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Acupuncture effective in treatment of osteoarthritis of knee

BALTIMORE, MARYLAND & DOS HERMANAS, SPAIN. Osteoarthritis is a major cause of incapacity and deteriorated quality of life in the elderly. It is the most common form of arthritis and occurs most frequently in the knee. Currently, there is no non-surgical cure for the disease and the focus of treatment is the management of pain and functional limitation. Although patient education, physical therapy, exercise, and weight loss are all an important part of intervention, medications are eventually required.

Because medications can cause serious side effects, alternative therapies, such as acupuncture, are receiving attention. While results of various trials suggest that acupuncture may be beneficial in treating the pain associated with knee osteoarthritis, its role is still controversial.

Two recently published studies demonstrate that patients with knee osteoarthritis who receive acupuncture as a complementary (adjunctive) therapy experience better results than those who receive patient education or drug treatment alone.

In one study, researchers at the University of Maryland School of Medicine evaluated 570 elderly patients with knee osteoarthritis to determine whether acupuncture provides greater pain relief and improved function compared with "fake" acupuncture or patient education only. The patients were randomly assigned to either a treatment group that received a total of 23 true acupuncture sessions over 26 weeks, or a control group that received 6 two-hour education sessions over 12 weeks or 23 fake acupuncture sessions over 26 weeks.

Similarly, Spanish researchers evaluated the effectiveness of a 12-week series of acupuncture treatments as a complementary therapy in 97 patients with knee osteoarthritis who were being treated with diclofenac. Like the first study, patients were randomly assigned to receive acupuncture (treatment group) or "fake" acupuncture (control group).

Measurements taken during both studies used the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to quantify the pain level and functional disability experienced by the participants. The Maryland researchers found that patients in the acupuncture group, at the end of the study (after 26 weeks), had experienced a 42% reduction in WOMAC pain score as compared to a 19% reduction in the control group. Similarly, a 40% improvement in function score was observed among acupuncture participants versus a 22% improvement in the control group. A global health assessment of the study participants indicated a 15% improvement for acupuncture patients compared to a 7% improvement in the control group. The Spanish researchers found an 82% improvement in WOMAC function score in the patients treated with true acupuncture (and diclofenac) as compared to a 40% improvement in patients treated with sham acupuncture (and diclofenac). Pain scores decreased by 86% in the true acupuncture group versus a decrease of 47% in the sham group. Patients in the true acupuncture group also reported a greater improvement in psychological functioning and consumed 39% less diclofenac tablets than the sham group (85 tablets, on average, versus 139 tablets) over the 12-week trial period.

These results suggest that acupuncture is more effective than drug therapy or patient education therapy alone, and the Maryland researchers conclude that acupuncture may have an important future role in a multidisciplinary approach to knee osteoarthritis treatment. The Spanish researchers recommend additional research to establish the duration of improvement after acupuncture and to establish treatment protocols.
Berman BM, et al. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Ann Intern Med. 2004 Dec 21;141(12):901-10
Vas J, et al. Acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee: randomised controlled trial. BMJ. 2004 Nov 20;329(7476):1216-19

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