significantly in the treatment group after treatment ( P < 0.01), while no significant difference was observed in the control group ( P > 0.05). (3) β-EP and Dyn levels in the treatment group were significantly increased after treatment ( P < 0.01, P < 0.01), but the control group showed no significant difference ( P > 0.05, P > 0.05). It is worth mentioning that the serum TNF-α, IL-1β, β-EP, and Dyn levels between the two groups were significantly different after 8 weeks of treatment ( P < 0.05). (4) Differences in the serum β-EP and Dyn levels in the patients of the treatment group were correlated with TNF-α and IL-1β levels after treatment, and the correlation was mainly negative (r < 0). Conclusion. Moxibustion can improve joint pain in patients with RA using conventional western medicine. One of the mechanisms may affect the serum β-EP and Dyn levels by downregulating the inflammatory factors to play an anti-inflammatory and analgesic role.

Comparison of Efficacy of Acupuncture-Related Therapy in the Treatment of Rheumatoid Arthritis: A Network Meta-Analysis of Randomized Controlled Trials

“…The literature screening process is shown in Figure 1. (23,28,30,32,34,35,39,43,50,51). The characteristics of the included studies are shown in Table 2, and the characteristics of intervention measures are shown in Table 3.…”

“…For random sequence generation, random number tables were used in 12 studies (22, 26-28, 31, 32, 35, 36, 45, 49, 50, 52), random numbers were generated by computer in 6 studies (21,23,29,37,42,48), and the remaining 14 studies (24,25,30,33,…”

“…In the included 32 studies ( 21 – 52 ), 12 articles reported moxibustion combined with DMARDs, eight articles reported conventional acupuncture combined with DMARDs, five articles reported electro-acupuncture combined with DMARDs, two articles reported acupoint embedding combined with DMARDs, two articles reported fire needle combined with DMARDs, five articles reported warm needle combined with DMARDs, one article reported auricular acupoints combined with DMARDs, and 30 articles reported DMARDs. There is one three-arm study ( 24 ) and 31 two-arm studies ( 21 – 23 , 25 – 53 ). Fourteen studies reported DAS28 ( 21 – 24 , 27 , 31 , 32 , 34 , 36 – 38 , 42 , 46 , 52 ), 23 studies reported VAS ( 21 – 23 , 26 , 28 – 30 , 32 , 33 , 35 – 37 , 40 – 42 , 44 – 50 , 52 ), 14 studies reported morning stiffness ( 21 – 24 , 26 – 28 , 31 , 37 , 42 , 43 , 46 , 49 , 52 ), 23 studies reported RF ( 21 – 23 , 26 , 28 – 30 , 32 , 33 , 35 – 37 , 40 – 42 , 44 – 50 , 52 ), 27 studies reported CRP ( 21 – 24 , 27 –…”

“…There is one three-arm study ( 24 ) and 31 two-arm studies ( 21 – 23 , 25 – 53 ). Fourteen studies reported DAS28 ( 21 – 24 , 27 , 31 , 32 , 34 , 36 – 38 , 42 , 46 , 52 ), 23 studies reported VAS ( 21 – 23 , 26 , 28 – 30 , 32 , 33 , 35 – 37 , 40 – 42 , 44 – 50 , 52 ), 14 studies reported morning stiffness ( 21 – 24 , 26 – 28 , 31 , 37 , 42 , 43 , 46 , 49 , 52 ), 23 studies reported RF ( 21 – 23 , 26 , 28 – 30 , 32 , 33 , 35 – 37 , 40 – 42 , 44 – 50 , 52 ), 27 studies reported CRP ( 21 – 24 , 27 – 33 , 35 , 37 , 39 – 52 ), 26 studies reported ESR ( 21 – 24 , 27 – 33 , 35 , 37 <...>…”

“…For random sequence generation, random number tables were used in 12 studies ( 22 , 26 – 28 , 31 , 32 , 35 , 36 , 45 , 49 , 50 , 52 ), random numbers were generated by computer in 6 studies ( 21 , 23 , 29 , 37 , 42 , 48 ), and the remaining 14 studies ( 24 , 25 , 30 , 33 , 34 , 38 – 41 , 43 , 44 , 46 , 47 , 51 ) only mentioned the word “random”. For allocation concealment, six studies ( 21 – 23 , 28 , 37 , 42 ) used sealed opaque envelopes, one study ( 32 ) used central allocation, one study ( 29 ) used lottery, and the remaining 24 studies did not report allocation concealment. For blinding of investigators and participants, due to the limitation of interventions, double-blind was not applied in all studies.…”