Comparison of the Efficacy between Conventional Moxibustion and Smoke-Free Moxibustion on Knee Osteoarthritis: A Randomized Controlled Trial

A comparison of jade moxibustion and traditional moxibustion in the treatment of knee osteoarthritis: A randomized clinical trial

BACKGROUND

This study was developed to compare the relative clinical efficacy of traditional moxibustion and Jade moxibustion in an effort to define the most effective approaches to treating knee osteoarthritis.

METHODS

In total, 94 patients were randomly assigned at a 1:1 ratio to the traditional moxibustion (TM) and Jade moxibustion (JM) groups. For JM, a jade kneepad was preheated for 3 minutes via electrification, with the jade in the kneepad being pressed onto acupoints when reaching an initial temperature of 46°C. For patients in the TM group, moxa cones were applied to acupoints for treatment. In total, 12 treatments were performed for patients in each group, with treatment being conducted 3 times per week. Study outcomes included 36-item short-form health survey and Western Ontario and McMaster Universities Osteoarthritis Index knee stiffness scores. In addition, serum levels of osteoarthritis-related cytokines were measured.

RESULTS

Overall, 89/94 patients completed this study, including 44 and 45 in the TM and JM groups, respectively. The 36-item short-form health survey physical functioning at weeks 12 and 24 (P = .033, 0.001), role-physical at weeks 4 and 24 (P = .030, 0.014), and role-emotional at week 4 (P = .045) were the only scores to differ significantly between the TM and JM groups. Western Ontario and McMaster Universities Osteoarthritis Index stiffness scores in the JM groups improved significantly relative to baseline at weeks 4, 8, 12, and 24 (all P < .01). The scores in the TM group differed significantly at all time points relative to baseline (all P < .01), with no differences between groups (all P > .05). Serum Interleukin-2 levels were lower in both groups (all P < .01). Cartilage oligomeric matrix protein and monocyte chemotactic protein-1 only differed significantly for patients treated via JM (P < .05, P < .01), with the same also being true for Interleukin-1β and Interleukin-8 in the TM group (all P < .01). No significant differences in other cytokines were observed, nor did they differ significantly between groups (all P > .05).

CONCLUSION

These results suggest that JM treatment can improve knee osteoarthritis patient quality of life, alleviating joint stiffness and restoring joint function with a level of efficacy comparable to TM.

Purinergic ATP triggers moxibustion-induced local anti-nociceptive effect on inflammatory pain model

Purinergic signalling adenosine and its A1 receptors have been demonstrated to get involved in the mechanism of acupuncture (needling therapy) analgesia. However, whether purinergic signalling would be responsible for the local analgesic effect of moxibustion therapy, the predominant member in acupuncture family procedures also could trigger analgesic effect on pain diseases, it still remains unclear. In this study, we applied moxibustion to generate analgesic effect on complete Freund's adjuvant (CFA)-induced inflammatory pain rats and detected the purine released from moxibustioned-acupoint by high-performance liquid chromatography (HPLC) approach. Intramuscular injection of ARL67156 into the acupoint Zusanli (ST36) to inhibit the breakdown of ATP showed the analgesic effect of moxibustion was increased while intramuscular injection of ATPase to speed up ATP hydrolysis caused a reduced moxibustion-induced analgesia. These data implied that purinergic ATP at the location of ST36 acupoint is a potentially beneficial factor for moxibustion-induced analgesia.

Traditional Chinese medicine therapies for patients with knee osteoarthritis: A protocol for systematic review and network meta-analysis

BACKGROUND

Knee osteoarthritis (KOA) is a common cause of chronic musculoskeletal pain and disability as well as a socioeconomic burden on healthcare services globally. Numerous clinical trials indicated that traditional Chinese medicine (TCM) may effectively improve the clinical symptoms of KOA patients. However, the comparative efficacy and safety of different TCM therapies in patients with KOA is not yet clear. In order to evaluate the efficacy and safety of TCM for KOA, we will conduct a systematic review and network meta-analysis on the existing randomized controlled trials (RCTs).

METHODS

A systematic literature search will be conducted in PubMed, Web of Science, Embase, EBSCO, Cochrane Library, China National Knowledge Infrastructure, Wanfang, Chinese Biomedical Literature Database, and the VIP Database for Chinese Technical Periodicals up to February 2022 to identify the relevant RCTs. The primary outcomes are visual analog scale, Western Ontario and McMaster Universities Osteoarthritis Index, Lysholm score, and Lequesne index. Secondary outcomes include the total clinical effective rate and adverse events. Study quality will be evaluated using the Cochrane risk of bias tool (RoB 2.0) for RCTs. Data analysis will be performed using Stata and WinBUGS. The quality of evidence will be assessed using the Grades of Recommendations Assessment Development and Evaluation.

