We aimed to explore the feasibility of evaluating effectiveness and safety of electroacupuncture (EA) for the treatment of knee osteoarthritis (KOA) based on different meridian syndromes.
Methods
A multicenter randomized controlled trial was conducted in Beijing from January 2019 to December 2019. Sixty KOA participants were randomly allocated to either EA (n=30) or SA (n=30) groups. Participants in EA group were treated with semi-standardized on different meridian syndrome, including five obligatory acupoints and three adjunct acupoints. Eight non-acupoints that were separated from conventional acupoints or meridians were used for the SA group. Both groups received 24 sessions within eight weeks. The primary outcome was response rate, defined as a change of ≥50% from baseline in total scores of Western Ontario and McMaster Universities osteoarthritis index (WOMAC) at the end of treatment. Secondary outcomes included function, pain, stiffness, quality of life and acupuncture-related adverse events at four and eight weeks.
Results
Of 60 participants randomized, 56 (93.3%) completed the study. Response rates were 60% for the EA group and 30% for the SA group after eight weeks. Significant differences were observed in WOMAC pain and total scores within two groups (P=0.026, P=0.043). Rates of adverse events were low and similarly distributed between groups.
Conclusion
EA intervention based on meridian differentiation in KOA was feasible and appeared safe, having a stronger impact on pain than SA. Future studies can be designed with larger sample size, adequately powered, randomization design and less biases. Trial registration number: NCT03274713.
NaYBaiRZhaoZWeiYLiDWangYSunCSunLZhangBJinTLiuW. IL1R1 gene polymorphisms are associated with knee osteoarthritis risk in the Chinese Han population. Oncotarget, 8: 4228-4233, 2017.
2.
JonesGDingCScottFCicuttiniF. Genetic mechanisms of knee osteoarthritis: a population based case-control study. Annals of the Rheumatic Diseases, 63: 1255-1259, 2004.
3.
SharmaL. Osteoarthritis of the Knee. The New England Journal of Medicine, 380: 2163-2196, 2012.
4.
ArdenNNevittMC. Osteoarthritis: epidemiology. Best Practice and Research Clinical Rheumatology, 20: 3-25, 2006.
5.
LitwicAEdwardsMHDennisonEMCooperC. Epidemiology and burden of osteoarthritis. British medical bulletin, 105: 185-199, 2013.
6.
HiligsmannMCooperCArdenNBoersMBrancoJCBrandiMLBruyereOGuilleminFHochbergMCHunterDJKanisJAKvienTKLaslopAPelletierJPPintoDRriterNSRizzoliRRovatiLCSeverensJLHSilvermanSTsouderosYTugwellPReginsterJY. Health economics in the field of osteoarthritis: an expert’s consensus paper from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Seminars in Arthritis and Rheumatism, 43: 303-313, 2013.
7.
HiligsmannMCooperCGuilleminFHochbergMCTugwellPArdenNBerenbaumFBoersMBoonenABrancoJCMariaLBBruyereOGasparikAKanisTKMartelPJPelletierJPPinedoVRPintoDReiterNSRizzoloRRovatiLCSeverensJLSilvermanSReginsterJY. A reference case for economic evaluations in osteoarthritis: an expert consensus article from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Seminars in Arthritis and Rheumatism, 44: 271-282, 2014.
8.
QiLTangYYouYQinFZhaiLPengHNieR. Comparing the Effectiveness of Electroacupuncture with Different Grades of Knee Osteoarthritis: A Prospective Study. Cellular Physiology and Biochemistry, 39: 2331-2340, 2016.
KremersHMLarsonDRCrowsonCSKremersWKWashingtonRESteinerCAJiranekWABerryDJ. Prevalence of Total Hip and Knee Replacement in the United States. The Journal of Bone and Joint Surgery, 97: 1386-1397, 2015.
11.
KurtzSOngKLauEMowatFHalpernM. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. The Journal of Bone and Joint Surgery, 89: 780-785, 2007.
12.
SkouSTRoosEMLaursenMBRathleffMSArendtNLSinonsenORansussenS. A Randomized, Controlled Trial of Total Knee Replacement. The New England Journal of Medicine, 373: 1597-1606, 2015.
