Moxibustion therapy for rheumatoid arthritis: A narrative review

Abstract

Moxibustion occupies a significant position in the comprehensive management of rheumatoid arthritis (RA). Moxibustion demonstrates unique efficacy in ameliorating both local joint and systemic symptoms, as well as in immunomodulation. Clinically, it offers operational convenience and is devoid of gastrointestinal adverse effects. Furthermore, when employed as an adjunct to conventional western medicine, it facilitates dose reduction of pharmacological agents while enhancing therapeutic efficacy and mitigating toxicity. To systematically evaluate this domain, we reviewed 193 domestic and international publications spanning the past 25 years. Our analysis indicates that moxibustion yields significant clinical benefits, including the improvement of morning stiffness, joint pain, and joint swelling indices, alongside an enhancement in overall quality of life for RA patients. Mechanistically, moxibustion has been shown to downregulate the secretion of pro-inflammatory cytokines such as TNF-α and IL-1β; inhibit synovial angiogenesis and cellular proliferation; attenuate pannus formation; mitigate cartilage and bone destruction; and increase the content of collagen and proteoglycans. These therapeutic effects are mediated through multiple pathways: suppressing T cell activation and rectifying imbalances in immune cells and molecules; regulating autophagy and apoptosis via signaling cascades, including the PI3K/Akt/mTOR pathway in synovial tissue and the HPA axis-mediated NMDA-NO-cGMP pathway; modulating the differentiation of osteoblasts and osteoclasts to delay cartilage degradation; and inhibiting ferroptosis. Beyond these local and immunological effects, this review highlights extra-articular mechanisms whereby moxibustion modulates immunity and ameliorates arthritic pathology. These include the regulation of cytokine levels through circadian rhythm oscillations and the modulation of gut microbiota to attenuate systemic inflammatory responses. Consequently, this review provides a more systematic and comprehensive elucidation of the clinical effects of moxibustion in RA treatment. This paper further deepens the understanding of its underlying mechanisms, specifically regarding the improvement of osteocyte differentiation, inhibition of ferroptosis, modulation of gut microbiota, and regulation of centrally secreted chemical mediators. Nevertheless, this review also identifies existing limitations within the field. Notably, the selection of acupoints remains relatively homogeneous, necessitating further investigation into the clinical efficacy of distinct acupoints and their combinations. Additionally, the establishment of standardized treatment protocols requires further implementation. With advancements in technology and deepening research endeavors, it is anticipated that additional clinical effects and therapeutic mechanisms of moxibustion will be further elucidated.