La fluorose est due à une prise excessive de fluor, dans l'eau potable fluorée par exemple. Un niveau modéré d'exposition chronique (supérieur à 1,5 mg/l d'eau) est assez courant. Une ingestion à long terme de grandes quantités peut mener à des problèmes squelettiques potentiellement graves (fluorose squelettique). Les premiers symptômes d'une fluorose squelettique incluent une rigidité et une douleur dans les articulations. Dans les cas graves, la structure de l'os peut changer et les ligaments peuvent se calcifier, avec un affaiblissement des muscles et des douleurs.

Pour évaluer l'effet de l'acupuncture sur la fluorose squelettique endémique (FSE), quatre-vingt-dix-neuf sujets (âgés de 30 à 75 ans) souffrant de FSE sont inclus dans un essai contrôlé randomisé. Ils sont répartis de façon aléatoire en deux groupes : un groupe de traitement par acupuncture et électroacupuncture (n=68, dont 27 hommes et 42 femmes) et un groupe témoin (n=31, dont 12 hommes et 19 femmes).

Le traitement par acupuncture est basé sur les principes de MTC : favoriser la circulation du Sang pour éliminer la stase du Sang, dissiper le Vent et éliminer l'Humidité, ainsi que soulager la douleur par des points locaux. Le traitement est réalisé au rythme d'une séance tous les deux jours, par cycle de un mois. Le traitement total comporte deux cycles. Chaque séance dure 30 minutes. Les points de base utilisés sont les suivants : 17 VG, 17V, 11GI, 4GI, 12Rt, 10Rt, 6Rt, 40E. Des points locaux sont ajoutés en cas de douleur (épaule : 15GI ; coude : 5P ; poignet : 4TR ; cou : 10V ; taille : 3VG ; hanche : 30VB ou 29VB ; genou : 35E, cheville : 41E ; points ashi. L'électroacupuncture est appliquée aux points 11GI, 4GI en unilatéral du même côté, et aux points locaux des deux côtés. Les aiguilles non associées à l'électroacupuncture sont manipulées manuellement (enfoncer ; soulever et rotation) pendant 1 minute toutes les 15 minutes. Le groupe contrôle est traité par Caltrate® et vitamine D en comprimés. Le fluorure urinaire, la calcémie, le taux de phosphate sérique ainsi que la douleur ont été évalués avant et après traitement.

Les résultats ont montré que chez les patients atteints de FSE, l'acupuncture, comme les médicaments, peut soulager avec efficacité la douleur (avec meilleur effet de l'acupuncture ; P <0,05). L'acupuncture peut aussi réduire le taux sérique de calcium et de phosphate. Mais l'effet de l'acupuncture est supérieur car le taux de fluorure urinaire est augmenté après un traitement par acupuncture alors qu'il reste inchangé après la prise de médicaments.

Méridiens Medline du 27 octobre 2013 au 24 novembre 2013 (articles en libre accès)

1 : Kaneko S, Watanabe M, Takayama S, Numata T, Seki T, Tanaka J, Kanemura S, Kagaya Y, Ishii T, Kimura Y, Yaegashi N. Heart rate variability and hemodynamic change in the superior mesenteric artery by acupuncture stimulation of lower limb points : a randomized crossover trial. Evid Based Complement Alternat Med. 2013 ;2013:315982. doi : 10.1155/2013/315982. Epub 2013 Nov 20. PubMed PMID : 24381632 ; PubMed Central PMCID : PMC3872304.

2 : Haddad-Rodrigues M, Spanó Nakano AM, Stefanello J, Campos Pereira Silveira RC. Acupuncture for anxiety in lactating mothers with preterm infants : a randomized controlled trial. Evid Based Complement Alternat Med. 2013 ;2013:169184. doi : 10.1155/2013/169184. Epub 2013 Nov 24. PubMed PMID : 24369477 ; PubMed Central PMCID : PMC3858010.

3 : Fang J, Zheng N, Wang Y, Cao H, Sun S, Dai J, Li Q, Zhang Y. Understanding Acupuncture Based on ZHENG Classification from System Perspective. Evid Based Complement Alternat Med. 2013 ;2013:956967. Epub 2013 Nov 21. Review. PubMed PMID : 24348731 ; PubMed Central PMCID : PMC3857847.

