Acupuncture Eases Axial Spondyloarthritis Pain, But Benefits Fade by One Year

For millions of people living with axial spondyloarthritis, a chronic inflammatory condition that fuses the spine and turns everyday movements into painful ordeals, the search for relief often extends far beyond the rheumatology clinic. Many patients quietly experiment with complementary therapies, and acupuncture sits near the top of that list. Now, one of the most rigorous tests of integrating Traditional Chinese Medicine into standard rheumatologic care has delivered a sobering verdict: acupuncture-based collaborative care can genuinely ease pain and improve disease activity in the short term, but those benefits evaporate over the course of a year.

The findings come from a pragmatic randomised controlled trial conducted in Singapore, published in BMC Complementary Medicine and Therapies. Researchers led by Yu Heng Kwan and Ting Hui Woon of Singapore General Hospital enrolled 139 patients with active axial spondyloarthritis and randomly assigned them to two groups. Seventy patients received a Traditional Chinese Medicine collaborative model of care, which involved ten TCM consultations paired with acupuncture sessions delivered over the first five weeks, layered on top of their usual rheumatologic care. The remaining 69 patients continued with standard rheumatologic care alone. The trial, registered on ClinicalTrials.gov as NCT03420404, was designed to reflect real-world clinical practice rather than the artificial conditions of a highly controlled explanatory study.

The scientific rationale for the intervention rests on long-standing hypotheses about acupuncture’s physiological effects. Acupuncture has been postulated to exert analgesic and anti-inflammatory actions, potentially modulating pain signaling pathways and inflammatory mediators relevant to conditions like axial spondyloarthritis. Whether those mechanisms translate into measurable, durable clinical benefit in patients already receiving modern disease management is precisely the question the Singapore team set out to answer with a design that could capture the therapy as it would actually be delivered in a health system.

Earlier reports from this trial had generated genuine excitement. At week six, the intervention group showed meaningful improvements in spinal pain, disease activity, and disease-specific quality of life compared with patients receiving usual care alone. Those primary and exploratory outcomes suggested that embedding TCM physicians and acupuncturists within a collaborative care framework alongside rheumatologists could offer patients something extra during a critical window of treatment. For a condition where non-steroidal anti-inflammatory drugs and biologic therapies leave many patients with residual symptoms, a safe adjunct that blunts pain would be a significant clinical advance.

The new publication, however, extends the analysis through week 52 and tempers that optimism considerably. The researchers tracked a comprehensive battery of validated outcome measures at weeks 6, 12, 24, and 52. These included spinal pain, the Bath Ankylosing Spondylitis Disease Activity Index known as BASDAI, the Bath Ankylosing Spondylitis Functional Index or BASFI, the Bath Ankylosing Spondylitis Patient Global Score, the Health Assessment Questionnaire, the 36-item Short Form survey capturing both physical and mental health components, and the Ankylosing Spondylitis Quality of Life instrument. Together, these measures span the full spectrum of what matters to patients: pain, stiffness, physical function, global wellbeing, and quality of life.

To analyze the longitudinal data, the team employed linear mixed models, a statistical approach well suited to repeated measures because it accounts for the correlation between observations taken from the same patient over time and can handle missing data more gracefully than simpler methods. The key quantity of interest was the average treatment effect across all four follow-up time points for each outcome. The result was consistent and unambiguous: for spinal pain, BASDAI, BASFI, HAQ, BAS-G, the SF-36 Physical Component Summary, the SF-36 Mental Component Summary, and ASQoL, the average treatment effects were not statistically significant. In other words, when the entire year of follow-up is considered as a whole, the collaborative TCM care did not outperform usual rheumatologic care.

What does this pattern of results actually mean? The data paint a picture of a treatment effect that is real but transient. The benefits observed at week six, immediately after the intensive five-week course of ten TCM consultations and acupuncture sessions, appear to have faded as the follow-up lengthened. By the time the analysis averages effects across the full year, the early gains are diluted to statistical insignificance. This is a familiar trajectory in trials of complementary therapies and, indeed, in trials of many interventions for chronic pain conditions: short-term symptomatic relief does not necessarily translate into sustained disease modification or long-term functional improvement.

