ArticlesAcupuncture in patients with osteoarthritis of the knee: a randomised trial
Introduction
Osteoarthritis most frequently affects the knee joint.1 Anti-inflammatory drugs used to treat the symptoms of this disorder are associated with various side-effects.2 Furthermore, for patients for whom these drugs do not lead to an adequate response, replacement surgery is often recommended.3 Patients with chronic pain are increasingly using acupuncture for pain relief.4 There is some evidence that acupuncture can be effective in treating pain and dysfunction in patients with osteoarthritis of the knee. In a systematic review including seven randomised controlled trials with a total of 393 patients, acupuncture was more effective than sham acupuncture in reducing pain, whereas for joint function the results were inconclusive.5 These previous studies, however, were based on small sample sizes and the follow-up period was never longer than 3 months.
We aimed to investigate the efficacy of acupuncture compared with minimal acupuncture and with no acupuncture in patients with pain and dysfunction due to osteoarthritis of the knee.
Section snippets
Patients
Patients were included in our study if they were aged 50–75 years, had been diagnosed with osteoarthritis according to the American College of Rheumatology criteria, had documented radiological alterations in the knee joint of grade 2 or more according to Kellgren-Lawrence criteria,6, 7 had an average pain intensity of 40 or more on a 100 mm visual analogue scale in the 7 days before baseline assessment, and if they gave written informed consent. The exclusion criteria were one or more of the
Results
Between March 6, 2002, and January 17, 2003, about 1100 patients with osteoarthritis of the knee applied to participate in the study. Figure 2 shows the trial profile. Of 300 patients randomised six were excluded from the intention-to-treat population because no baseline data were available, and they did not receive the study intervention. All the remaining 294 patients treated in a total of 28 outpatient centres were included in the intention-to-treat population. Three patients in the
Discussion
In this study, patients with osteoarthritis of the knee who received acupuncture had significantly less pain and better function after 8 weeks than did patients who received minimal acupuncture or no acupuncture. After 26 and 52 weeks, exploratory analysis indicated that the differences between acupuncture and minimal acupuncture were no longer significant.
The present study is, to date, one of the largest and most rigorous trials of the efficacy of acupuncture available. Its strengths include a
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