Rheumatoid Arthritis
No published clinical study of leech therapy in rheumatoid arthritis was identified; early disease-modifying treatment remains the standard, and leeches must never replace or delay it.
Patient Summary
- Is this FDA-cleared for this use?
- No — not FDA-cleared. The FDA cleared medicinal leeches in 2004 only for venous congestion in microsurgical reconstruction (K040187). No published clinical study of leech therapy for rheumatoid arthritis was identified, and the use is not FDA-evaluated.
- What evidence exists?
- No published clinical study of leech therapy for rheumatoid arthritis was found in the medical literature we searched, so it is not known whether it helps or how safe it is in people with this disease. A main reference book on leech therapy says rheumatoid arthritis is not a clear indication, advises against using leeches on a joint that is acutely inflamed, and says that rheumatoid arthritis medicine must never be interrupted. Another reference lists arthritis among possible uses but gives no data for rheumatoid arthritis. Many people with rheumatoid arthritis take medicines that weaken the immune system, which raises the risk of infection, and leech bites can become infected. What is known to help is disease-modifying treatment (methotrexate first, then biologic or targeted medicines when needed), started early and adjusted with a rheumatologist until the disease is under control.
- Main risks
- Bleeding and oozing from each bite site for several hours, sometimes for more than 24 hours
- Infection at a bite site or, rarely, Aeromonas infection from leech gut bacteria, which is more dangerous when rheumatoid arthritis medicines weaken the immune system
- A published case series describes infections after leech therapy for thumb-base arthritis that were treated in a hand-surgery department; the authors note that such infections are typically treated with intravenous antibiotics combined with surgery
- Bleeding into a joint, reported in a published case report after leech therapy
- Slow healing of bite sites if the skin is thin or fragile, for example from diabetes or long-term steroid medicine
- Itching, redness, and irritation at the bite sites (common)
- Allergic reaction to leech saliva (uncommon)
- Loss of disease control, with possible joint damage, if effective treatment is delayed, reduced or stopped
- Who should not consider this
- Patients taking immune-suppressing medicine for rheumatoid arthritis, such as methotrexate, biologic or targeted medicines, or higher-dose steroids
- Patients whose joints are inflamed now (hot, red, swollen, painful)
- Patients whose diagnosis and treatment plan have not been settled with a rheumatologist, or who are thinking of pausing, cutting or replacing their medicine
- Patients with rheumatoid arthritis that affects more than the joints (for example blood vessels, lungs or eyes) until a rheumatologist has evaluated it
- Patients taking blood thinners such as warfarin, apixaban, rivaroxaban, dabigatran, or heparin
- Patients with hemophilia or other inherited bleeding disorders
- Patients with anemia
- Patients with a weakened immune system, especially severe neutropenia
- Patients who have had serious infections in the past
- Patients with thin, fragile skin, diabetes or poor wound healing
- Pregnant patients (leech therapy is not done during pregnancy)
- What to ask your clinician
- Is my rheumatoid arthritis well controlled on my current treatment, and does my rheumatologist know I am considering leech therapy?
- My medicines weaken my immune system: what does that mean for my risk of infection after leech bites?
- Is any joint inflamed right now, and could that be the start of a flare?
- Is there any published study of leech therapy in rheumatoid arthritis? (None was identified for this page.)
- Can I be sure my rheumatoid arthritis medicine will not be paused, reduced or replaced?
- Do my aspirin or anti-inflammatory pain medicines add to the bleeding risk?
- Whom do I call, and how fast can I be seen, if a bite site looks infected?
- What would it cost, and would insurance cover it?
- When to seek urgent care
- Fever above 38.0 C / 100.4 F or chills, especially while taking immune-suppressing medicine (call your doctor the same day; go to the ER if you feel very ill)
- A joint that suddenly becomes hot, red, very painful or swollen, with or without fever (possible joint infection)
- Spreading redness, warmth, pus, red streaks, or increasing pain around the bite sites
- Bleeding from a bite site lasting more than 24 hours or soaking through dressings
- Fever with new cough or shortness of breath
- Hives, facial or tongue swelling, throat tightness, or breathing difficulty
What this does NOT mean
- It does not mean leech therapy is FDA-cleared for rheumatoid arthritis — it is not.
- It does not mean leech therapy treats the disease itself — no study has tested whether it slows joint damage or controls the underlying immune process.
- It does not mean leech therapy can replace, delay or reduce methotrexate, biologic or other prescribed medicines; stopping disease-modifying treatment often leads to a flare.
