Acupuncture for Rheumatoid Arthritis Treatment: Biological Mechanisms of Anti-Inflammation and Analgesia

Rheumatoid arthritis (RA) is a common chronic inflammatory autoimmune joint disease, and its main clinical manifestations include bone joint swelling, pain, and progressive destruction. Acupuncture has become an important clinical treatment for RA due to its high safety profile, minimal side effects, and cost-effectiveness. However, it still needs to be further promoted and improved in the future. This review systematically summarizes the current status of acupuncture's clinical application and mechanism research in both domestic and international treatments of RA over the past decade. First, it outlines the current clinical application of acupuncture for RA, and offers a focus on summarizing advances in mechanism research. Findings indicate that acupuncture can alleviate chronic RA inflammation by regulating macrophage polarization, the M1/M2 cell ratio, and Treg/Th17 cell balance. It regulates the Keap1-Nrf2/ARE/HO-1 signaling pathway to reduce oxidative stress in inflamed tissues. Decreasing RANKL protein levels inhibits osteoclast generation while protecting bone joints. Additionally, it suppresses synovial angiogenesis, specifically activates autophagy to positively regulate the AMPK/ULK1 signaling pathway, and suppresses the abnormal activation of the PI3K/Akt/mTOR signaling pathway that causes excessive autophagy in synovial cells. It also alleviates chronic pain through both the release of peripheral local mediators and central nervous system signaling regulation while improving pain-related anxiety and depression.