4 : Liu L, Cheung RT. Effects of pretreatment with a combination of melatonin and electroacupuncture in a rat model of transient focal cerebral ischemia. Evid Based Complement Alternat Med. 2013 ;2013:953162. doi : 10.1155/2013/953162. Epub 2013 Nov 20. PubMed PMID : 24348730 ; PubMed Central PMCID : PMC3853035.

5 : He W, Litscher G, Jing XH, Shi H, Wang XY, Gaischek I, Su YS, Litscher D, Yang ZK, Xin JJ, Hu L. Effectiveness of Interstitial Laser Acupuncture Depends upon Dosage : Experimental Results from Electrocardiographic and Electrocorticographic Recordings. Evid Based Complement Alternat Med. 2013 ;2013:934783. doi : 10.1155/2013/934783. Epub 2013 Nov 20. PubMed PMID : 24348729 ; PubMed Central PMCID : PMC3853036.

6 : Jincao Z, Zhongchao W, Zhongjie C, Xiaoguang Z, Jing H, Yue J, Guiran L, Li P. Clinical effect of acupuncture on endemic skeletal fluorosis : a randomized controlled trial. Evid Based Complement Alternat Med. 2013 ;2013:839132. doi : 10.1155/2013/839132. Epub 2013 Nov 17. PubMed PMID : 24348724 ; PubMed Central PMCID : PMC3855966.

7 : Du M, Chen R, Quan R, Zhang L, Xu J, Yang Z, Yang D. A brief analysis of traditional chinese medical elongated needle therapy on acute spinal cord injury and its mechanism. Evid Based Complement Alternat Med. 2013 ;2013:828754. doi : 10.1155/2013/828754. Epub 2013 Nov 24. PubMed PMID : 24348723 ; PubMed Central PMCID : PMC3857841.

8 : Xu J, Chen Y, Liu S, Hou X. Electroacupuncture regulates apoptosis/proliferation of intramuscular interstitial cells of cajal and restores colonic motility in diabetic constipation rats. Evid Based Complement Alternat Med. 2013 ;2013:584179. doi : 10.1155/2013/584179. Epub 2013 Nov 18. PubMed PMID : 24348706 ; PubMed Central PMCID : PMC3852313.

9 : Ablin J, Fitzcharles MA, Buskila D, Shir Y, Sommer C, Häuser W. Treatment of Fibromyalgia Syndrome : Recommendations of Recent Evidence-Based Interdisciplinary Guidelines with Special Emphasis on Complementary and Alternative Therapies. Evid Based Complement Alternat Med. 2013 ;2013:485272. Epub 2013 Nov 21. Review. PubMed PMID : 24348701 ; PubMed Central PMCID : PMC3856149.

10 : Yuan HW, Ma LX, Zhang P, Lin C, Qi DD, Li J, Xin SY, Hu NJ, Li CH, Liu YQ, Hao J, Xie JP, Cui H, Zhu J. An exploratory survey of deqi sensation from the views and experiences of chinese patients and acupuncturists. Evid Based Complement Alternat Med. 2013 ;2013:430851. doi : 10.1155/2013/430851. Epub 2013 Nov 21. PubMed PMID : 24348700 ; PubMed Central PMCID : PMC3857737.

11 : Yang ZK, Wu ML, Xin JJ, He W, Su YS, Shi H, Wang XY, Hu L, Jing XH, Litscher G. Manual acupuncture and laser acupuncture for autonomic regulations in rats : observation on heart rate variability and gastric motility. Evid Based Complement Alternat Med. 2013 ;2013:276320. doi : 10.1155/2013/276320. Epub 2013 Nov 21. PubMed PMID : 24348694 ; PubMed Central PMCID : PMC3857851.

12 : Xu MS, Zhang SJ, Zhao D, Liu CY, Li CZ, Chen CY, Li LH, Li MZ, Xu J, Ge LB. Electroacupuncture-Induced Neuroprotection against Cerebral Ischemia in Rats : Role of the Dopamine D2 Receptor. Evid Based Complement Alternat Med. 2013 ;2013:137631. doi : 10.1155/2013/137631. Epub 2013 Nov 21. PubMed PMID : 24348687 ; PubMed Central PMCID : PMC3856151.

