Electro-acupuncture also may have worked better because it stimulated a larger area, says Jeffrey I. Gold, PhD, director of the Pediatric Pain Management Clinic at Children’s Hospital in Los Angeles. Gold runs one of only two pediatric acupuncture programs in the United States, treating, among others, patients with juvenile idiopathic arthritis.

How acupuncture affects inflammatory markers like TNF-alpha is anyone’s guess. “No one has figured out one single mechanism for acupuncture’s effects,” says Gold. “But MRI studies show that an acupuncture site specifically induces a response in various portions of the brain. This gives it the possibility of affecting any organ or system that [interacts] with the brain. Acupuncture affects immunity, and the neurological, hormonal and psychological. It doesn’t only block pain signals.”

What Other Research Says

The China Academy researchers aren’t the first to show that acupuncture can lower inflammatory markers in people with RA. A 2008 Arthritis & Rheumatism review of eight acupuncture studies involving 536 patients with RA found that five studies reported a reduction in erythrocyte sedimentation rate (ESR), three saw a reduction in C-reactive protein (CRP), and one study described a significant drop in both. The studies lasted 11 weeks on average. ESR is a blood test that measures inflammation in the body. Levels of CRP, also measured by a blood test, also indicate inflammation. Six of the studies reported decreased pain, and four reported reduction in morning stiffness.

Acupuncture relieves pain by stimulating the releases of endorphins, the body’s own natural pain killers, says Jamie Starkey, LAc, the lead acupuncturist for the Center for Integrative Medicine, Cleveland Clinic in Cleveland. “We’re activating the peripheral nervous system, which then activates the central nervous system, so that the brain begins to release endorphins.” 

And it works locally, she says, releasing a pain-relieving neurotransmitter called adenosine wherever the needles are inserted. “But why it happens, we are still not sure,” says Starkey.

In a 2008 German study published in Research in Complementary Medicine involving 44 patients with RA, patients either received auricular (ear) electro-acupuncture or autogenic (a form of relaxation) training once a week for six weeks. At study’s end, ESR was significantly reduced and TNF-alpha significantly increased compared to the relaxation group.

In this case, the TNF-alpha increase may have been a good thing, explains Gold: “TNF-alpha is not necessarily bad. It is an important part of our immune system. And when you treat RA, you don’t just treat blood markers. While an increase in TNF-alpha may be undesirable in some scenarios, it can actually be of benefit when placed in context with other factors. The answers may lie in understanding the balance between different players in the immune reaction, instead of focusing on a single factor.”