A six-week RCT shows small, but not clinically meaningful, improvements in pain and disease activity.
Adding acupuncture within a Traditional Chinese Medicine–rheumatology care model produced small reductions in pain and disease activity in axial spondyloarthritis, though effects fell short of clinical importance and broader outcomes were unchanged.
In the AcuSpA study, 139 patients with active disease despite NSAIDs were randomised to usual care alone or usual care plus a structured TCM collaborative model, including 10 acupuncture sessions delivered over five weeks.
At six weeks, the intervention group reported lower spinal pain scores than controls by 0.75 points on an 11-point scale, with a similar reduction in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores of 0.71 points.
While statistically significant, both differences fell short of minimal clinically important differences for axSpA, typically around 1.3–1.6 points.
The results of the AcuSpa study have been published in Eular Rheumatology Open.
“This is the first pragmatic RCT to assess the clinical effectiveness and safety of a TCMCMC in the treatment of patients with axSpA,” the researchers wrote.
Disease-specific quality of life, measured using the Ankylosing Spondylitis Quality of Life scale, showed a modest improvement after baseline adjustment, but generic quality of life measures did not shift meaningfully.
Functional impairment, disability and global wellbeing remained unchanged, underscoring the limited short-term impact beyond symptom relief.
The trial’s pragmatic design – conducted in a tertiary care setting with flexible rheumatologic management and individualised acupuncture protocols – was intended to reflect real-world practice, including the way patients often seek complementary therapies when conventional options underperform or are poorly tolerated.
The researchers noted that while biologics and targeted therapies offered higher response rates, cost, access and safety concerns continued to drive interest in adjunctive approaches.
Safety signals were minimal, with one mild acupuncture-related adverse event (bruising) and no serious complications reported.
For clinicians, the findings suggested that acupuncture delivered within a coordinated care model may offer incremental symptom relief for selected patients, particularly those seeking non-pharmacological options.
However, the modest effect sizes, lack of impact on function and short follow-up period tempered enthusiasm. The study was powered only for pain outcomes, and exploratory analyses carried a risk of type I error.
Longer-term data are critical to better understand the potential effects of TCMCMC on AxSpA, the researchers said. They pointed to evidence from chronic low back pain indicating larger effects with extended acupuncture courses, and suggested that future trials should evaluate durability, optimal dosing and integration pathways within multidisciplinary care.
For now, the TCM collaboration appeared safe and feasible, but its clinical value remained incremental rather than transformative, they said.
Related
“In summary, we found that participants who received TCMCMC had lower spinal pain, disease activity (based on BASDAI scores) and better disease-specific quality of life (based on ASQoL scores) at week six, with modest effects observed, compared with those who only received usual rheumatologic care,” the researchers concluded.
“However, further follow-up would be needed to determine the long-term trajectory of the effectiveness of TCMCMC on spinal pain, disease activity and disease-specific quality of life, given that axSpA is a chronic inflammatory condition with fluctuations in disease activity throughout the disease course.”