13 : Zheng J, Zhao Y, Wang Y, Hu S, Lu P, Shen X. The infrared radiation temperature characteristic of acupoints of mammary gland hyperplasia patients. Evid Based Complement Alternat Med. 2013 ;2013:567987. doi : 10.1155/2013/567987. Epub 2013 Nov 14. PubMed PMID : 24327822 ; PubMed Central PMCID : PMC3847962.

14 : Shi X, Litscher G, Wang H, Wang L, Zhao Z, Litscher D, Tao J, Gaischek I, Sheng Z. Continuous auricular electroacupuncture can significantly improve heart rate variability and clinical scores in patients with depression : first results from a transcontinental study. Evid Based Complement Alternat Med. 2013 ;2013:894096. doi : 10.1155/2013/894096. Epub 2013 Nov 12. PubMed PMID : 24324522 ; PubMed Central PMCID : PMC3845853.

15 : Kim SY, Shin YI, Nam SO, Lee CH, Shin YB, Ko HY, Yun YJ. Concurrent Complementary and Alternative Medicine CAM and Conventional Rehabilitation Therapy in the Management of Children with Developmental Disorders. Evid Based Complement Alternat Med. 2013 ;2013:812054. doi : 10.1155/2013/812054. Epub 2013 Nov 12. PubMed PMID : 24324519 ; PubMed Central PMCID : PMC3845708.

16 : Landgren K. Acupuncture in practice : investigating acupuncturists' approach to treating infantile colic. Evid Based Complement Alternat Med. 2013 ;2013:456712. doi : 10.1155/2013/456712. Epub 2013 Nov 13. PubMed PMID : 24324513 ; PubMed Central PMCID : PMC3846151.

17 : Chen CW, Tai CJ, Choy CS, Hsu CY, Lin SL, Chan WP, Chiang HS, Chen CA, Leung TK. Wave-induced flow in meridians demonstrated using photoluminescent bioceramic material on acupuncture points. Evid Based Complement Alternat Med. 2013 ;2013:739293. doi : 10.1155/2013/739293. Epub 2013 Nov 7. PubMed PMID : 24307911 ; PubMed Central PMCID : PMC3838801.

18 : Yuan HW, Ma LX, Qi DD, Zhang P, Li CH, Zhu J. The Historical Development of Deqi Concept from Classics of Traditional Chinese Medicine to Modern Research : Exploitation of the Connotation of Deqi in Chinese Medicine. Evid Based Complement Alternat Med. 2013 ;2013:639302. Epub 2013 Nov 5. Review. PubMed PMID : 24302968 ; PubMed Central PMCID : PMC3835614.

19 : Wang Y, Yin LM, Xu YD, Lui YY, Ran J, Yang YQ. The Research of Acupuncture Effective Biomolecules : Retrospect and Prospect. Evid Based Complement Alternat Med. 2013 ;2013:608026. Epub 2013 Nov 2. Review. PubMed PMID : 24302967 ; PubMed Central PMCID : PMC3835779.

20 : Ehling D. Integrative techniques using acupuncture, Chinese herbal medicine, diet, and supplements for polycystic ovary syndrome : a case report. J Integr Med. 2013 Nov ;11(6):422-7. doi : 10.3736/jintegrmed2013055. PubMed PMID : 24299606.

21 : Pach D, Yang-Strobel X, Lüdtke R, Roll S, Icke K, Brinkhaus B, Witt CM. Standardized versus Individualized Acupuncture for Chronic Low Back Pain : A Randomized Controlled Trial. Evid Based Complement Alternat Med. 2013 ;2013:125937. doi : 10.1155/2013/125937. Epub 2013 Oct 28. PubMed PMID : 24288556 ; PubMed Central PMCID : PMC3830844.

22 : Hon KL, Luk DC, Leong KF, Leung AK. Cupping Therapy May be Harmful for Eczema : A PubMed Search. Case Rep Pediatr. 2013 ;2013:605829. doi : 10.1155/2013/605829. Epub 2013 Oct 27. PubMed PMID : 24282650 ; PubMed Central PMCID : PMC3825217.

23 : Darwish SF, El-Bakly WM, Arafa HM, El-Demerdash E. Targeting TNF-α and NF-κB activation by bee venom : role in suppressing adjuvant induced arthritis and methotrexate hepatotoxicity in rats. PLoS One. 2013 Nov 20 ;8(11) :e79284. doi : 10.1371/journal.pone.0079284. eCollection 2013. PubMed PMID : 24278124 ; PubMed Central PMCID : PMC3835890.

