Effects of laser acupuncture tele-therapy for rheumatoid arthritis elderly patients
Adly et al. · Lasers in Medical Science · 2022
Evidence Level
MODERATEOBJECTIVE
Evaluate the efficacy of laser acupuncture via telemedicine to treat rheumatoid arthritis in older adults during the pandemic
WHO
60 older adults (65-75 years) with active rheumatoid arthritis
DURATION
4 weeks of treatment with 6 sessions per week
POINTS
ST-36 (Zusanli), LR-8 (Ququan), SP-9 (Yinlingquan), PC-6 (Neiguan)
🔬 Study Design
Group A (Treatment)
n=30
Remote laser acupuncture + methotrexate + aerobic exercise
Group B (Control)
n=30
Methotrexate + aerobic exercise only
📊 Results in numbers
Reduction in IL-6
Improvement in HAQ
Reduction in MDA
Increase in ATP
📊 Outcome Comparison
Satisfaction with telemedicine
This study showed that laser acupuncture applied remotely can help older adults with rheumatoid arthritis, reducing inflammation and improving quality of life. The treatment was performed at home with telemedicine guidance, offering a safe alternative during the pandemic.
Article summary
Plain-language narrative summary
Rheumatoid arthritis (RA) is a progressive autoimmune disease that significantly affects older adults, representing one of the most functionally limiting conditions in this age group. With the aging of the population and the increasing incidence of late-onset RA, there is a growing need for safe and effective therapeutic approaches for this vulnerable population. This study investigated an innovative solution: the application of laser acupuncture via telemedicine as adjuvant therapy for older adults with RA.
The randomized clinical trial involved 60 patients aged 65 to 75 years, diagnosed with active RA according to the criteria of the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR). Participants were randomized into two groups: the experimental group received remote laser acupuncture combined with methotrexate and aerobic exercise, while the control group received methotrexate and exercise only. Treatment lasted four weeks, with six weekly sessions of laser acupuncture.
Laser acupuncture was performed using an intelligent infrared laser system with a wavelength of 808 nm, continuous mode, power density of 100 mW/cm², and energy density of 7.5 J/cm². The acupuncture points selected were Stomach 36 (ST-36), Ququan (LR-8), Yinlingquan (SP-9), and Neiguan (PC-6), chosen for their ability to produce systemic effects through the immune-neuroendocrine network.
The results demonstrated significant efficacy of laser acupuncture across multiple parameters. Inflammatory markers, including interleukin-6 (IL-6) and C-reactive protein (CRP), showed a statistically significant reduction in the treated group (p < 0.05). The oxidative marker malondialdehyde (MDA) also decreased significantly, while the antioxidant marker adenosine triphosphate (ATP) increased considerably. In addition, there was significant improvement on the Health Assessment Questionnaire (HAQ) and on RA-related quality of life (RAQoL).
The telemedicine system developed allowed safe and effective remote monitoring. The platform included two-way communication between patients and health care professionals, educational diagrams on acupuncture point location, demonstration videos, and videoconferencing features. Patients showed high satisfaction with the system, with high scores for convenience (4.9/5), overall satisfaction (4.6/5), and preference over in-person consultations (4.7/5).
The proposed mechanisms of action involve regulation of the immune system through stimulation of the selected acupuncture points. Stimulation of ST-36 has been shown to activate specific neural pathways and produce analgesic effects through the release of chemokines such as CXCL1. Inhibition of nuclear factor kappa B (NF-κB) and its target gene p53 may explain the anti-inflammatory and antioxidant effects observed.
This study represents a significant advance in the application of digital health technologies to integrative medicine, especially relevant during the COVID-19 pandemic, when older adults faced a higher risk of exposure. The approach offers a safe and effective alternative to in-person treatment, maintaining therapeutic quality while providing convenience and accessibility.
The clinical implications are substantial, suggesting that laser acupuncture via telemedicine can be integrated as adjuvant therapy in the management of RA in older adults, potentially reducing dependence on conventional medications and their adverse effects. The demonstration of improvements in inflammatory and oxidative markers provides a solid scientific basis for the efficacy of this innovative therapeutic approach.
