Background and Purpose
Rheumatoid arthritis (RA) is a frequent inflammatory joint disease affecting 1% of the population and is the most common systemic autoimmune disease worldwide. RA begin with inflammation of the joint synovium, proceed to the deformation of the joint, and result in various symptoms including pain. According to the statistics of the Health Insurance Review and Assessment Service from 2017 to 2021, the number of RA patients who visited the hospital was 124,030 to 146,321. According to a domestic cohort study, the quality of life score of RA patients was 0.68, which is lower than the quality score of cancer patients (0.75). These data shows that RA has a serious impact on the decline in quality of life.
Regarding the treatment of RA, the representative treatments including medication have been suggested, but limitations have been reported. On the other hand, a number of studies have been reported that Korean medicine treatments such as acupuncture, moxibustion, herbal medicine, and pharmacopuncture, which can help relieve symptoms and improve the quality of life, are effective in treating RA and have few side effects. Therefore, For the contribution to the health promotion of RA patients, it is necessary to develop systematic and high-quality clinical practice guideline (CPG).
This Korean medicine CPG of RA was developed first in the Republic of Korea. By 2022, a survey of clinical practice of RA by Korean medicine doctors was conducted, relevant data including previous CPGs was reviewed, and Korean medicine related clinical evidence were collected and analyzed according to the opinion of domestic experts. These process was conducted for the purpose of providing high quality of Korean medicine treatment to RA patients and helping clinical physicians make good decisions.
Overview of disease
RA is a representative autoimmune disease and is one of the chronic inflammatory diseases that invade various tissues and organs. Clinical manifestations vary, but joint symptoms are representative. In other words, symptoms including pain, tenderness, swelling, stiffness, and redness are occurs in the joints, and there are several affected joints, which are often accompanied by restriction of joint movement and deterioration of quality of life.
RA diagnosis is based on the blood tests, radiologic testm and the patient’s symptoms. Through blood tests, the presence of Rheumatoid factor and anti-CCP antibody and acute phase reactants are checked, and the degree of cartilage damage or erosion is checked through radiologic test. In addition, the duration of symptoms and the number of joint involvement are used as diagnostic criteria for rheumatoid arthritis.
In Korean medicine, it corresponds to Bi syndrome (痺證), and is classified according to the causative symptom, such as xingbi (行痹), tongbi (痛痹), zhebi (着痹), and rebi (熱痹). In Traditional Chinese medicine, the etiology was subdivided, and herbal medicine according to the pattern identification, acupuncture, moxibustion, Chinese tablets, and external treatment were suggested. For the treatment of RA, physicians can use Korean medicine treatment methods such as acupuncture, moxibustion, herbal medicine, and pharmacopuncture. Each treatment can be used alone or in combination according to the patient’s age, symptoms, and joint site. In addition, it requires life management and education that can be implemented in daily life.