24 : Wang G, Tian Y, Jia S, Zhou W, Zhang W. Pilot study of blood perfusion coherence along the meridian in forearm. BMC Complement Altern Med. 2013 Nov 23 ;13:327. doi : 10.1186/1472-6882-13-327. PubMed PMID : 24267384 ; PubMed Central PMCID : PMC3842661.

25 : Kim SA, Lee BH, Bae JH, Kim KJ, Steffensen SC, Ryu YH, Leem JW, Yang CH, Kim HY. Peripheral afferent mechanisms underlying acupuncture inhibition of cocaine behavioral effects in rats. PLoS One. 2013 Nov 18 ;8(11) :e81018. doi : 10.1371/journal.pone.0081018. eCollection 2013. PubMed PMID : 24260531 ; PubMed Central PMCID : PMC3832370.

26 : Sun J, Jin C, Wu H, Zhao J, Cui Y, Liu H, Wu L, Shi Y, Zhu B. Effects of electro-acupuncture on ovarian P450arom, P450c17α and mRNA expression induced by letrozole in PCOS rats. PLoS One. 2013 Nov 18 ;8(11) :e79382. doi : 10.1371/journal.pone.0079382. eCollection 2013. PubMed PMID : 24260211 ; PubMed Central PMCID : PMC3832614.

27 : Yao W, Shen Z, Ding G. Simulation of interstitial fluid flow in ligaments : comparison among Stokes, Brinkman and Darcy models. Int J Biol Sci. 2013 Nov 5 ;9(10):1050-6. doi : 10.7150/ijbs.7242. eCollection 2013. PubMed PMID : 24250250 ; PubMed Central PMCID : PMC3831118.

28 :[ Silva ED, Tesser CD. Acupuncture patients' experience in the Brazilian Unified National Health System in different healthcare settings and social (de)medicalization]. Cad Saude Publica. 2013 Nov ;29(11):2186-96. Portuguese. PubMed PMID : 24233034.

29 : Skjeie H, Skonnord T, Fetveit A, Brekke M. Acupuncture for infantile colic : a blinding-validated, randomized controlled multicentre trial in general practice. Scand J Prim Health Care. 2013 Dec ;31(4):190-6. doi : 10.3109/02813432.2013.862915. Epub 2013 Nov 15. PubMed PMID : 24228748 ; PubMed Central PMCID : PMC3860294.

30 : Li J, Zheng H, Zhao L, Li Y, Zhang Y, Chang XR, Wang RH, Shi J, Cui J, Huang YL, Li X, Chen J, Li DH, Liang FR. Acupuncture for patients with mild hypertension : study protocol of an open-label multicenter randomized controlled trial. Trials. 2013 Nov 11 ;14:380. doi : 10.1186/1745-6215-14-380. PubMed PMID : 24216113.

31 : Yi PL, Lu CY, Cheng CH, Tsai YF, Lin CT, Chang FC. Amygdala opioid receptors mediate the electroacupuncture-induced deterioration of sleep disruptions in epilepsy rats. J Biomed Sci. 2013 Nov 12 ;20:85. doi : 10.1186/1423-0127-20-85. PubMed PMID : 24215575 ; PubMed Central PMCID : PMC3831849.

32 : Yang M, Li X, Liu S, Li Z, Xue M, Gao D, Li X, Yang S. Meta-analysis of acupuncture for relieving non-organic dyspeptic symptoms suggestive of diabetic gastroparesis. BMC Complement Altern Med. 2013 Nov 9 ;13:311. doi : 10.1186/1472-6882-13-311. PubMed PMID : 24206922.

33 : McKee MD, Kligler B, Fletcher J, Biryukov F, Casalaina W, Anderson B, Blank A. Outcomes of acupuncture for chronic pain in urban primary care. J Am Board Fam Med. 2013 Nov-Dec ;26(6):692-700. doi : 10.3122/jabfm.2013.06.130003. PubMed PMID : 24204065 ; PubMed Central PMCID : PMC3979293.