13.
Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthritis and Rheumatology, 43: 1905-1915, 2000.
14.
NavarroSFCoronelPCollantesENavarroFJSernaARNaranjoAGimenoMHerreroBGAMELIA study group. A 40-month multicentre, randomised placebo-controlled study to assess the efficacy and carry-over effect of repeated intra-articular injections of hyaluronic acid in knee osteoarthritis: the AMELIA project. Annals of the Rheumatic Diseases, 70: 1957-1962, 2011.
15.
RichettePFrazierABardinT. Impact of anti-inflammatory therapies, xanthine oxidase inhibitors and other urate-lowering therapies on cardiovascular diseases in gout. Current Opinion in Rheumatology, 27: 170-174, 2015.
16.
NissenSEYeomansNDSolomonDHLuscherTFLibbyPHusniMEGrahamDYBorerJSWisniewskiLMWolskiKEWangQMenonVRuschitzkaFGaffneyMBeckermanBBergerMFBaoWLincoffAMPRECISION Trial Investigators. Cardiovascular Safety of Celecoxib, Naproxen, or Ibuprofen for Arthritis. The New England Journal of Medicine, 375: 2519-2529, 2016.
17.
CaoXWGuoDLiuJWNiuWLiuJPanJKXieHOuyangWWLinDK. The efficacy and safety of the Shaoyao Shujin tablet for knee osteoarthritis: study protocol for a randomized controlled trial. Trials, 17: 1-3, 2016.
18.
ZhangRLaoLRenKBermanBM. Mechanisms of acupuncture-electroacupuncture on persistent pain. Anesthesiology, 120: 482-503, 2014.
19.
LiAZhangYLaoLXinJRenKBermanBMZhangRX. Serotonin Receptor 2A/C Is Involved in Electroacupuncture Inhibition of Pain in an Osteoarthritis Rat Model. Evidence-based Based Complementary and Alternative Medicine, 2011: 1-6, 2011.
20.
ChenNWangJMucelliAZhangXWangC. Electro-Acupuncture is Beneficial for Knee Osteoarthritis: The Evidence from Meta-Analysis of Randomized Controlled Trials. The American Journal of Chinese Medicine, 45: 965-985, 2017.
21.
AhsinSSaleemSBhattiAMIlesRKAslamM. Clinical and endocrinological changes after electro-acupuncture treatment in patients with osteoarthritis of the knee. Pain, 147: 60-66, 2009.
22.
HeLF. Involvement of endogenous opioid peptides in acupuncture analgesia. Pain, 31: 99-121, 1987.
23.
GordonJS. Alternative medicine and the family physician. American Family Physician, 54: 2205-2212, 2218-2220, 1996.
24.
SangdeeCTeekachunhateanSSananpanichKSugandhavesaNChiewchantanakitSPojchamarnwiputhSJayasvastiS. Electroacupuncture versus diclofenac in symptomatic treatment of osteoarthritis of the knee: a randomized controlled trial. BMC Complementary and Alternative Medicine, 2: 3, 2002.
25.
WangTQLiYTWangLQShiGXTuJFYangJWHouYQLinLLSunNZhaoJJHouHKLiuCZ. Electroacupuncture versus manual acupuncture for knee osteoarthritis: a randomized controlled pilot trial. Acupuncture in Medicine, 38: 291-300, 2020.
26.
MiuraKOharaTZeredoJLOkadaYTodaKSumikawaK. Effects of traditional "Juci" (contralateral acupuncture) on orofacial nociceptive behavior in the rat. Journal of Anesthesia, 21: 31-36, 2007.
27.
MacPhersonHAltmanDGHammerschlagRYoupingLTaixiangWWhiteAMoherDSTRICTA Revision Group. Revised Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): extending the CONSORT statement. PLoS Medicine, 7: e1000261, 2010.
28.
SchulzKFAltmanDGMoherDCONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. BMJ, 340: c332, 2010.
29.
KellgrenJHLawrenceJS. Radiological assessment of osteoarthritis. Annals of the Rheumatic Diseases, 16: 494-502, 1957.
30.