- It does not mean a missing study proves that leech therapy fails — it means that nobody knows, and the main reference book advises against use on an acutely inflamed joint.
Safety cross-references
Clinical Profile
- Category
- Musculoskeletal
- ICD-10
- M05.79, M06.09, M05.9, M06.00, M06.9
- Safety tier
- High
Evidence Summary
Rheumatoid arthritis is a chronic, systemic autoimmune inflammatory disease that mainly affects the joints (Di Matteo 2023, Lancet). Standard care is treat-to-target treatment with disease-modifying antirheumatic drugs: the EULAR 2022 and 2025 updates recommend methotrexate first, usually with short-term glucocorticoids, and then a biologic or targeted synthetic drug if the response is insufficient. In the TICORA randomized trial (Grigor 2004, n=111), intensive tight-control management lowered disease activity more than routine care. No published clinical study of leech therapy in rheumatoid arthritis was identified in PubMed, Europe PMC or ClinicalTrials.gov (searched 2026-11-12). The two main reference books are cautious. Michalsen, Roth and Dobos (2007) call rheumatoid arthritis (chronic polyarthritis) not a clear indication, note that older studies do not separate inflammatory from degenerative joint disease, advise against applying leeches to acutely inflamed joints and conclude that the literature does not provide sufficient proof of efficacy. The only rheumatoid arthritis report they cite is one unpublished observational study from a 2002 rheumatology congress, which cannot be checked. They state that antirheumatic therapy must not be interrupted, rule out leech therapy in marked immunosuppression, list immune and connective tissue diseases among relative contraindications, and conclude that the risk of serious Aeromonas infection is increased in patients with severe underlying disease or immunosuppression. They also say that once acute inflammation has subsided, leeching may be attempted for pain while antirheumatic therapy continues; this is clinical opinion rather than trial evidence, and this page does not recommend it. Baskova and Isakhanyan (2004) list arthritis and polyarthritis among reported indications and cite short Russian reports of analgesic and anti-inflammatory effects in inflammatory joint disease, and of less pain and swelling when leeches were combined with apitherapy (treatment with bee products), without data specific to rheumatoid arthritis. Infection is the central safety concern: in one Australian clinic, 13% of 263 patients with rheumatoid arthritis had an infection that required hospital admission within 19 months (Wang 2021; not a leech-therapy study), and a 2026 hand-surgery case series (n=5) described infections after leech therapy for thumb-base osteoarthritis. Nothing identified shows that leech therapy slows joint damage or controls the underlying disease, and it is not a substitute for disease-modifying medicines.
What the books describe
Below is a summary of what books on hirudotherapy say about this condition. These are the authors’ observations, not a proven effect and not a promise of results. Hirudotherapy has contraindications; the decision is made by a physician.
- In the clinical sections of their book Baskova and Isakhanyan name rheumatoid arthritis once — in retelling experience of treating children, among other diseases; they do not write separately about rheumatoid arthritis in adults, and in the list of indications they give a general line “arthritis, polyarthritis, arthroses” without dividing it into types, and note that for these conditions — skin diseases, systemic connective tissue diseases, joints — the literature has only a few publications[B1].
- Among the observations Baskova and Isakhanyan cite: according to Starodubskaya (1998), in inflammatory joint diseases the leeches showed an analgesic and anti-inflammatory effect, and according to Melnik and Razumova (1999), in polyarthritis and arthroses combining treatment with bee products and leeches improved the general condition and reduced pain and swelling in the area of the joint; the numbers of patients and comparison groups are not stated in the retelling, and it is not clear from the text whether the patients included people with rheumatoid arthritis or whether the joints were acutely inflamed[B1].
- Flecken and Michalsen write that rheumatoid arthritis (chronic polyarthritis) is not a clear indication: older studies do not differentiate sufficiently between inflammatory and activated degenerative (wear-and-tear) joint diseases, and more recent study findings, in their words, suggest that leeches should not be used to treat acute joint inflammation in patients with rheumatoid arthritis[B3].
- In the chapter on the scientific basis Michalsen writes that articles in the older and more recent literature contradict each other on the use of leeches in chronic polyarthritis and rheumatoid arthritis, and that the data in the literature do not provide sufficient proof of efficacy; he retells one unpublished observational study by researchers in Moscow (51 patients with rheumatoid arthritis and 51 with degenerative joint diseases; no comparison group is mentioned in the text) in which, in his words, function, joint pain and morning stiffness improved significantly in nearly all patients in both groups[B3].
