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CASE SNIPPET
Year : 2023 | Volume
: 69
| Issue : 1 | Page : 61-62
Gold thread acupuncture for chronic pain in multiple joints
GW Kim, YJ Yun, JH Seo, MH Ko
Correspondence Address:
M H Ko
Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju
Republic of Korea
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/jpgm.jpgm_324_22
How to cite this article:A 73-year-old male patient was hospitalized for a stroke. Since the last 30 years, he had been suffering from pain in the lower back and multiple joints; and these symptoms had persisted despite medications. Gold thread acupuncture is a common mode of treatment for joint pains in our country. About 30 years ago, he had undergone gold thread acupuncture sessions (once or twice/month) as treatment for his lower back pain. Nevertheless, over the years, the pain had extended to his knees, elbows, wrists, and fingers. Consequently his gold thread acupuncture sessions frequency had increased to 3 to 4 times/week. The patient had undergone a total left hip arthroplasty in 2015.
The patient had initially came to the hospital with complaints of dizziness. His mental status was alert (24/30 points on Korean-Mini-Mental State Examination (K-MMSE); and he was able to accurately describe the exact pain sites. His Modified-Bathel-Index (MBI) was 39/100 and he described his pain as a 7/10 on a numeric rating scale (NRS). His brain imaging studies revealed right occipital, thalamic and cerebellar infarctions. Physical examination of the patient revealed symmetric deformations and limitation of motion in fingers of both hands. He also complained of pain across multiple joints; lower back, both sacro-iliac joints, knees, wrists, and fingers. Numerous radio-dense gold threads were visible in the cervical, lumbar, knee, shoulder, and abdomen X-rays [Figure 1]. We additionally took a lumbar spine SPECT/CT which revealed that the gold threads were located in the subcutaneous-muscle layers [Figure 2]. Serological tests were performed and CRP levels were assessed. Based on the 2010 ACR/EULAR RA classification criteria, the patient met the diagnostic criteria of rheumatoid arthritis (RA) by 9 points: (i) more than 10 joints including at least one small joint affected (5 points), (ii) low positive RA factor - 19.5 IU/ml, upper normal limit being 14 IU/ml (2 points), (iii) raised CRP - 40 mg/dL, upper normal limit being 5 mg/dL (1 point), and (iv) symptoms lasting more than 6 weeks (1 point). Over the next few weeks, the patient received the recommended treatment for RA (methotrexate and a steroid). On follow-up, his pain in multiple joints had reduced to 3/10 on a NRS.
Figure 1: Numerous radio-dense gold needles visible on the cervical, lumbar, knee, shoulder and abdomen X-rays.
Figure 2: Numerous gold needles visible only in the subcutaneous-muscle layers, and not within joints, on the lumbar spine SPECT/CT.Previous studies have reported the presence of gold threads from acupuncture in a few joints, though few have reported significant quantities of the material across multiple joints.[1],[2],[3] The present case illustrates how diagnosis and treatment of RA gets delayed as a consequence of indiscriminate acupuncture sessions in which several gold threads are left in situ. The sympotoms of the present patient only improved after diagnosis of RA was made and recommended treatment given.
Declaration of patient consent
The authors certify that appropriate patient consent was obtained.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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