Acupuncture in Psoriatic Arthritis: Available Evidence and Research Perspectives

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Introduction

Psoriatic arthritis (PsA) is a chronic inflammatory condition within the spectrum of spondyloarthritides, affecting peripheral joints, the axial skeleton, and the skin. Approximately 30% of individuals with psoriasis are at risk of developing PsA at some point in their lifetime. The global prevalence ranges from 0.05% to 1%, depending on the population studied [1, 2]. The pathophysiology of PsA involves a complex interplay between genetic, immunological, and environmental factors. Activation of the IL-23/IL-17 immune axis plays a central role, leading to chronic inflammation, enthesitis formation, and bone erosion. T helper 17 (Th17) lymphocytes and activated dendritic cells release pro-inflammatory cytokines such as TNF-α, IL-17, and IL-22, which perpetuate inflammation and joint damage [1, 3]. In recent years, significant advances have been made in PsA treatment with biologic and targeted therapies, including TNF inhibitors and agents targeting interleukins 17 and 23. Despite these improvements in disease control, many patients continue to experience residual symptoms such as pain, fatigue, and functional limitations in daily activities—not to mention challenges related to accessibility of high-cost therapies and their potential adverse effects [4].

Acupuncture, an ancient practice of Traditional Chinese Medicine, has been increasingly investigated in rheumatologic conditions such as rheumatoid arthritis and osteoporosis, demonstrating positive effects in pain reduction and inflammation modulation, as well as central and peripheral nervous system influences [5]. However, research specifically addressing its use in PsA remains scarce and insufficiently explored. This article critically examines the available evidence on acupuncture in PsA, highlighting relevant studies and outlining future directions for clinical research.

Methods

A systematized narrative review was conducted in September 2025. Searches were performed in PubMed/MEDLINE, SciELO, Web of Science, and grey literature, including Chinese repositories and journals of Traditional Chinese Medicine.

Search strategy The following terms were used: psoriatic arthritis, acupuncture, moxibustion, case report, and cohort study, combined with Boolean operators. Equivalent terms in Chinese were also applied for searches in regional databases. Inclusion criteria Primary studies involving patients with a confirmed diagnosis of PsA who underwent acupuncture, either alone or in combination with conventional treatment, were included. Clinical outcomes had to be reported, including pain, stiffness, function, or laboratory markers. Studies focusing exclusively on cutaneous psoriasis or other inflammatory diseases were excluded.

Data extraction and analysis The following data were extracted: year, country, study design, number of participants, clinical characteristics, acupuncture protocol, frequency and duration of sessions, assessed outcomes, and adverse events.

Methodological quality was assessed descriptively, considering diagnostic clarity, standardization of treatment, presence of a control group, sample size, and transparency in the reporting of results.

Results

Four studies were included: three case reports and one prospective cohort study. A summary of the included studies, including their design, interventions, and main outcomes, is presented in Table 1.

Table 1: Summary of studies on acupuncture in psoriatic arthritis. Author/Year (Ref.) Country Study Design N (Participants)

Patient Characteristics Intervention / Technique Acupuncture Points Used Frequency / No. of Sessions Outcomes Assessed Main Findings Martin, 2020 [5] USA Case report 1 Female, 73 years old, dactylitis in interphalangeal joints Traditional acupuncture + supplementat ion (turmeric, sarsaparilla, vitamin D3)

LI4 (Hegu), ST36 (Zusanli), SP6 (Sanyinjiao), BL23 (Shenshu), EX-HN3 (Yintang)

2 sessions, once weekly Pain, stiffness, edema, range of motion Immediate improvement in pain, stiffness, and edema; sustained benefits for 12 months; effect confounded by concomitant supplementation Marchetti, 2020 [6] Italy Case report 1 Adolescent with severe pain in hips, lower limbs, and feet Traditional acupuncture LI4 (Hegu), LI11 (Quchi), ST36 (Zusanli), SP6 (Sanyinjiao)

4 sessions, once weekly, 30 minutes each Pain, functional mobility, adverse events Complete resolution of pain and functional improvement after 4 weeks; no adverse events reported Smith, 2016 [7] USA Case report (non-indexed journal)

Adult with polyarticular psoriatic arthritis Combined acupuncture techniques (manual + electroacupu ncture)

Not clearly specified; general reference to points for joint pain 6 sessions over 3 weeks Pain, stiffness, function Subjective improvement reported, without

objective

measures; limited by lack of peer review Li, 2017 [8] China Prospective cohort 68 Adults with confirmed psoriatic arthritis treated in TCM centers Acupuncture combined with conventional treatment Variable protocols including ST36, SP6, LI4, BL23, GB34 2–3 times per week for 6 months Pain, morning stiffness, joint function Reduction in pain and functional improvement in a subset of patients; absence of control group and methodological limitations Abbreviations: BL: Bladder; EX-HN: Extra Head and Neck points; GB: Gallbladder; LI: Large Intestine; SP: Spleen; ST: Stomach; TCM: Traditional Chinese Medicine The first report describes a 73-year-old female patient presenting with dactylitis affecting the interphalangeal joints. Two sessions of traditional acupuncture were performed, combined with oral supplementation of turmeric, sarsaparilla, and vitamin D3. Immediate improvements were observed in pain, stiffness, and swelling, along with increased range of motion. A 12-month follow-up indicated sustained benefits. However, the presence of co-interventions precludes determining whether the observed improvement was attributable solely to acupuncture [5].

