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Rheumatoid Arthritis
Rheumatoid arthritis (chronic polyarthritis) is not a clear indication for leech therapy. Older studies generally do not differentiate sufficiently between inflammatory and activated degenerative joint diseases, and more recent study findings suggest that leeches should not be used to treat acute joint inflammation in patients with rheumatoid arthritis (see Chapter 6). Primary symptoms of swelling in larger proximal joints without marked reddening
or clear evidence of inflammation in laboratory tests (C-reactive protein and blood sedimentation rate), are potential indications for leeching.
Fibromyalgia Syndrome
Local techniques for symptomatic treatment of fibromyalgia should be used with restraint since they could obstruct self-help and lifestyle measures and keep the patient from coming to terms with the disease. Leech therapy has been reported to achieve good results in patients with rheumatic soft-tissue complaints and fibromyalgia syndrome many times over. However, in light of the multilocational nature of pain and unclear causes of the disease, local leech therapy would appear to be a lesser priority. The primary treatment options are classical naturopathic methods such as moderate exercise, hydrotherapy, and "mind-body medicine" (relaxation techniques, stress reduction, coming to terms with the disease), as well as psychosomatic therapy. Leech therapy may be worth a try in patients with severe yet primarily localized tenderness (e.g., in the pcs anserinus of the knee joint or iliosacral joint). However, the 18 tender points used for diagnosis do not necessarily correspond to the optimal leech application sites. Leech therapy should always be incorporated in the overall treatment concept as a supplement to the primary therapy.
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Arthrosis, Arthritis, and Chronic Pain Syndromes
These are clearly the predominant indications for leech therapy in modern medical practice. Historically, leeches were mainly used for treatment of arthritis urica and abscessing infectious joint diseases. For epidemiologi-cal reasons, degenerative joint diseases are more prevalent in the European population today. As their frequency has steadily increased, so these diseases have become more and more prominent in clinical leech therapy in the last decades.
Osteoarthritis of the Knee (Gonarthrosis)
Symptomatic gonarthrosis is one of the best studied indications for leech therapy. In outpatient clinics and on hospital wards such as the former Department of Naturopathic Medicine at Moabit Hospital in Berlin, leech therapy has long achieved very high subjective success ratings after single periarticular leech applications in patients with painful osteoarthritis of the knee. Our research team published a pilot study on the efficacy of leeches in the treatment of painful osteoarthritis of the knee in 2001. Sixteen consecutive patients with confirmed, long-standing cases of painful gonar-throsis that was worse on one side were included in the study. A single treatment with four to six leeches was performed in 10 patients, and standard treatment was continued in the other six. In this controlled but nonrandomized study, leech therapy achieved a rapid and significant (approximately 60%) reduction of pain compared to the control group. The difference in pain reduction became statistically significant three days after treatment and was even more pronounced four weeks after treatment.
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