Gold threads around the sacroiliac joints: traces of attempts to relieve pain in a case of advanced ankylosing spondylitis

Article information

Korean J Intern Med. 2022;37(6):1267-1268

Publication date (electronic) : 2022 July 27

doi : https://doi.org/10.3904/kjim.2022.172

Wan-Hee Yoo^1,2, Yunjung Choi^1,2

¹Division of Rheumatology, Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Korea

²Research Institute of Clinical Medicine, Jeonbuk National University & Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, Korea

Correspondence to: Yunjung Choi, M.D., Tel: +82-63-250-1671, Fax: +82-63-254-1609, E-mail: imcyj@jbnu.ac.kr

Received 2022 May 11; Revised 2022 May 24; Accepted 2022 May 25.

A 47-year-old male presented to our rheumatology clinic with complaints of exaggerated thoracic kyphosis and limited range of back motion. In his early 20s, he visited a rheumatology clinic because of hip pain and lower back stiffness and was diagnosed to have ankylosing spondylitis. Plain radiographs identified grade II sacroiliitis and elevated C-reactive protein levels and human leukocyte antigen B27 positivity were also detected. At that time, he was prescribed anti-inflammatory drugs but he refused to take the medicine as he experienced gastrointestinal disturbance and eventually lost to follow-up. Upon his initial presentation to our clinic, radiography revealed numerous gold threads around his sacroiliac (SI) joints (Fig. 1), and it was speculated that the patient had experienced serious SI joint pain. In our clinic, we performed the screening and prophylaxis prior to initiating anti-tumor necrosis factor (TNF)-α treatment and prescribed the anti-TNF inhibitor. The patient reported a substantial diminishment in pain and is currently on a regular follow-up schedule.

Figure 1

This plain radiograph of the sacroiliac joints (A, right; B, left) shows numerous linear radiopaque materials, which correspond to gold threads implanted by acupuncture therapy. Subchondral sclerosis, erosion, and joint space narrowing are present in both sacroiliac joints.

Acupuncture is a procedure of inserting needles into the specific acupoints in the body and manipulating them for the purpose of analgesia. Gold threads acupuncture has been performed using specially designed needles for implantation of multiple small pieces of gold threads in anticipation of their acting as stimulants to relieve pain. However, the therapeutic potential of acupuncture in inflammation is still controversial, and numerous adverse reactions has been reported including foreign body granuloma formation, mycobacterial infection, cutaneous tuberculosis and panniculitis.

Ankylosing spondylitis is a chronic immune-mediated inflammatory disorder that causes severe pain and disability of axial skeleton predominantly. The well-established treatments including non-steroidal anti-inflammatory drugs and biologic therapy provide pain relief and impede radiographic progression.

This study was approved by the Jeonbuk National University Hospital Ethics Committee (CUH202111014-HE001).