Rheumatoid arthritis (RA) is a systemic autoimmune disease that affects approximately 1% of the adult population worldwide. Characterized by chronic synovial inflammation, progressive joint destruction, and refractory pain, RA imposes a significant burden even under cutting-edge pharmacologic treatment — including conventional DMARDs and biologic agents. A considerable proportion of patients maintain residual disease activity, persistent pain, and cumulative side effects from medications, which justifies the search for adjuvant therapies with complementary mechanisms.
A review published in February 2026 in the American Journal of Chinese Medicine (Vol. 54, no. 2, pp. 349–374) by Liu and colleagues consolidates a decade of experimental and clinical research to map, in molecular detail, how medical acupuncture interferes with the principal inflammatory and pain-related circuits of rheumatoid arthritis. The work identifies six distinct biological pathways, ranging from modulation of immune cells in the synovium to inhibition of microglial activation in the dorsal horn of the spinal cord.
OVERVIEW OF THE REVIEW
The Six Molecular Pathways: From Synovial Tissue to the Spinal Cord
What distinguishes this review from previous publications is the systematic organization of mechanisms into six biological axes that, together, explain why medical acupuncture can produce simultaneous effects on inflammation, pain, joint destruction, and oxidative stress in RA. Each pathway is detailed below.
Additional Mechanisms: Angiogenesis, Autophagy, and Central Analgesia
Beyond the three pathways described above, the review details three complementary mechanisms that broaden the spectrum of acupuncture’s action in RA: suppression of pathological synovial angiogenesis, regulation of cellular autophagy, and — particularly relevant for pain control — inhibition of microglial activation in the central nervous system.
Acupoints with Documented Effect in RA
Although the review does not prescribe a single clinical protocol, the studies compiled converge on a core of acupoints frequently used in the experimental models and clinical trials of acupuncture for rheumatoid arthritis. ST-36 (Zusanli) appears recurrently in studies of macrophage and microglia modulation. SP-6 (Sanyinjiao) is frequently associated with effects on Treg/Th17 balance. LI-4 (Hegu), in turn, is one of the most studied acupoints in analgesia and modulation of pro-inflammatory cytokines.
Frequently Asked Questions
No. Medical acupuncture is an adjuvant therapy — complementary to pharmacologic treatment with DMARDs and biologic agents, never a substitute. The mechanisms identified in the review act on pathways complementary to those of the drugs, suggesting additive benefit when both approaches are combined. The therapeutic decision should always be coordinated between the medical acupuncturist and the rheumatologist.
The acupoints most frequently cited in the compiled studies are ST-36 (Zusanli), SP-6 (Sanyinjiao), and LI-4 (Hegu). ST-36 appears recurrently in studies of macrophage and microglia modulation; SP-6 in effects on Treg/Th17 balance; and LI-4 in analgesia and modulation of pro-inflammatory cytokines.
NF-κB and STAT3 are transcription factors that, when activated in microglia (the immune cells of the central nervous system), promote production of inflammatory cytokines such as IL-1β, TNF-α, and IL-6 in the dorsal horn of the spinal cord. That activation contributes to central pain sensitization in RA. Acupuncture, by inhibiting that axis, reduces production of those cytokines and promotes central analgesia.
The review compiles evidence from experimental models and clinical trials at different stages of RA. However, most preclinical data use induced-RA models, which may not fully reflect the complexity of the human disease in very advanced stages. Clinical applicability depends on individualized assessment by the physician.
The reviewed studies report a favorable safety profile, with adverse events limited to mild local reactions (hematomas, pain at the insertion point). Nonetheless, patients on intensive immunosuppression should be evaluated for the risk of local infections. The indication should be made by a medical acupuncturist in coordination with the rheumatologist.
Fonte Original
American Journal of Chinese Medicine(em inglês)Founded in 1989 by physicians trained at the University of São Paulo (USP) and specialized in China, CEIMEC is a Brazilian national reference in the teaching and practice of medical acupuncture. With more than 3,000 physicians trained over 35 years, it collaborates with HC-FMUSP and is recognized by the Brazilian Medical College of Acupuncture (CMBA/AMB).
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