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 twenty-five 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. 艾灸疗法在类风湿关节炎的综合治疗中占有重要的一席之地, 在缓解关节及全身症状,调节免疫上具有独特作用, 临床操作方便,无胃肠道反应;与西药联用还能起到减少西药用量,减毒增效的作用.为了系统地评估艾灸治疗类风湿性关节炎的价值, 我们回顾了近25年来发表的193篇中外文献, 发现艾灸疗法具有改善类风湿关节炎患者晨僵,关节疼痛,关节肿胀指数及整体生活质量, 降低 TNF-α,IL-1β等炎症因子的分泌, 抑制滑膜血管新生与细胞增殖, 减轻血管翳形成, 缓解软骨及骨破坏, 增加胶原蛋白与蛋白多糖含量等作用;其机制与抑制 T 细胞活化并纠正免疫细胞及分子失衡, 通过滑膜组织PI3K/Akt/mTOR,HPA 轴介导的 NMDA-NO-cGMP等信号通路调控细胞自噬与凋亡, 调节成骨细胞与破骨细胞分化,延缓软骨降解, 抑制铁死亡有关.除了上述免疫及关节局部效应, 我们还发现艾灸能通过昼夜节律振荡调节细胞因子水平,影响肠道菌群减轻全身炎症反应等关节外途径调控免疫,改善关节炎性病变.本综述更系统,更全面地阐述了艾灸治疗类风湿性关节炎的临床效应, 并介绍了艾灸通过改善骨细胞分化,抑制铁死亡,调节肠道菌群,调节中枢分泌的化学物质治疗类风湿性关节炎的机制, 进一步丰富和深化了对艾灸治疗类风湿性关节炎效应与机制的全面认知.同时也揭示了部分存在的问题, 如治疗穴位的选择较为单一, 不同穴位及其组合的临床功效还需研究, 标准化治疗方案的制定需要进一步落实等.随着科技的进步和研究的深入, 更多的临床效应和治疗机制将会进一步揭示.
KWAN et al. (Sun,) studied this question.