- In the chapter on rheumatic diseases Storck writes that after redness and heat have subsided in response to physical therapy and medication, leeching can be very useful for reducing or eliminating pain in inflammatory rheumatoid arthritis, but the primary antirheumatic treatment must not be interrupted during leech therapy; he gives no study data for this statement[B3].
- Flecken and Michalsen write that hirudotherapy should never be performed in patients with severe, unstable diseases of the organs or marked suppression of the immune system (chemotherapy), while severe, chronic yet stable organ diseases — such as cirrhosis of the liver (with a warning about coagulation disorders), connective tissue diseases, dialysis, immune diseases and diseases of the blood-forming organs — they classify as relative contraindications; whether rheumatoid arthritis is named among them directly is not clear from the text[B3].
- Both books list hemophilia and concurrent use of anticoagulants (medicines that reduce blood clotting) among the contraindications[B1][B3].
Treatment specifics
How many leeches, where they are placed, how long a session lasts, and whether to repeat are clinical decisions made by a qualified provider under institutional protocol — not something to self-administer. Discuss the specifics with a clinician experienced in medicinal leech therapy. (Clinicians: where the society's reference books describe a protocol, it is shown in the clinician view — switch the audience selector in the top bar to “Clinician”.)
Contraindications
- Hemophilia or another bleeding disorder
- Taking anticoagulants (blood thinners such as warfarin or heparin)
- Anemia or suppressed blood formation
- Low blood pressure, shock, collapse or fainting
- Severe wasting (cachexia)
- Intolerance of leeches or a history of severe allergic reactions
- Pregnancy
- Stomach or duodenal ulcer, erosive gastritis
- Acute infectious disease or high fever
- Severe unstable illness, markedly weakened immunity (for example during chemotherapy) or HIV infection
- Drinking alcohol at the time of treatment
- No consent from the patient
- Treatment with immunosuppressive medicines for rheumatoid arthritis (for example methotrexate, biologic or targeted synthetic DMARDs, or higher-dose corticosteroids), because of the risk of infection
- A joint that is acutely inflamed (a flare with redness, heat and swelling)
- Rheumatoid arthritis not yet diagnosed and treated by a rheumatologist, or any plan to pause, reduce or replace disease-modifying treatment
- Active rheumatoid arthritis with features beyond the joints (for example vasculitis, lung or eye involvement) until evaluated by a rheumatologist
- A history of serious infections
- Thin or fragile skin or poor wound healing, for example from diabetes or long-term corticosteroid treatment
- A suddenly hot, swollen, painful joint, especially with fever, until a joint infection has been ruled out
Related Conditions
Knee Osteoarthritis
Off-label use; several small RCTs in knee OA report pain and function improvement with leeches versus NSAID gel, sham leech or TENS, though results against sham and TENS are mixed, and a 2022 trial against physiotherapy found no therapeutic effect.
Ankylosing Spondylitis Axial Pain (Investigational Adjunct)
Investigational adjunct for axial pain in ankylosing spondylitis; NSAIDs, biologic DMARDs (TNF and IL-17 inhibitors), and structured exercise remain evidence-based first-line therapy.
Acute Gout Flare
Investigational use for acute monoarticular gout when NSAIDs and colchicine are contraindicated; evidence limited to a few small Ayurvedic pilot studies.
Thumb Carpometacarpal (CMC-1) Osteoarthritis
Off-label use with one small RCT (Michalsen 2008, 32 women) in which single-session leech therapy reduced pain and improved hand function more than topical diclofenac for about 2 months.
References
- [B1]
Баскова И.П., Исаханян Г.С. Гирудотерапия. Наука и практика [Hirudotherapy: Science and Practice]
Monograph in Russian, 506 pp., ISBN 5-89527-058-1. Chapter 15: sensation at the bite, length of the session; secretion kininases and pain.
- [B3]
Michalsen A., Roth M., Dobos G. Medicinal Leech Therapy
ISBN 978-3-13-143581-1 / 978-1-58890-563-5. Chapter 9, p. 107: perceptions of the bite — a local dragging pain lasting around one to five minutes.
The information on this page is based on the hirudotherapy books listed under References and reflects the experience their authors describe. Sensations and results differ from person to person. This information is not medical advice, a diagnosis or a prescription, and it does not replace an examination by a physician. Do not stop or change any prescribed treatment without your physician. Hirudotherapy has contraindications.