Effectiveness and feasibility of acupuncture for knee osteoarthritis: a pilot randomized controlled trial

Lin, Lu-Lu; Li, Yong-Ting; Tu, Jian‐Feng; Yang, Jing‐Wen; Sun, Ning; Zhang, Shuai; Wang, Tianqi; Shi, Guang‐Xia; Du, Yi; Zhao, Jingjie; Xiong, Da-Chang; Hou, Hai-Kun; Liu, Cun‐Zhi

doi:10.1177/0269215518790632

Cited by 30 publications

(52 citation statements)

References 32 publications

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“…It is also considered a potential non-pharmacologic intervention to prevent or to slow KOA progression although clinical guidelines have contradictory views [8,9]. Our previous pilot study also showed that MA (three sessions per week for eight weeks) is more feasible and safe compared with sham acupuncture for patients with KOA [10]. Since acupuncture was known to reduce systemic concentrations of pro-inflammatory cytokines, the anti-inflammatory effect are suggested as a potential working mechanism.…”

Section: Introductionmentioning

confidence: 96%

Effect of Electro-acupuncture (EA) and Manual Acupuncture (MA) on Markers of Inflammation in knee osteoarthritis

Shi

Wang

Yang

et al. 2019

Preprint

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Background Inflammation plays a significant role in the pathogenesis of knee osteoarthritis (KOA). Although both Electro-acupuncture (EA) and Manual Acupuncture (MA) are known to influence systemic inflammation, little is known about the potential changes in inflammation as a working mechanism of EA and MA in KOA.Methods Data from the Acupuncture for Knee Osteoarthritis Trial (ATKOA) were used. Serum concentrations of inflammatory factors (tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-6, IL-8, IL-18, IL-4, IL-10,IL-13,IL-15, IL-17, monocyte chemotactic protein-1 (MCP-1), CCchemokine ligand 5 (CCL5), and cartilage degradation biomarkers (matrix metalloproteinase-1 MMP-1, MMP-3, MMP-13 and cartilage oligomeric matrix protein COMP) were measured at baseline and after 8 weeks of treatment. Clinical outcomes were valid and reliable self-reported pain and function measures for osteoarthritis using the Western Ontario and McMasters osteoarthritis index questionnaire (WOMAC) and Visual Analogue Scale (VAS) at baseline and post-treatment.Results Both 8-weeks EA and MA significantly reduced pro-inflammatory cytokines (TNFα, IL-1β) and cartilage degradation biomarkers (MMP-3, MMP-13), significantly increased the anti-inflammatory cytokine IL-13 compared with pre-treatment (p<0.05). Further, the reduction of TNF-α were more significant in EA when compared to MA (p=0.046). While, there was no significant difference between groups in cytokines IL-1β (p=0.102), MMP-3(p=0.113), MMP-13(p=0.623) or IL-13(p=0.935). Moreover, in both EA and MA the effect of acupuncture on the VAS and WOMAC function scale after 8 weeks is clinically important, although no significant differences were found between groups.Conclusions 8 weeks of both EA and MA seem to provide improvement in pain relief and function among individuals with mild to moderate knee OA. This benefit is partly mediated by changes of major inflammatory factors TNF-α, IL-1β and IL-13.

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Section: Introductionmentioning

confidence: 96%

Effect of Electro-acupuncture (EA) and Manual Acupuncture (MA) on Markers of Inflammation in knee osteoarthritis

Shi

Wang

Yang

et al. 2019

Preprint

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“…8,9 Our previous pilot study also showed that MA (three sessions per week for 8 weeks) is more feasible and safe compared with sham acupuncture for patients with KOA. 10 Since acupuncture was known to reduce systemic concentrations of pro-inflammatory cytokines, the anti-inflammatory effect is suggested as a potential working mechanism. For example, EA at the ST36 acupuncture point reduced the lipopolysaccharide (LPS)-induced serum levels of cytokines TNF-α, monocyte chemotactic protein-1 (MCP-1), and this anti-inflammatory mechanism mediated by the sciatic and vagus nerve.…”

Section: Introductionmentioning

confidence: 99%

<p>Effect of Electro-Acupuncture (EA) and Manual Acupuncture (MA) on Markers of Inflammation in Knee Osteoarthritis</p>

