Acupuncture and Knee Osteoarthritis: Does Dose Matter?

Effect of 4 weeks vs 8 weeks of acupuncture for knee osteoarthritis in China: protocol for a randomised controlled trial

INTRODUCTION

Knee osteoarthritis represents the prevalent and incapacitating disease. Acupuncture, a widely used clinical treatment for knee osteoarthritis, has been shown to ameliorate pain and enhance joint function in affected individuals. However, there is a lack of evidence comparing different courses of acupuncture for knee osteoarthritis. In this trial, we will assess the effect of 4 weeks vs 8 weeks of acupuncture in patients with knee osteoarthritis.

METHODS AND ANALYSIS

The protocol is a pragmatic, parallel, two-arm randomised controlled trial, with the data analyst and assessor being blinded. 148 eligible patients with knee osteoarthritis will be randomly allocated in a 1:1 ratio to receive 4-week or 8-week acupuncture. Electroacupuncture will be administered three times per week for 4 or 8 weeks, respectively. Patients with knee osteoarthritis in both groups will be followed up to 26 weeks. The primary outcome is the response rate at week 26, and secondary outcomes include knee joint pain, knee joint function, knee joint stiffness, quality of life, patient global assessment, the Osteoarthritis Research Society International response rate and rescue medicine. A cost-effectiveness analysis will be carried out over 26 weeks.

ETHICS AND DISSEMINATION

The protocol has been approved by the Medical Ethical Committee of Beijing University of Chinese Medicine (2023BZYL0506). The study findings will be disseminated through presentation in a medical journal. Additionally, we plan to present them at selected conferences and scientific meetings.

TRIAL REGISTRATION NUMBER

Chinese Clinical Trials Registry (ChiCTR2300073383; https://www.chictr.org.cn/showproj.html?proj=199310).

Imaging Study on Acupuncture Inhibiting Inflammation and Bone Destruction in Knee Osteoarthritis Induced by Monosodium Iodoacetate in Rat Model

Objective

We aim to explore whether acupuncture inhibits inflammation and bone destruction in rat model monosodium iodoacetate (MIA)-induced knee osteoarthritis (KOA) by 18F-fluorodeoxyglucose (18F-FDG) small-animal positron emission tomography (PET) and micro-computed tomography (CT) imaging.

Methods

KOA was induced in rats by intra-articular injection MIA (2 mg/50 μL) through the right knee of the rats. Forty male Sprague Dawley rats weighing 280 to 340 g (12 weeks old) were randomly divided into four groups including Control group, KOA group, KOA plus manual acupuncture group (KOA+MA), KOA plus sham acupuncture group (KOA+SA). The acupuncture treatment lasted for three weeks (one-day rest after six days of treatment). Paw withdrawal threshold test and open-field test were used to assess mechanical allodynia and locomotor activity respectively for once a week. Hematoxylin and eosin (H&E) staining was used to assess the damage of the cartilage, synovium and infrapatellar fat pad (IFP). 18F-FDG PET was performed to quantify joint inflammation. The influence on the subchondral bone in these rats was confirmed by micro-CT.

Results

Mechanical hyperalgesia, joint inflammation, and obvious bone destruction were observed in the KOA group. H&E staining of the knee joint found that manual acupuncture played a protective effect in cartilage, synovium and IFP destruction. However, compared with KOA group, the results in sham acupuncture had no significant difference. After manual acupuncture treatment in KOA rats, inflammation was significantly suppressed shown by 18F-FDG PET imaging. Micro-CT analysis of the knee joint revealed that manual acupuncture protected bone by inhibiting osteophyte development and subchondral bone remodeling.

Conclusion

The results of 18F-FDG PET and micro-CT showed that manual acupuncture inhibited inflammation and bone destruction, which provides reliable evidence for the effectiveness of acupuncture in hindering development of KOA, and provides reliable evidence for clinical application of acupuncture.

Touching-bone acupuncture in the treatment of chronic pain: A protocol for an overview of systematic reviews and meta-analysis

BACKGROUND

Chronic pain is the most common disease in the world, which lead the patients to suffer the disability both physically and psychologically. The chronic pain can affects the patients to work, socialize, sleep and can lead to depressive illness, decreased motivation, and a reduction in physical activity. Acupuncture is a promising treatment for the chronic pain which has a long history of use in China. This protocol aims to assess the effectiveness and safety of touching periosteum acupuncture therapy on patients with chronic pain.

METHODS

Randomized controlled trial literatures which include touching periosteum acupuncture therapy for treating chronic pain will be searched from 8 electronic databases including China Biology Medicine disc, VIP database, WanFang database, China National Knowledge Infrastructure, PubMed, Cochrane Library, Excerpt Medical Database, and Web of Science. The language will be restricted to Chinese and English. The primary outcome is to measure the relief of the pain by Visual Analogue Scale. Two or 3 reviewers will conduct the study selection, data extraction and the evaluation of the risk of bias. RevMan software (V.5.3) will be used to perform the assessment of the risk of bias and data synthesis.

RESULTS

From this study, we will confirm the effectiveness of safety of in the treatment of chronic pain.

CONCLUSIONS

We will ascertain the effectiveness of safety of touching periosteum acupuncture therapy in the treatment of chronic pain, to provide evidence to guide touching periosteum acupuncture therapy for patients with chronic pain in the future.

ETHICS AND DISSEMINATION

Ethics approval will not be necessary, because the included publications in our study are all from published articles. This systematic review will be published in a peer-reviewed journal or conference report to provide a reference in this field.

TRIAL REGISTRATION

CRD42021243387.