• The ACR core disease measures [ Time Frame: wk52 ] [ Designated as safety issue: Yes ]
• DAS 28 score [ Time Frame: wk52 ] [ Designated as safety issue: Yes ]
• The number of patients who achieved ACR 20 at week 10. [ Time Frame: wk52 ] [ Designated as safety issue: Yes ]

• The ACR core disease measures
• DAS 28 score
• The number of patients who achieved ACR 20 at week 10.

To study the efficacy of acupuncture used as an adjunct measure for patients with refractory RA

The study employs a randomized, prospective, double-blind, placebo-controlled trial to evaluate the effect of electroacupuncture, traditional Chinese acupuncture and sham acupuncture in patients with refractory RA. All patients received 20 sessions over a period of 10 weeks. Six acupuncture points were chosen. Primary outcome is the changes in the pain score. Secondary outcomes included the changes in the ACR core disease measures, DAS 28 score and the number of patients who achieved ACR 20 at week 10.

Inclusion Criteria:

• Fulfilled The American College of Rheumatology (ACR)[10] criteria of RA
• Active disease affecting the hands and wrists defined as having at least 4 tender joints and 2 swollen joints
• Early morning stiffness of greater than 45 minutes
• ESR > 28 mmHg or CRP > 10
• Patients taking disease modifying anti-rheumatic drugs (DMARDs) were eligible if they were on a stable dose for at least 3 months before screening.
• Patients on stable doses of one non-steroidal anti-inflammatory drug (NSAID) or up to 10 mg daily prednisone were also included.

Exclusion Criteria:

• Under the age of 18 years
• Pregnancy
• Previously had acupuncture
• Localized skin infections
• Anticoagulated
• Bleeding diathesis
• Intra-articular corticosteroid within 4 weeks preceding the study
• Any severe chronic or uncontrolled co-morbid disease
• Fear of needles