Shi¹,

Tu²,

Wang³

et al. 2020

JPR

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Background: Inflammation plays a significant role in the pathogenesis of knee osteoarthritis (KOA). Although both electro-acupuncture (EA) and manual acupuncture (MA) are known to influence systemic inflammation, little is known about the potential changes in inflammation as a working mechanism of EA and MA in KOA. Methods: Data from the Acupuncture for Knee Osteoarthritis Trial (ATKOA) were used. Serum concentrations of inflammatory factors (tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-6, IL-8, IL-18, IL-4, IL-10, IL-13, IL-15, IL-17, monocyte chemotactic protein-1 (MCP-1), CC-chemokine ligand 5 (CCL5), and cartilage degradation biomarkers (matrix metalloproteinase-1 MMP-1, MMP-3, MMP-13 and cartilage oligomeric matrix protein COMP)) were measured at baseline and after 8 weeks of treatment. Clinical outcomes were valid and reliable self-reported pain and function measures for osteoarthritis using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and visual analogue scale (VAS) at baseline and post-treatment. Results: Both 8-weeks EA and MA significantly reduced pro-inflammatory cytokines (TNFα, IL-1β), and cartilage degradation biomarkers (MMP-3, MMP-13) significantly increased the anti-inflammatory cytokine IL-13 compared with pre-treatment (p<0.05). Further, the reduction of TNF-α was more significant in EA when compared to MA (p=0.046). While there was no significant difference between groups in cytokines IL-1β (p=0.102), MMP-3 (p=0.113), MMP-13 (p=0.623) or IL-13 (p=0.935). Moreover, in both EA and MA, the effect of acupuncture on the VAS and WOMAC function scale after 8 weeks is clinically important, although no significant differences were found between groups. Conclusion: Eight weeks of both EA and MA seem to provide improvement in pain relief and function among individuals with mild to moderate knee OA. This benefit is partly mediated by changes of major inflammatory factors TNF-α, IL-1β and IL-13. Trial Registration: Controlled-Trials.com Identifier: NCT03274713.

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“…Based on the results of a previous trial [16], the response rates of EA, MA and SA group are assumed to be 70%, 60% and 40%, respectively. With a 2-sided significance level of 2.5% and power of 80%, 128 participants in each group will be required to detect a difference as small as 20% between each acupuncture group and control group.…”

Section: Sample Sizementioning

confidence: 99%

“…Based on previous pilot trial [16], high-dose acupuncture (24 sessions in 8 weeks) may be an effective option for knee osteoarthritis. Electro-acupuncture (EA) combines manual acupuncture (MA) with electric stimulus [17].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of electro-acupuncture and manual acupuncture versus sham acupuncture for knee osteoarthritis: statistical analysis plan for a randomized controlled trial

Yang

Wang

et al. 2019

Preprint

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Background: Acupuncture therapies are widely used for knee osteoarthritis (KOA), despite contradictory evidences. Current study is designed to determine the efficacy of electro-acupuncture and manual acupuncture versus sham acupuncture for KOA. Methods/design: Current study is a multi-center, three-arm, randomized controlled trial which will enroll 480 participants with KOA in China. Participants will be randomly assigned (1:1:1) to receive 24 sessions of electro-acupuncture, manual acupuncture, or sham acupuncture over 8 weeks. The primary outcome is the response rate - the proportion of patients who simultaneously achieve minimal clinically important improvement in pain and function domains at 8 weeks. The primary outcome will be analyzed using Z-test with intention-to-treat set. Secondary outcomes contain pain, function, global patient assessment and quality of life. Full details of the statistical analysis plan for the primary and secondary outcomes will be described in this article. The statistical analysis plan was written and submitted without knowledge of the study data. Discussion: The data will be analyzed according to this pre-specified statistical analysis plan to avoid data-driven analysis and enhance the transparency of current trial. The trial will provide high-quality evidence on the efficacy of acupuncture for KOA.

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Effectiveness and feasibility of acupuncture for knee osteoarthritis: a pilot randomized controlled trial

Abstract: It showed that three sessions per week acupuncture intervention of knee osteoarthritis was feasible and safe. No difference was observed between groups due to small sample size. Larger (sample size ⩾ 296) randomized controlled trials of this intervention appear justified.

Cited by 30 publications

References 32 publications

Effect of Electro-acupuncture (EA) and Manual Acupuncture (MA) on Markers of Inflammation in knee osteoarthritis

Effect of Electro-acupuncture (EA) and Manual Acupuncture (MA) on Markers of Inflammation in knee osteoarthritis

<p>Effect of Electro-Acupuncture (EA) and Manual Acupuncture (MA) on Markers of Inflammation in Knee Osteoarthritis</p>

Efficacy of electro-acupuncture and manual acupuncture versus sham acupuncture for knee osteoarthritis: statistical analysis plan for a randomized controlled trial

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