RESULTS

The results of this study will be submitted to a peer-reviewed journal for publication.

CONCLUSIONS

This study will provide evidence-based medical evidence for the treatment of KOA with TCM therapies and offer better assistance for clinical practice.

PROTOCOL REGISTRATION NUMBER

INPLASY202230008.

An Overview of Systematic Reviews of Moxibustion for Knee Osteoarthritis

Background

Currently, many systematic reviews (SRs) of moxibustion as a treatment of KOA have been published. However, the evidence of different SRs of moxibustion to treat KOA has not been comprehensively evaluated.

Aim

This overview aimed to evaluate the existing results and provide scientific evidence of the effectiveness and safety of moxibustion in the treatment of KOA.

Methods

We conducted a comprehensive search of Embase, PubMed, Web of Science, Cochrane Library, SinoMed, CNKI, Wanfang, VIP, and other databases until October 31, 2021. A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2) was used to assess the methodological quality of SRs. Preferred Reporting Item for Systematic Reviews and Meta-Analyses was used to evaluate the reporting quality, and the risk of bias in SRs was evaluated by ROBIS Tool. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool to determine the strength of evidence and conducted a meta-analysis of the total effectiveness rate.

Results

Finally, 10 qualified SRs were included, including 57 randomized controlled trials and 5,149 participants. All SRs evaluated by AMASTAR-2 had more than one critical deficiency, so all SRs were rated as critically low. In the PRISMA checklist, the manuscript structures of the included SRs were relatively complete. Including four SRs with a low risk of bias and six with a high risk of bias using the ROBIS tool. In GRADE, two items (6.25%) were rated as high quality, three (9.37%) as medium quality, 17 (53.12%) as low quality and 10 (31.25%) as very low quality. A re-meta-analysis showed that moxibustion and moxibustion combined treatment improved the total effectiveness rate in knee osteoarthritis (risk ratio = 1.17, 95% confidence interval 1.13–1.21, P < 0.001 and risk ratio = 1.13, 95% CI: 1.04–1.23, P < 0.001), with low heterogeneity (I² = 36.3%, P = 0.020, and I² = 0.0%, P = 0.956). A total of eight SRs reported adverse events, and no serious adverse events occurred in the moxibustion group and control group.

Conclusion

Moxibustion seems to be effective in treating KOA. Four SRs reported 10 common discomfort symptoms caused by moxibustion, and these adverse events can spontaneously subside, even can be avoided, therefore, moxibustion for KOA appears to be safe. However, the reliability of the results is reduced by the high risk of bias of the original studies and the low methodological quality of SRs. Therefore, future studies should pay more attention to the quality of the original study and the evidence quality of the SRs to provide more powerful and scientific evidence of the effectiveness and safety of moxibustion treatment of KOA.

A comparison of the efficacy and safety of traditional Chinese medicine external treatment for the knee osteoarthritis: A protocol for systematic review and network meta-analysis

BACKGROUND

Knee osteoarthritis (KOA), also known as degenerative osteoarthritis, is a common and frequently occurring disease in orthopedics with cartilage degeneration as the pathogenic cause and articular bone hyperplasia as the sign. Many studies have confirmed that KOA can be effectively treated by traditional Chinese medicine (TCM) external treatment. So we take advantage of the method of network meta-analysis to systematically compare the efficacy and safety of different types of TCM external treatment for the KOA.

METHODS

We will research on external treatment of KOA by traditional Chinese medicine using randomized controlled trials (RCTs) in search database (EMBASE, PubMed, Web of Science, Chinese National Knowledge Infrastructure [CNKI], Weipu database [VIP], Wanfang, and China BioMedical Literature [CBM]). The data and evidence obtained will be processed using Stata 15.0 and WinBUGS 1.4.3.

RESULTS

We will evaluate the efficacy and safety of traditional Chinese medicine external treatment for the knee osteoarthritis in this study.

CONCLUSION

This study will provide a new regimen for KOA treatment. It has extremely high reference value.

INPLASY REGISTRATION NUMBER

INPLASY2020120001.

DOI NUMBER

: 10.37766/inplasy2020.12.0001.

Research Trends of Acupuncture Therapy on Knee Osteoarthritis from 2010 to 2019: A Bibliometric Analysis

Background

Acupuncture has been widely applied to relieve knee osteoarthritis (KOA) in many countries. However, the bibliometric analysis of the global use of acupuncture on KOA is largely unknown. Therefore, this study aimed to explore the current status and trends of the global use of acupuncture on KOA in recent 10 years by using CiteSpace (5.6.R3).

Methods

Publications regarding acupuncture therapy for treating KOA between 2010 and 2019 were extracted from the Web of Science database. CiteSpace was used to analyze the number of publications, countries, institutions, journals, authors, cited references and keywords by using standard bibliometric indicators.

