Rheumatoid arthritis is a kind of autoimmune disorder with unclear causes. In terms of TCM,rheumatoid arthritis as well as osteoarthritis and fibromyalgia pertain to the category of arthromyodynia. Acupuncture has accumulated an abundant experience in treating this disorder. For different joints affected, point selection and needle-manipulation techniques may vary. When treating large joints such as shoulders or knees, acupuncture methods are similar to that of the frozen shoulder or knee osteoarthritis .Here we emphasize on treating small joints.

Select reflex points with tenderness, swelling, or a higher skin temperature at affected joints or their adjacent regions. Mainly apply needling therapy, but can be combined with moxibustion or infrared radiation. The following are the commonly used points for corresponding joints.

Elbow: Zhouliao (LI12), Quchi (Lill), Qinglengyuan (TE11), Tianjing (TE10), Cuoshan (EX124), Shousanli (LI10), and Sidu (TE9). Wrist: Yangchi (TE4), Yangxi (L15), Yanggu (S15), Shenmen (HT7), Daling (PC7), and Taiyuan (LU9). Metacarpophalangeal joints: Baxie (EX132), Hegu

(L14), Sanjian (L13), Zhongzhu (TE3), and Yemen

(TE2). Ankle: Qiuxu (GB40), Jiexi (ST41), Shangqiu (SP5), Kunlun (BL60), Taixi (K13), and Shenmai (BL62).Metatarsophalangeal joints: Bafeng (EX163). Interphalangeal joints: On the ventral or lateral side of affected joints. When puncturing points on mass muscles or in articular cavities, select thick filiform needles and repeatedly apply various needle-manipulation techniques, such as needle thrusting, lifting, and twisting, or apply the heat-producing technique to attain regional warmness. When puncturing points on the bone surface, insert the needles obliquely or horizontally and slightly move needles back and forth within these points, as if “rubbing against the periosteum”, and then retain the needles for 30 min. For patients with severe articular pain or pain involving multiple joints, select other associate points or advanced needling techniques to help raise the pain threshold or the immunity, such as NTNM (nerve trunk needling method). When NTNM is applied, the patient may feel an electric-shock sensation that radiates toward distant portions of the body without retaining the needles.