34 : Arvidsdotter T, Marklund B, Taft C. Effects of an integrative treatment, therapeutic acupuncture and conventional treatment in alleviating psychological distress in primary care patients—a pragmatic randomized controlled trial. BMC Complement Altern Med. 2013 Nov 7 ;13:308. doi : 10.1186/1472-6882-13-308. PubMed PMID : 24200100.

35 : Zhang XZ, Zhang L, Guo J, Zeng L, Yang Y, Zhang T, Shi GX, Liu HL, Wang LP. Acupuncture as prophylaxis for menstrual-related migraine : study protocol for a multicenter randomized controlled trial. Trials. 2013 Nov 6 ;14:374. doi : 10.1186/1745-6215-14-374. PubMed PMID : 24195839 ; PubMed Central PMCID : PMC3830503.

36 : Yan H, Su Y, Chen L, Zheng G, Lin X, Chen B, Zhou B, Zhang Q. Rehabilitation for the management of knee osteoarthritis using comprehensive traditional Chinese medicine in community health centers : study protocol for a randomized controlled trial. Trials. 2013 Nov 4 ;14:367. doi : 10.1186/1745-6215-14-367. PubMed PMID : 24188276.

37 : Cheshire A, Polley M, Peters D, Ridge D. Patient outcomes and experiences of an acupuncture and self-care service for persistent low back pain in the NHS : a mixed methods approach. BMC Complement Altern Med. 2013 Nov 1 ;13:300. doi : 10.1186/1472-6882-13-300. PubMed PMID : 24180515 ; PubMed Central PMCID : PMC3827006.

38 : Cho JH, Nam DH, Kim KT, Lee JH. Acupuncture with non-steroidal anti-inflammatory drugs (NSAIDs) versus acupuncture or NSAIDs alone for the treatment of chronic neck pain : an assessor-blinded randomised controlled pilot study. Acupunct Med. 2014 Feb ;32(1):17-23. doi : 10.1136/acupmed-2013-010410. Epub 2013 Oct 30. PubMed PMID : 24171895 ; PubMed Central PMCID : PMC3932742.

39 : Chen J, Zhao L, Zheng H, Li Y, Yang M, Chang X, Gong B, Huang Y, Liu Y, Liang F. Evaluating the prophylaxis and long-term effectiveness of acupuncture for migraine without aura : study protocol for a randomized controlled trial. Trials. 2013 Oct 30 ;14:361. doi : 10.1186/1745-6215-14-361. PubMed PMID : 24171782 ; PubMed Central PMCID : PMC3816544.

40 : Sun ZR, Yue JH, Zhang QH. Electroacupuncture at Jing-jiaji points for neck pain caused by cervical spondylosis : a study protocol for a randomized controlled pilot trial. Trials. 2013 Oct 29 ;14:360. doi : 10.1186/1745-6215-14-360. PubMed PMID : 24168460.

41 : Zheng W, Wang H, Zhang L, Bian Z, Shang H. Target dIsease-Guided placEbo-contRolled (TIGER) design : a novel method for clinical trials of acupuncture. Trials. 2013 Oct 29 ;14:359. doi : 10.1186/1745-6215-14-359. PubMed PMID : 24168427 ; PubMed Central PMCID : PMC3816100.

42 : Tippens KM, Chao MT, Connelly E, Locke A. Patient perspectives on care received at community acupuncture clinics : a qualitative thematic analysis. BMC Complement Altern Med. 2013 Oct 29 ;13:293. doi : 10.1186/1472-6882-13-293. PubMed PMID : 24168022.

43 : Yi PL, Lu CY, Cheng CH, Tsai YF, Lin CT, Chang FC. Activation of amygdala opioid receptors by electroacupuncture of Feng-Chi (GB20) acupoints exacerbates focal epilepsy. BMC Complement Altern Med. 2013 Oct 29 ;13:290. doi : 10.1186/1472-6882-13-290. PubMed PMID : 24165229 ; PubMed Central PMCID : PMC3816151.

44 : Yang L, Yue N, Zhu X, Han Q, Liu Q, Yu J, Wu G. Electroacupuncture upregulates ERK signaling pathways and promotes adult hippocampal neural progenitors proliferation in a rat model of depression. BMC Complement Altern Med. 2013 Oct 28 ;13:288. doi : 10.1186/1472-6882-13-288. PubMed PMID : 24165147 ; PubMed Central PMCID : PMC3813990.