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ET , Sunday Oct. 17, 2004
Arthritis News
TRADITIONAL CHINESE ACUPUNCTURE PROVES
EFFECTIVE AS ADJUNCTIVE THERAPY FOR OSTEOARTHRITIS
OF THE KNEE
SAN ANTONIO, TEXAS - Traditional Chinese acupuncture - the use
of fine needles inserted into the skin at precise points - in
conjunction with medical treatment reduces pain and improves
function in patients with knee osteoarthritis, according to research
presented this week at the American College of Rheumatology Annual
Scientific Meeting in San Antonio, Texas.
Osteoarthritis, the most common form of arthritis, is a chronic
disease. It causes the breakdown of cartilage, the shock absorbing
tissue that covers the ends of bones in a joint, resulting in
pain and loss of motion. Today, more than half of the 35 million
people in the U.S. age 65 and older have evidence of osteoarthritis
in at least one joint.
To study therapies for the disease, 570 patients, average age
65.5 years, with osteoarthritis of the knee participated in a
26-week randomized controlled trial. The patients were divided
into three groups, each group undergoing either traditional Chinese
acupuncture (needling of a predefined set of points according
to the diagnosis of Bi syndrome) or sham acupuncture (tapping
of needles at the same predefined set of points), or participating
in the Arthritis Self-Help Course while continuing their regular
medical regimen.
Patients randomized to acupuncture received a total of 23 treatments
from licensed, trained and certified acupuncturists. Patients
in the education group participated in two-hour group sessions
over a 12 week-period. All were advised to continue regular analgesic
or anti-inflammatory treatment as needed. Prior to and throughout
the study, participants' arthritis pain and function levels were
compared using the WOMAC Osteoarthritis index, a questionnaire
used to measure pain, function and stiffness of the knee. At
the end of 26 weeks, there was a greater decrease in pain subscores
and improvement in function subscores for patients in the acupuncture
group than for those int eh group receiving sham acupuncture
(-3.79 and -12.42 respectively for pain and function in the acupuncture
group versus -2.92 and -9.87 in the sham acupuncture group).
Acupuncture, which was cited in 1997 by a National Institutes
of Health panel as an acceptable treatment for many pain conditions,
is one of the most popular complementary and alternative therapies
within the U.S. attracting an estimated 15 million Americans.
While previous individual studies of acupuncture as therapy for
osteoarthritis have been small, and many clinicians doubted its
effectiveness, data gained during this study confirmed a significant
improvement in patients receiving traditional Chinese acupuncture
therapy as compared to those in both the sham acupuncture and
the education groups.
"These data show that traditional Chinese acupuncture provides
clinically important relief of pain and improvement in function
in patients with symptomatic knee osteoarthritis when added to
background therapy," said Marc C, Hochberg, MD, MPH, Professor
of Medicine and Head, Division of Rheumatology & Clinical
Immunology at the University of Maryland School of Medicine,
Baltimore, MD, and an investigator in the study.
The American College of Rheumatology is the professional organization
for rheumatologists and health professionals who share a dedication
to healing, preventing disability and curing arthritis and related
rheumatic and musculoskeletal diseases. For more information
on the ACR's annual meeting, see www.rheumatology.org/annual.
###
Editor's Notes: Dr. Hochberg will present this research
during a scientific session at the ACR Annual Scientific Meeting
from 10:45 - 11:00 am CT (11:45 am - noon ET) on Wednesday,
October 20, in Ballroom C of the Henry B. Gonzalez Convention
Center. He will be available for media questions during a briefing
at 8:30 am CT (9:30am ET) on Monday, October 18, in the on-site
Press Conference Room, Room 218.
Presentation Number: 1718
Traditional Chinese Acupuncture is Effective
as Adjunctive Therapy in Patients with Osteoarthritis of the
Knee
Marc Hochberg, Lixing Lao, Barker Bausell, Patricia Langenberg,
Brian Berman. University of Maryland, Baltimore, MD
Purpose: A systematic review of randomized
controlled trials (RCTs) of traditional Chinese acupuncture (TCA)
in patients with knee osteoarthritis (OA) suggested that patients
who received TCA had improvement in both pain and function compared
to controls; however, all of the individual studies were small
and had methodological limitations (Arthritis Rheum 2001;44:819-25).
Methods: A multicenter 26-week NIH-funded
RCT was conducted to assess the efficacy of TCA compared with
two control groups: sham acupuncture (SA) and education. 570
patients with symptomatic knee OA, defined as moderate or greater
pain on a 5-point Likert scale despite background therapy, who
fulfilled ACR criteria were enrolled. Patients had a mean [SD]
age of 65.5 [8.6] years; 69% were white, 64% were women. 190
patients were randomized to each group in blocks of multiples
of three. Patients in the TCA group received a total of 23 treatments
with 32 gauge acupuncture needles inserted to a conventional
depth at 9 standard points that traversed the area of knee pain
(Rheumatol 1999;38:346-54); guide tubes were tapped at 2 sham
points on the abdomen. Patients in the SA group had needles inserted
in the 2 sham points on the abdomen and guide tubes tapped onto
the surface at the 9 identical standard points.
The acupuncturists were licensed and trained and certified by
one of the authors. Patients in the education group received
the Arthritis Self-Help Course over 12 weekly 2-hour group sessions.
All patients were advised to continue background analgesic or
antiinflammatory therapy. The primary outcomes were change in
the WOMAC pain and function scales over time. Research assistants
who collected outcomes data, participants who received TCA or
SA and statisticians were masked to treatment allocation. An
intent-to-treat analysis using a mixed longitudinal model was
performed; statistical comparison was made between the TCA and
SA groups only.
Results: At entry, the mean [SD] WOMAC
pain and function subscale scores were 8.94 [3.50] and 31.7 [12.0]
(ranges of 0-20 and 0-68, respectively); there were no differences
by treatment group. There was a significant time*group interaction
for improvement in both the WOMAC pain and function subscales
for the patients who received TCA vs SA; the mean changes from
baseline by group at weeks 4, 8, 14 and 26 are shown in the Table.
These results were confirmed in analyses limited to completers,
and using LOCF to impute missing data (data not shown). No serious
treatment-related adverse events occurred during the trial.
Conclusions: These data confirm that
TCA is effective as an adjunctive therapy for reducing pain and
improving function in patients with symptomatic knee OA.
Change from baseline in outcome measures
(WOMAC Pain/Function) by treatment group |
Week |
No |
TCA |
SA |
P-value |
4 |
TCA 173
SA 163 |
Pain -2.22 (0.24)
Funct -7.56 (0.78) |
Pain -1.98 (0.25)
Funct -5.90 (0.66) |
Pain 0.48
Funct 0.15 |
8 |
TCA 169
SA 161 |
Pain -3.15 (0.29)
Funct -10.77 (0.90) |
Pain -2.66 (0.26)
Funct -7.84 (0.76) |
Pain 0.18
Funct 0.01 |
14 |
TCA 158
SA 157 |
Pain -3.63 (0.31)
Funct -12.18 (0.96) |
Pain -2.68 (0.33)
Funct -9.40 (0.94) |
Pain 0.02
Funct 0.04 |
26 |
TCA 142
SA 141 |
Pain -3.79 (0.33)
Funct -12.42 (1.12) |
Pain -2.92 (0.30)
Funct -9.87 (0.93) |
Pain 0.003
Funct 0.009 |
Disclosure: M. Hochberg,
None; L. Lao, None; B. Bausell, None; P. Langenberg,
None ; B. Berman, None
