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.”
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