Wei Liu,1,2,* Yihua Fan,1,2,* Yuanhao Wu,1,2,* Xu Hou,3 Bin Xue,1,2 Peihao Li,1,2 Shumin Zhang,1,2 Qingyun Yue1,2
1First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, People’s Republic of China; 2National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, People’s Republic of China; 3Department of Endocrinology and Metabolic Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, 250021, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Wei Liu No. 88, Chang Ling Road, Li Qi Zhuang Jie, Xi Qing District, Tianjin, People’s Republic of China
Objective: Knee osteoarthritis (KOA) is prevalent in middle-aged and elderly people. This condition negatively affects the quality of life of patients. Although non-steroidal anti-inflammatory drugs (NSAIDs) are often used to relieve symptoms associated with KOA, it is associated with many side effects. Acupuncture and moxibustion therapies have been applied in the treatment of KOA. However, the efficacy of various acupuncture and moxibustion treatments has not been compared.
Methods: Randomized controlled trials (RCTs) on the application of acupuncture and moxibustion in the treatment of KOA were searched in English databases and Chinese databases. Data were retrieved from establishment of the database to September 2020. Data analysis was performed using Stata14.0 and GeMTC 0.14.3 softwares.
Results: A total of 40 RCTs involving 3215 patients with KOA were retrieved. Network meta-analysis revealed that the fire needle was superior to western medicine, electro-acupuncture, conventional acupuncture, warm needle and sham acupuncture; warm needle was better than conventional acupuncture and western medicine whereas electro-acupuncture was better than conventional acupuncture in improving pain scores in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Moreover, we found that fire needle and warm needle more effectively improved WOMAC stiffness scores than western medicine and sham moxibustion, whereas electro-acupuncture was superior to western medicine and sham moxibustion in improving WOMAC stiffness scores. Further analysis revealed that fire needle, warm needle and electro-acupuncture were more effective in improving WOMAC joint function scores than conventional acupuncture and western medicine. The fire needle was superior to conventional acupuncture and sham acupuncture, whereas electro-acupuncture was better than western medicine, conventional acupuncture and sham acupuncture in improving visual analogue scale scores.
Conclusion: This study shows that fire needle is superior to warm needle and electro-acupuncture, whereas warm needle and electro-acupuncture are better than conventional acupuncture, western medicine, sham moxibustion and sham acupuncture.
Keywords: knee osteoarthritis, acupuncture, moxibustion, randomized controlled trials, network meta-analysis
Knee osteoarthritis (KOA) is a common disease associated with knee joint degeneration among the elderly. The disease has seriously negative effects on the quality of life of patients. Moreover, it is one of the main diseases leading to knee dysfunction and disability among the elderly people.1,2 Globally, KOA is the 11th leading cause of disability, affecting about 3.8% of the world’s population.3 With the progressively increasing aging population in China, the incidence of KOA has been on the rise, reaching about 85% among those aged over 65 years.4 The development of KOA is associated with a variety of factors, including age, sex, aging, trauma, obesity, inflammation, occupation, activity, metabolism, and heredity among others.5 Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended for the treatment of early and middle-term KOA.6 Although their analgesic effects are very good, patients often develop pains after drug withdrawal. Cases of gastrointestinal discomfort, liver and kidney function damage as well as other adverse reactions have also been reported.7 Acupuncture and moxibustion have shown good therapeutic effects on KOA with few adverse reactions,8,9 and have been adopted in China’s Guidelines for the Diagnosis and Treatment of Osteoarthritis7 and the Guidelines of the American Academy of Orthopaedic Surgeons.10 There are many types of acupuncture and moxibustion treatments, with varying clinical effects. Direct comparisons of the curative effects of different acupuncture and moxibustion therapies have not been done so far. Therefore, we used network meta-analysis to compare the efficacy of different types of acupuncture and moxibustion therapies in KOA patients to provide a basis for selection of optimal acupuncture and moxibustion therapies in the clinical treatment of KOA.