Several explanations merit consideration. Axial spondyloarthritis is a progressive inflammatory disease, and the standard care received by both groups, which can include non-steroidal anti-inflammatory drugs, conventional disease-modifying anti-rheumatic drugs, biologic agents, and targeted synthetic therapies, continues to evolve over a year of treatment. Any modest symptomatic benefit from acupuncture may be overwhelmed by the natural fluctuation of the disease and by adjustments in conventional therapy. It is also possible that the intensive early dosing of acupuncture was insufficient to maintain effects, and that ongoing booster sessions might have preserved the benefit, though the trial was not designed to test that hypothesis. Additionally, pragmatic trials trade some internal control for real-world relevance, and factors such as patient expectations, concurrent treatments, and the heterogeneity of disease severity can all influence the detectable treatment effect.

The trial’s methodology strengthens the credibility of its conclusions. The study followed the Consolidated Standards of Reporting Trials and the Standards for Reporting Interventions in Clinical Trials of Acupuncture, used the Pragmatic Explanatory Continuum Indicator Summary Framework-2 to position the design on the pragmatic spectrum, and aligned its outcome selection with the Outcomes Measures in Rheumatology initiative. A Data and Safety Monitoring Board oversaw the trial, reviewing it in December 2019 and recommending continuation without change. The study was approved by the SingHealth Centralised Institutional Review Board and conducted under the principles of the Declaration of Helsinki, with all participants providing informed consent. Funding came from the Singapore Ministry of Health Traditional Chinese Medicine Research Grant and the Reverie Rheumatology Research Fund, with the funders having no role in study design, data analysis, or the decision to publish.

For patients and clinicians, the practical message is nuanced rather than dismissive. The trial does not claim that acupuncture is useless; it demonstrates that a defined, time-limited course of TCM collaborative care produces short-term improvements in spinal pain, disease activity, and disease-specific quality of life that are not sustained through a full year. Patients who find symptomatic relief from acupuncture during flare periods may still have legitimate reasons to pursue it, provided they continue their prescribed rheumatologic treatment. But health systems and policymakers weighing whether to invest in integrated TCM-rheumatology services now have high-quality evidence that such programs, at least in this configuration, deliver a temporary rather than lasting advantage. The challenge for future research is clear: determine whether modified treatment schedules, different patient subgroups, or combined approaches can convert short-term relief into durable, year-long benefit for people living with this demanding disease.

Subject of Research: Long-term effectiveness of Traditional Chinese Medicine collaborative care with acupuncture for axial spondyloarthritis

Article Title: Traditional Chinese medicine collaborative care in the management of patients with axial spondyloarthritis: long-term outcomes of a pragmatic randomised controlled trial through week 52

Article References: Kwan, Y. H., Woon, T. H., Sum, C. W. Y., Tai, B. C., Huang, Y., Bilger, M., Phang, J. K., Tan, H. C., Quek, S.-A., Lee, J. V., Koh, H. L., Leung, Y. Y., Yeo, S. I., Ng, S. C., Wang, C. T. M., Fong, K. Y., Thumboo, J., Østbye, T., & Fong, W. (2026). Traditional Chinese medicine collaborative care in the management of patients with axial spondyloarthritis: long-term outcomes of a pragmatic randomised controlled trial through week 52. BMC Complementary Medicine and Therapies. https://doi.org/10.1186/s12906-026-05562-5

Image Credits: AI Generated

DOI: 10.1186/s12906-026-05562-5

Keywords: axial spondyloarthritis, acupuncture, Traditional Chinese Medicine, randomised controlled trial, rheumatology, BASDAI, spinal pain, quality of life, integrative medicine, chronic inflammatory disease, pragmatic trial, Singapore