Osteoarthritis most frequently affects the knee joint. Despite a limited evidence base, arthritis patients are increasingly turning to acupuncture, especially as side-effects of non-steroidal anti-inflammatory drugs are common and wide-ranging.
Around 300 Patients with chronic osteoarthritis of the knee were randomly assigned to acupuncture, minimal (sham) acupuncture (superficial needling at non-acupuncture points), or a waiting list control. Patients were allowed to use non-steroidal anti-inflammatory drugs throughout the study. Physicians administered acupuncture and minimal acupuncture in 12 sessions over 8 weeks. Patients completed questionnaires at the start of treatment, and after 8 weeks, 6 months, and 1 year.
Analgesic use was similar for patients in the three groups. After 8 weeks, patients given acupuncture had a substantially lower score on an established osteoarthritis index than patients in the control group (26 points and 50 points, respectively). Minimal acupuncture also had short-term benefit compared with no acupuncture (36 points on the osteoarthritis index). However, at 1-year follow-up there was no significant difference in scores between the three groups.
Lead investigator Claudia Witt (Charite University Medical Center, Berlin, Germany) comments: "Acupuncture treatment had significant and clinically relevant short-term effects when compared to minimal acupuncture or no acupuncture treatment in patients with osteoarthritis of the knee. We now need to assess the long-term effects of acupuncture, both in comparison to sham interventions and to standard treatment."
In an accompanying Comment, Andrew Moore (Pain Research, University of Oxford, UK), states: "The bottom line from Witt and colleagues' large, long, and high-quality study of acupuncture for knee osteoarthritis is that doing something is better than doing nothing." However he cautions that it is too soon to draw firm conclusions from the current study: "We are still some way short of having conclusive evidence that acupuncture is beneficial in arthritis or in any other condition, other than in a statistical or artificial way. There is limited evidence of effect and, with exceptions, of cost-effectiveness. Most importantly, the need for needles is still in doubt."
Dr Claudia Witt, Institute of Social Medicine, Epidemiology and Health Economics, Charite University Medical Center, 10098 Berlin, Germany; T) +49 30 4505 29002; claudia.witt@charite.de
Professor Andrew Moore, Pain Research, The Churchill, Oxford OX3 7LJ, UK; T) +44 (0)1865 226132; andrew.moore@pru.ox.ac.uk
Journal
The Lancet