Acupuncture and osteoarthritis.

Osteoarthritis is the most frequent type of arthritis and accounts for much disability and increased health care costs, especially among the elderly. No curative therapies exist for this condition. The present debate about the adverse effects of all non-steroidal anti-inflammatory drugs has stimulated substantial attention in alternative therapies. Other therapies e.g., hyaluronate injections, opioids, and physical therapy have variable effectiveness and may also have potential toxicities. Recently, there has been an increasing interest in acupuncture for treatment for osteoarthritis. A systematic review of seven randomized controlled trials (RCT) suggested that acupuncture treatment led to improved knee pain and function. These studies, however, have weakness in methodology such as small sample sizes, inadequate control groups and short follow-ups. A recent well conducted clinical trial funded by the Center for Complementary and Alternative Medicine has shown the effectiveness of acupuncture. This clinical trial studied 570 subjects with osteoarthritis of the knee. Subjects were randomized to the true acupuncture group receiving twenty three acupuncture treatments and the sham acupuncture group receiving the same number of treatments over twenty six weeks. Pain and function were measured at 4, 8, 14, and 26 weeks using the Western Ontario and McMaster Universities Osteoarthritis Index. Pain decreased and function increased to clinically significant degrees in the true acupuncture group only. Pain decreased in the true acupuncture group at all four time points, but did not reach statistical significance until the 14th week. The pain score decreased 3.6 units in the true acupuncture group compared with 2.7 units in the sham acupuncture group. Significant improvement in function took place by the 8th week for more than 12 units. Side effects were not significant. In conclusion, acupuncture treatment resulted in reduced pain and improved function in knee osteoarthritis with a minimum side effects. Scattered reports suggest that acupuncture may also be effective in treatment of osteoarthritis of other large joints. Therefore, acupuncture may play a bigger role in managing osteoarthritis in the future.

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