UM SOM: Integrative Medicine

Arthritis and Related Disorders

Arthritis is one of the most prevalent chronic disorders affecting our society, particularly in the elderly. Current pharmacological treatment is often inadequate and patient and physician are left weighing the benefits against the side-effects.

Osteo- and Rheumatoid Arthritis

Acupuncture as an Adjunctive Therapy in Osteoarthritis of the Knee
Brian Berman: Principal Investigator
Marc Hochberg: Co-Investigator
NIH, NCCAM 5U01 AT00171

In collaboration with investigators from the Division of Rheumatology and Department of Epidemiology, we published a ground-breaking study on the use of acupuncture for osteoarthritis. The study, published as the lead article in the December 2004 edition of Annals of Internal Medicine, is one of the largest randomized controlled trials of acupuncture to-date (570 patients). The results indicated that acupuncture is a safe and effective adjunctive treatment for people with osteoarthritis of the knee. This work builds on our systematic review of the evidence for acupuncture in the treatment of OA published in 2001 and a preliminary study also funded by NCCAM at the NIH.

Cost-Effectiveness of & Long-Term Outcomes Following Acupuncture Treatment for Osteoarthritis of the Knee
Marc Hochberg: Principal Investigator
Brian Berman, Donald Steinwachs, Kevin Frick: Co-Investigators
NIH ,NCCAM Project #,1 5 P50 AT00084

This study, funded as one of the core projects of our NIH Center, is following all the patients enrolled in our large acupuncture and OA of the knee trial. Patients participating in the study are being followed for a total of five years in order to estimate the cost-effectiveness of the acupuncture intervention as well as to determine long-term outcomes and health care utilization and costs.

The Effects of Electro-acupuncture (EA) on Persistent Inflammation and Pain
Lixing Lao: Principal Investigator
Grant Zhang, Ke Ren: Co-Investigators
NIH, NCCAM Project #3, 5 P50 AT00084

Persistent inflammation and pain are the commonest symptom of most arthritis related disorders. This study is being conducted in our basic science lab and is designed to assess the anit-hyperalgesic and anti-inflammatory effects of EA and to investigate EA’s mechanisms (e.g., whether or not it can inhibit inflammation-induced c-fos expression) of action. We have conducted experiments on testing EA parameters and acupuncture point specificity. The purpose of these experiments is to employ an earlier established inflammatory pain model to 1) investigate the anti-hyperalgisic and anti-inflammatory effects of EA, 2) identify optimal EA parameters, 3) test acupuncture point specificity on pain control, and 4) examine the effect of EA on inflammation-induced Fos protein expression in the spinal cord. A paper has been published on the preliminary findings.

The Effect of Acupuncture on Inflammatory Arthritis
Grant Zhang

Using an established animal model of adjuvant arthritis (AA) that features a similar disease course and pathogenic mechanisms to human rheumatoid arthritis, this project is designed to examine the effects of electroacupuncture (EA) on (1) inflammatory pain as well as edema in AA and (2) T cell response to potentially pathogenic determinants within mycobacterial hsp65 in Lewis rats. The project also examines the effects of preventive, early and later EA treatment as well as specific T-cell activities associated with these treatments. To date, eight experiments have been performed for this project. Different treatment frequency and different timing of EA (e.g., in reference to the injection of CFA, the agent causing the inflammation) have been evaluated. These experiments have demonstrated EA can delay the onset of the arthritis in one set of conditions, but so far these initial results have not been replicated, hence the findings are as yet inconclusive.

Study of the Traditional Chinese Herbal Compound, HLXL

We have conducted a number of preclinical trials on the Chinese herbal compound, HLXL, that has been traditionally used by Chinese medical practitioners for the treatment of arthritis related symptoms. These studies have focused on toxicology and mechanism of action. In addition, we have conducted a phase I human study and obtained an IND from the FDA. We are conducting a Phase II study of HLXL as part of our NIH center grant funding.

The Consistency of Traditional Chinese Medicine (TCM) Rheumatoid Arthritis Diagnosis and Herbal Prescription
Grant Zhang, Principal Investigator
NIH, NCCAM 5 R21 AT00590

This project was designed to examine the consistency of TCM diagnoses and herbal prescriptions under controlled conditions (three practitioners separately examining, and prescribing for, the same 120 patients). Two journal articles have been published based upon this study.

Herbal Medicines for the Treatment of OA
L. Long, K. Soeken and E. Ernst

In a review of the literature that we conducted in conjunction with colleagues at the University of Exeter we found that there is promising evidence both for the effectiveness and safety of a range of herbal preparations that are commonly used in the treatment of osteoarthritis (please check the study to identify the particular herbs). In addition, the evidence suggests that some herbal preparations reduce consumption of non-steroidal anti-inflammatory drugs. Considering the large numbers of people suffering from OA, and the known adverse effects associated with NSAID use, we concluded that some herbal medicines might offer a much-needed alternative for patients with osteoarthritis.

S-adenosyl-Methionine (Sam-e) in the Treatment of Osteoarthritis
K. Soeken, E. Ernst, L.Long

Neutraceuticals, such as Sam-e, are commonly used by people who suffer from arthritis. We conducted a systematic review of the literature in conjunction with the University of Exeter, Department of Complementary Medicine

The Effect of Acupuncture on Inflammatory Arthritis
Grant Zhang: Principal Investigator
NIH P50 Development & Feasibility Study, 5 P50 AT00084

This pre-clinical study examined (a) the effect of electroacupuncture on inflammatory pain and edema and (b) the effect of electro-acupuncture on T cell response to potentially pathogenic determinants within the target antigen (Bhsp65).

Mindfulness Intervention for Rheumatoid Arthritis
Brian M. Berman: Principal investigator

This is a randomized, waitlist-controlled study to assess the efficacy of mindfulness-based stress reduction in reducing psychological and physical symptoms of rheumatoid arthritis. Sixty-three rheumatoid arthritis patients are randomized to conventional care only (control) or to conventional care plus mind-body skills (intervention). The main outcomes are change in depressive symptoms and rheumatoid arthritis disease status. The intervention consists of Mindfulness-Based Stress Reduction (MBSR), a meditation and stress-reduction program developed by Kabat-Zinn and colleagues. The MBSR intervention involves weekly 2 ½ hour classes, with daily home meditation and relaxation exercises for 8 weeks, and monthly refresher classes for 3 months. Control group participants are offered the MBSR course free of charge upon completion of all assessment visits in their cohort.

Is the Anti-Arthritic Activity of Green Tea Mediated by Modulation of the Antigen (hsp65) – Specific, Pathogen or Regulator T Cell Responses?
Kamal D. Moudgil: Principal Investigator
NIH P50 Development & Feasibility Study, 5 P50 AT00084

This project was a pilot study designed to ascertain (1) whether the polyphenolic fraction of green tea does exert anti-arthritic activity and if it does (2) what is the optimum dose and (3) what is the mechanism for this effect. The preliminary findings showed that 0.8% PGT fed to Lewis rats for 2 weeks prior to induction of adjuvant arthritis significantly down modulated the course of the disease. Dr. Mougdil has received NIH funding for a larger trial.