Collective evidence from in vivo experiments shows that BVA has a potent analgesic and anti-inflammatory effect. Two clinical studies on degenerative arthritis and three clinical studies on RA suggest that BVA may become a promising treatment for both RA and OA. The number of controlled studies of BVA in arthritis is quite small, and their quality is limited. However, it would be worth considering BVA as an applicable treatment for arthritis in CAM.
Many animal investigations cited in this review have shown that BVA is capable of producing anti-nociception and anti-inflammatory actions in several animal models (10
). Several studies suggested that the effects of bee venom were intensified by acupuncture stimulations, which may help in reaching therapeutic goals. The anti-nociceptive property of BVA may be explained by the process of counter irritation; that is, when noxious stimuli are applied to body regions, these stimuli increase the pain thresholds and reduce pain rating scores through the body. For centuries, pain has been relieved by counter-irritation methods such as moxibustion (a method of burning herbs to stimulate acupuncture points) on arthritic limbs (25
The two uncontrolled investigations (20
) and one RCT study (22
) from the above search results showed that bee venom therapy was very effective in the treatment of RA. The treatment goal for RA can be summarized as follows: first, pain and inflammation should be prevented, since it can lead to pain in the joints, disformity of the joints, or loss of functions; second, chronic inflammation is inhibited so that loss of function in the joints is prevented or minimized to help patients back to normal life. The RCT study of Lee et al
) observed that BVA treatment improved the number of painful joints, swollen joints, morning stiffness and hematological indices. Utilizing the Korean health-related questionnaire, it also showed that BVA treatment could contribute to improvement of patients' quality of life.
One RCT investigations (25
) and one uncontrolled trial study (23
) demonstrated that herbal acupuncture using bee venom for knee arthritis was effective. Previous studies have established the effectiveness of acupuncture treatment both in relieving pain and recovering dysfunction of knees in elderly patients with OA in comparison to non-acupuncture treated control groups (26
). Kwon et al
) compared therapeutic effects of acupuncture by hand manipulation with herbal acupuncture using bee venom. BVA is more effective than acupuncture. Computerized IRT objectively displayed changes in skin temperature in the painful region. Computerized IRT is a method of examination whereby infrared rays naturally emitted from the body are detected, displaying minute changes in body temperature on painful or other diseased parts on the computer monitor. It is a widely employed method of examination, now used for evaluation of pain and prognosis. Kwon et al
) showed that the temperature on the knee region significantly decreased after treatment with bee venom. However, significant change was examined in all groups with severe, moderate or mild degrees of degenerative arthritis.
RA is a typical autoimmune disease, of which exact causative factor have not yet been verified various aspects. The pathogenesis and pathophysiology of RA are being investigated. Until now, there are no methods recommended from perfect prevention or perpetual extermination after onset of RA. Existing methods of treatment for RA can be categorized as medication, surgery, rehabilitation and physical therapy. Medication therapy used in most cases utilizes various kinds of medicine such as NSAIDs, adrenal cortical hormone, anti-rheumatic drugs and immunosuppressive agents, which can cause severe adverse effects such as depression, peptic ulcers, enterohemorrhage, liver malfunction and renal disorders. OA is the most commonly examined arthritis, also known as ‘degenerative arthritis’ or ‘degenerative arthritic disease’. Mostly occurring in middle-aged or elderly people, it attacks the weight-bearing joints—mostly the knee joint—and causes local degenerative changes in cartilage, hypertrophy of subchondral bones, excessive bone formation around osteochondral regions and disformity of joints. Clinically, it shows repetitive pain, ankylosis and gradual dysfunction of movement with inflammatory changes occurring only in a few patients. Western medical treatment of knee arthritis utilizes conservative methods such as medication therapy, rest and exercise, and physical therapy, and surgical methods like arthroscopic debridement, osteomy, arthroscopic surgery and total knee arthroplasty. Patients with mild symptoms should be provided with teaching, physical therapy, and non-narcotic medication and when these do not improve symptoms, prescription of non-steroidal drugs can be considered only when patients have no contraindications for the drug. Steroids are administered to patients with exudative knee arthritis. These treatments have certain adverse effects in RA, calling for safer and more effective methods of treatment (27
In general, in order to determine the appropriateness of using CAM therapy in various conditions, it is necessary to consider the relevant problems such as: the severity and acuteness of illness; curability of the illness by conventional forms of treatment; degree of invasiveness, associated toxicities and side effects of conventional treatment; availability and quality of evidence of utility and safety of desired CAM treatments; level of understanding of risks and benefits of CAM treatments combined with the patient's understanding and voluntary acceptance of those risks; and the patient's persistence of intention to use CAM therapies (29
). A number of complications or adverse effects of conventional treatment call for safer and more effective methods of treatment (7
). There have been investigations on the effects of acupuncture treatment on RA and OA (7
). Recently, bee venom therapy has been proposed as another approach. Several clinical trials have demonstrated that BVA could improve arthritis-related symptoms. However, evidence for BVA is still scarce. In order to enlarge the clinical therapeutic field of BVA throughout the world, rigorous trials of well-organized design are urgently required to determine the role of BVA in treatming of arthritis. A greater understanding of the risks and benefits of BVA is also needed.
Safety intervention is important for estimating its risk–benefit framework. Serious adverse events such as anaphylaxis and non-serious adverse effects such as local swelling or itching are reported with BVA treatment but are infrequent provided that it is practiced according to established safety rules in appropriate anatomic regions (30
). Similarly, there is concerned about the extra cost of BVA. At present no conclusive cost-effectiveness of BVA for arthritis is available, but it requires consideration from an economic point of view. In addition, the determination of acupoints, amount and concentration of bee venom should be carefully considered. Studies on the standardization of such measurements are also required.
Most systematic reviews of therapeutic interventions include only RCTs, which are generally considered as the gold standard for evaluation. However, the medical literature is full of non-randomized and uncontrolled studies. It is certainly highly problematic to draw conclusions on causal effects from non-randomized or uncontrolled studies. However, RCTs also have flaws in other aspects. First, they often recruit only a small and non-representative sample of patients who are then treated and monitored under man-made conditions (31
). As a result, the degree to which the results can be generalized and are externally valid is unclear. Second, RCTs in chronic conditions have limited observation periods because of ethical reasons, feasibility or resources (33
). If the number or quality of available randomized trials is not sufficient to draw conclusions, non-randomized studies might be useful to give a better overview of what is known so far and to inform future research. It is obvious that the number of subjects and the quality of the studies in this review have limitations. However, BVA is considered to be highly promising in the treatment of arthritis.