Strengths
- 1Well-structured randomized controlled design
- 2Innovative and comprehensive telemedicine system
- 3Assessment of multiple objective biomarkers
- 4High patient acceptance and satisfaction
- 5Clinical relevance during the COVID-19 pandemic
Limitations
- 1Relatively small sample size (n = 60)
- 2Treatment duration limited to 4 weeks
- 3No long-term follow-up
- 4No classification by Traditional Chinese Medicine syndromes
- 5Lack of cost-effectiveness analysis
Expert Commentary
Dr. Marcus Yu Bin Pai
MD, PhD · Pain Medicine · Physical Medicine and Rehabilitation · Medical Acupuncture
▸ Clinical Relevance
Late-onset rheumatoid arthritis places the physician before a frequent therapeutic dilemma: how to enhance inflammatory control without expanding the burden of adverse effects in older patients with comorbidities and established polypharmacy? This randomized trial with 60 patients aged 65 to 75 offers a practical answer by demonstrating that laser acupuncture, administered remotely as an adjuvant to methotrexate and aerobic exercise, produces measurable reductions in IL-6, CRP, and MDA in just four weeks. For the physiatrist or rheumatologist who follows patients with active RA and limited tolerance for pharmacological escalation, this represents a low-risk, highly acceptable tool. The telemedicine modality opens concrete space for patients with mobility difficulties, frail older adults, or those in situations of isolation, maintaining therapeutic rigor without requiring physical presence at the service.
▸ Notable Findings
What makes this work especially relevant is the convergence of inflammatory and oxidative outcomes in a single four-week protocol. The reduction in IL-6 with a between-group difference of 38.47 and the increase in ATP with a difference of 44.52 suggest that laser acupuncture acts not only as a peripheral inflammatory modulator, but also influences cellular energy metabolism — a mechanism consistent with the mitochondrial biostimulation attributed to the 808 nm laser in continuous mode. The concomitant drop in MDA reinforces a real antioxidant effect, not trivial in joint tissue subjected to chronic oxidative stress. The points selected — ST-36, SP-9, LR-8, and PC-6 — have a recognized systemic action profile, and the hypothesis of NF-κB axis inhibition as a mediator of this effect deserves attention in future research. Patient satisfaction with the remote system, close to the ceiling of the scale, is also a relevant clinical datum, since adherence is a determinant of real efficacy.
▸ From My Experience
In my practice with older rheumatologic patients at the pain outpatient clinic, laser acupuncture has been part of the adjuvant protocol for some years now, especially when there is a contraindication to conventional needling due to anticoagulation or skin fragility. I typically observe the first signs of functional improvement between the third and fifth session, with more consistent gain in morning stiffness and grip capacity starting in the second week. For maintenance, I work with cycles of eight to twelve sessions, reviewed every two to three months according to disease activity. What this article reinforces is something I have seen empirically: the combination of laser acupuncture with supervised aerobic exercise enhances the functional outcome in a way that neither intervention alone tends to achieve. The patient profile that responds best, in my experience, is one with moderately active RA, already stabilized with conventional DMARD therapy, but with residual complaints of fatigue and functional limitation — exactly the patient represented in this study.
Full original article
Read the full scientific study
Lasers in Medical Science · 2022
DOI: 10.1007/s10103-021-03287-0
Access original articleScientific Review
Marcus Yu Bin Pai, MD, PhD
CRM-SP: 158074 | RQE: 65523 · 65524 · 655241
PhD in Health Sciences, University of São Paulo. Board-certified in Pain Medicine, Physical Medicine and Rehabilitation, and Medical Acupuncture. Scientific review and curation of every entry in this library.
Learn more about the author →Medical disclaimer: This content is for educational purposes only and does not replace consultation, diagnosis, or treatment by a qualified professional. Some information may be assisted by artificial intelligence and is subject to inaccuracies. Always consult a physician.
Content reviewed by the medical team at CEIMEC — Integrated Centre for Chinese Medicine Studies, a reference in Medical Acupuncture for over 30 years.
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