Results

A total of 343 publications were retrieved from 2010 to 2019. The total number of publications continually increased over the past four years, and the most active journals, countries, institutions and authors in the field of acupuncture therapy on patients with KOA were identified. The Evid Based Complement Alternat Med (28) was the most prolific journal, and the Ann Intern Med (202) was the most cited journal. The most productive country and institution in this field was China (115) and University of York (18), respectively. Hugh Macpherson (18) was the most prolific author and Witt C ranked the first in the cited authors. In the ranking of frequency in cited reference, the first article was published by Scharf HP (54). The keyword of ‘randomized controlled trial’ ranked first for research developments with the highest citation burst (3.9486). Besides, there were three main frontiers in keywords for KOA research, including ‘research method, ‘age’ and ‘measure of intervention’.

Conclusion

The findings from this bibliometric study provide current status and trends in clinical research of acupuncture therapy on patients with KOA over the past ten years, which may help researchers identify hot topics and explore new directions for future research in this field.

The Effectiveness and Safety of Moxibustion for Treating Knee Osteoarthritis: A PRISMA Compliant Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background

Knee osteoarthritis (KOA) seriously affects people's life. Therefore, it has already become a worldwide health concern. Moxibustion has a significant clinical effect on KOA. This systematic review and meta-analysis is performed to renew previous studies and strictly evaluate the quality of RCT and thus test the effect and safety of moxibustion for KOA.

Objective

To evaluate the effectiveness and safety of moxibustion treatment for alleviating pain and improving lower limb function for patients with KOA.

Materials and Methods

CNKI (1979∼2019), CBM (1979∼2019), VIP (1989∼2019), WF (1998∼2019), PubMed (1966∼2019), Embase (1980∼2019), Cochrane Library, and Web of Science (1900∼2019) were all retrieved by a computer from their inception to June 02, 2019, replenished by manual retrieval of relevant bibliographies. Randomized controlled trials (RCTs) were included if moxibustion was compared to western medicine or negative control (placebo moxibustion or no treatment or UC) for treating KOA. The primary outcomes were the total effect and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC scale). The secondary outcomes include VAS, Symptom score, Lysholm score, and Lequesne score. RCTs were collected, and the quality of evidence was evaluated by using the Jadad scale and Cochrane risk assessment tools. We used RevMan5.3.0 software for meta-analysis.

Results

A total of 39 RCTs were included, including 3293 patients. In the assessment of the quality, the evidence differs from low to high based on the Cochrane Bias Evaluation Tools and Jadad scale. Fourteen trials were of high quality, ten were of moderate quality, and 15 were of low quality. Therefore, the quality of the included studies was moderate. In this study, there were 66.67% of the literature, and only 17.95% of the literature correctly reported randomized grouping and allocation of hidden information, respectively. In adverse reactions, only 13 trials included were reported in the study. The main adverse reactions of moxibustion are burns and blisters, whereas the western medicine group was in epigastric discomfort. As for the total effective rate, the meta-analysis of 27 RCTs showed a significant effect of moxibustion VS western medicine (RR = 1.20, 95% CI = 1.16 to 1.25, I² = 45%, P=0.007); as for the WOMAC scale, the subgroup meta-analysis of 13 trials showed that there was a statistically significant effect of moxibustion VS western medicine (MD = −11.08, 95% CI = −11.72 to −10.44, I² = 98%, P < 0.00001) and 2 trials on moxibustion VS negative control (MD = −8.38, 95% CI = −12.69 to −4.06, I² = 0%, P=0.77); as for the VAS score, the meta-analysis of 6 trials showed that there was a significant effect of moxibustion VS western medicine (MD = −2.12, 95% CI = −2.30 to −1.93, I² = 98%, P < 0.00001); as for the symptom score, the meta-analysis of 7 trials showed that there was a significant effect of moxibustion VS western medicine (MD = −0.81, 95% CI = −1.24 to −0.37, I² = 50%, P=0.06); as for the Lysholm score, the meta-analysis of 5 trials showed that there was a significant effect of moxibustion VS western medicine (MD = 7.61, 95% CI = 6.04 to 9.17, I² = 95%, P < 0.00001); and as for the Lequesne score, the meta-analysis of 3 trials showed that there was a significant effect of moxibustion VS western medicine (MD = 3.29, 95% CI = 2.93 to 3.65, I² = 99%, P < 0.00001).

Conclusion

Moxibustion treatment for KOA is more effective than the positive control (western medicine) or negative control (placebo moxibustion or no treatment or UC), and there were fewer adverse reactions to moxibustion. Due to the universally low quality of the eligible trials, it still needs further large-scale and high-quality randomized controlled trials to verify the effectiveness and safety of moxibustion in the treatment of KOA.