ICH harmonized tripartite guideline: guideline for good clinical practice. Essential documents for the conduct of a clinical trial. Journal of Postgraduate Medicine, 47: 264-267, 2001.
31.
BellamyNBuchananWWGoldsmithCHCampbellJStittLW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. Journal of Rheumatology, 15: 1833-1840, 1988.
32.
GoldsmithCHBoersMBombardierCTugwellP. Criteria for clinically important changes in outcomes: development, scoring and evaluation of rheumatoid arthritis patient and trial profiles. OMERACT CommitteeJournal of Rheumatology, 20: 561-565, 1993.
33.
WittCMJenaSBrinkhausBLieckerBWegscheiderKWillichSN. Acupuncture in patients with osteoarthritis of the knee or hip: a randomized, controlled trial with an additional nonrandomized arm. Arthritis and Rheumatism, 54: 3485-3493, 2006.
34.
WareJJKosinskiMKellerSD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Medical Care, 34: 220-233, 1996.
35.
LamCLKTseEYYGandekB. Is the standard SF-12 Health Survey valid and equivalent for a Chinese population?Quality of Life Research, 14: 539-547, 2005.
36.
LiuCZXieJPWangLPLiuYQSongJSChenYYShiGXZhouWGaoSZLiSLXingJMMaLXWangYXZhuJLiuJP. A randomized controlled trial of single point acupuncture in primary dysmenorrhea. Pain Medicine, 15: 910-920, 2014.
37.
ChenLFangJJinXKeelerCLGaoHFangZChenQ. Acupuncture treatment for ischaemic stroke in young adults: protocol for a randomized, sham-controlled clinical trial. BMJ open, 6: e010073, 2016.
38.
BermanBMLaoLLangenbergPLeeWLGilpinAMKHochbergMC. Effectiveness of Acupuncture as Adjunctive Therapy in Osteoarthritis of the Knee A randomized, controlled trial. Annals of Internal Medicine, 141: 901-910, 2004.
39.
VasJMendezCPereaMEVegaEPanaderoMDLeonJMBorgeMAGasparOSanchezRFAguilarIJuradoR. Acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee: randomised controlled trial. BMJ, 329: 1216, 2004.
40.
TuJFYangJWShiGXYuZSLiJLLinLLDuYZYuXGHuHLiuZSJiaCSWangLQZhaoJJWangJWangTWangYWangTQZhangNZouXWangYShaoJKLiuCZ. Efficacy of intensive acupuncture versus sham acupuncture in knee osteoarthritis: A randomized controlled trial. Arthritis and Rheumatology, undefined: undefined, 2020.
41.
AhsinSSaleemSBhattiAMIlesRKAslamM. Clinical and endocrinological changes after electro-acupuncture treatment in patients with osteoarthritis of the knee. Pain, 147: 60-66, 2009.
42.
MiaoHYQuCzHuangHX. Effects of acupuncture on NGF and SP in rats with knee osteoarthritis. China Emergency in Traditional Chinese Medicine, 28: 1598-1604, 2019.
43.
WangTQShiGXYangNNWangLQHuSQLiuCZ. Discussion on the theoretical basis of acupuncture for improving knee osteoarthritis based on the theory of "brain gut axis". Hebei Journal of Traditional Chinese Medicine, 34: 61-64, 2019.
44.
YinCSChaeYKangOSKimSTHahmDHParkJYLeeHParkHJ. Deqi Is Double-Faced: The Acupuncture Practitioner’s and the Subject’s Perspective. Evidence-Based Complementary and Alternative Medicine, 2015: 1-6, 2015.
45.
WuZ. Arthralgia: the dominant disease of acupuncture and moxibustion. China Acupuncture, 38: 91, 2018.
46.
LiYShiGTuJWangXLiuC. Analysis of acupuncture and moxibustion treatment of knee osteoarthritis. Liaoning Journal of Traditional Chinese Medicine, 44: 2179-2182, 2017.
47.
NgSSMLeungWWMakTWCHonSSFLiJCMWongCYNTsoiKKFLeeJFY. Electroacupuncture reduces duration of postoperative ileus after laparoscopic surgery for colorectal cancer. Gastroenterology, 144: 307-313, 2013.
