Heat Therapy Called Moxibustion May Help People with Ankylosing Spondylitis, Short-term Study Finds

Moxibustion, a form of heat therapy widely used in East Asia, given in combination with conventional treatments may be of benefit to people with ankylosing spondylitis, at least in the short-term, a study reported.

Benefits, mostly patient reported after a four-week treatment, included better physical function and health-related quality of life, as well as lower disease activity.

The study, “Moxibustion therapy in Chinese patients with ankylosing spondylitis: A randomized controlled pilot trial,” was published in the journal European Journal of Integrative Medicine.

According to guidelines, first-line treatments for ankylosing spondylitis (AS) include nonsteroidal anti-inflammatory drugs (NSAIDs), disease modifying anti-rheumatic drugs (DMARDs), and TNF (tumor necrosis factor) inhibitors.

These agents, however, can be prohibitively expensive for patients in some countries, including China. There and elsewhere, interest is growing in complementary and alternative medicine (CAM).

One type of CAM, known as manipulative and manual therapy (MMT), was recommended as a non-pharmacological treatment in international guidelines issued by the Assessment in SpondyloArthritis international Society (ASAS)/European League Against Rheumatism (EULAR) in 2010.

Moxibustion, a type of MMT, is a heat therapy using dried plant materials called “moxa” that are burned on or very near the surface of the skin.

The goal is to warm and stimulate the flow of Qi (energy flow) in the body in an effort to dispel pathogenic influences.

Use of moxibustion is quite common in Asia, with one study reporting that 50% of Korean medical doctors used moxibustion in treating arthritis patients. In addition to massage and acupressure, “moxibustion is considered to be one of the most accepted MMTs for the management of rheumatic conditions in China,” the researchers wrote.

To better understand the effect of moxibustion on AS outcomes, researchers in China evaluated the short-term effectiveness and safety of moxibustion therapy in people with this disease.

They conducted a controlled study (AMCTR-IPR-18000206) that enrolled 64 AS patients, randomly assigned to a control (32) or a treatment group (32). Of these, two patients in the treatment group left before the study concluded, one due to mild discomfort after two weeks of moxibustion intervention and one who declined continued participation.

Patients’ mean age and mean disease durations were 46.53 years and 9.83 years, respectively. Most (77.42%) were male.

The control group received standard therapy alone (prescription medication, aerobic exercise, and self-education programs), while the treatment group received in-patient moxibustion therapy in addition to standard therapy for four weeks (once a day for seven days). Outcomes were measured after six weeks.

No significant differences in physical function and disease activity were noted between the two groups at the beginning of the study.

Results showed that treatment with moxibustion significantly improved physical function and reduced disease activity, as observed with the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Bath Ankylosing Spondylitis Disease Activity Indexes (BASDAI), respectively.

Use of moxibustion led to significant improvement in some domains of the health related quality of life survey (HRQoL) and ASQOL (ankylosing spondylitis quality of life) scale.

Patients’ blood samples were analyzed both at the study’s start and after six weeks, showing a decrease in C-reactive protein levels — a marker of inflammation — in treated patients. However, this decrease was not statistically significant.

No significant adverse effects were observed during the course of the study.

“Moxibustion in combination with conventional therapies may exhibit beneficial effects for AS patients in the short-term, such as improved physical function and health-related quality of life and decreased disease activity,” the researchers wrote.

However, they emphasize that these positive results should be interpreted with caution, as most of the outcomes evaluated were limited to self-assessment tools. The study also lacked long-term follow-up, they said, adding that further studies are necessary.