The second report describes a pediatric case involving an adolescent with severe pain in the hips, lower limbs, and feet. The patient underwent four weekly acupuncture sessions, each lasting 30 minutes. At the end of treatment, complete resolution of pain and significant functional improvement were reported, with no adverse effects [6]. The third report was published in a low-visibility journal and described the treatment of psoriatic arthritis using multiple acupuncture styles. Although it provides supplementary information, the lack of peer review and limited methodological detail restrict its reliability [7]. The prospective Chinese cohort study, conducted in 2017, included adults diagnosed with PsA treated in Traditional Chinese Medicine clinics. Patients received acupuncture in combination with conventional therapy over a six-month period. The study reported reductions in joint pain, improvement in morning stiffness, and increased functional capacity in a subset of participants. However, the absence of a control group, lack of standardized acupuncture protocols, and incomplete methodological reporting limit the validity of these findings. Furthermore, as the study is available only in a low-visibility repository, its results should be interpreted with caution [8].

Discussion

The available literature on acupuncture in PsA remains limited and is based on low-quality evidence. All identified case reports demonstrated significant clinical improvements in pain, stiffness, and joint function, with no reports of serious adverse events [5–7]. These findings are consistent with evidence from other inflammatory conditions, such as rheumatoid arthritis, in which acupuncture has shown analgesic potential and modulatory effects on pro-inflammatory cytokines [5].

The pathophysiology of PsA involves abnormal immune system activation, with a central role played by the IL-23/IL-17 axis, infiltration of T helper 17 (Th17) cells, and production of cytokines such as TNF-α and IL-22, which drive synovial inflammation, enthesitis, and bone remodeling [1, 3]. Experimental studies suggest that acupuncture may modulate these processes by influencing neuroimmune pathways, reducing levels of inflammatory cytokines, and promoting autonomic nervous system balance. These mechanisms may partly explain the beneficial effects observed in the analyzed reports.

Despite its promising potential, the available evidence has important limitations. Individual case reports are inherently subject to biases, including placebo effects, therapist-related influences, and external factors. In one of the reports, the simultaneous oral administration of supplements precludes attributing outcomes exclusively to acupuncture [5]. Although the Chinese cohort study provides additional population-level data, the absence of a control group and lack of methodological standardization limit the interpretability of its findings [8].

Nevertheless, the present analysis has notable strengths. A comprehensive search strategy was employed, encompassing not only conventional databases but also hard-to-access journals and grey literature, allowing identification of the most complete body of evidence currently available. Moreover, this review highlights specific knowledge gaps and provides clear directions for future clinical investigations.

To advance the field, well-designed randomized controlled trials are essential. These should include sham-controlled groups, standardized acupuncture protocols, and validated outcome measures such as DAPSA (Disease Activity Index for Psoriatic Arthritis), PsAID (Psoriatic Arthritis Impact of Disease), and ACR20 (American College of Rheumatology 20% improvement criteria). In addition, incorporating quality-of-life assessments and imaging techniques such as ultrasonography may provide further insights into the underlying pathophysiological mechanisms and clinical impact of acupuncture in PsA. Future studies should also focus on long-term safety evaluation.

Conclusion

The use of acupuncture as a complementary approach for managing symptoms of psoriatic arthritis appears promising based on the currently available studies. However, the existing evidence is limited to three case reports and one low-quality prospective cohort, which is insufficient to support robust clinical recommendations. Well-designed, large-scale, multicenter controlled studies are essential to accurately determine the benefits and risks of this intervention in the context of psoriatic arthritis.

Declarations

Author Contributions Jozélio Freire de Carvalho: Conceptualization, study design, literature review, data interpretation, and manuscript drafting. Walter Viterbo: Study design, critical revision of the manuscript, and final approval of the version to be published. All authors have read and approved the final version of the manuscript.

Funding

The authors declare that no financial support was received for the research, authorship, and/or publication of this article.

Conflicts of Interest

The authors declare that they have no conflicts of interest related to this work.

Ethics Approval and Consent to Participate Not applicable. This study is a narrative review based on previously published data.

Consent for Publication Not applicable.

Availability of Data and Materials All data analyzed in this study are included in the published articles cited in the reference list.

Use of Artificial Intelligence The authors declare that artificial intelligence tools were used to assist in language refinement and manuscript preparation.

All content was critically reviewed, validated, and approved by the authors, who take full responsibility for the integrity and accuracy of the work.

Acknowledgments

The authors would like to acknowledge all researchers whose studies contributed to this review.