[Aama-cases] Traditional Chinese Acupuncture May Be Effective for Osteoarthritis of Knee/Medscape

[Paul J Allen]

Interesting study and comments from David Felson of the Arthritis 
Foundation.

Paul Allen
___________________________________________________________________

Traditional Chinese Acupuncture May Be Effective for Osteoarthritis of 
Knee

Jane Salodof MacNeil

Oct. 20, 2004 (San Antonio) — Traditional Chinese acupuncture reduces 
knee pain and improves function for osteoarthritis patients, according 
to a 26-week, randomized controlled trial funded by the National 
Institutes of Health and reported yesterday at the annual scientific 
meeting of the American College of Rheumatology.

Lead investigator Marc C. Hochberg, MD, MPH, from the University of 
Maryland School of Medicine in Baltimore, presented data showing that 
patients treated with traditional acupuncture improved more than 
control groups given either a "sham" acupuncture treatment or an 
educational alternative. All 570 patients were told to continue using 
their analgesic or anti-inflammatory medications during the trial.

Average pain and function subscores on the Western Ontario and McMaster 
Universities Osteoarthritis Index were 8.94 and 31.7, respectively, 
with no difference between treatment groups at baseline. Pain scores 
decreased by 3.79 points and function scores by 12.42 points for 
traditional acupuncture patients who completed 26 weeks of therapy. 
Control subjects receiving the sham treatment showed a more modest 
improvement: reductions of 2.92 points for pain and 9.87 for function.

  The comparative changes in pain and function scores were statistically 
significant and "significantly better" than the outcomes for the 
education group, according to Dr. Hochberg. He noted that the 
educational alternative, Arthritis Self-Help Course, a 12-week series 
of two-hour group sessions, had previously been proven effective as an 
adjunct therapy.

  The "sham" acupuncture consisted mostly of needles taped, instead of 
inserted, to specific points on a patient's body. Because all of the 
patients were new to acupuncture, Dr. Hochberg said, they did not know 
they were not receiving the traditional Chinese treatment for Bi 
syndrome, a diagnosis of knee pain.

  Two thirds of the largely white population was women. Their average 
age was 65.5 years.

"Our study validates the efficacy and safety of traditional Chinese 
acupuncture as an adjunctive treatment for patients with symptomatic 
osteoarthritis of the knee," Dr. Hochberg told Medscape.

"It is part of the plethora of options available to the physician for 
treating his or her patient," he added, suggesting that it can be 
especially useful for patients who have a medical condition that 
precludes surgery. "I would say this study moves traditional Chinese 
acupuncture from the so-called list of unproven remedies the Arthritis 
Foundation used to have to the list of proven remedies."

  A medical advisor for the Arthritis Foundation who participated in a 
description of acupuncture as unproven told Medscape the statement 
should be reconsidered and probably would be in light of the study. 
David T. Felson, MD, MPH, from the Boston University Medical Campus in 
Massachusetts, said, however, that the language is not likely to change 
considerably.

"This does provide new evidence that is important, and it would make 
sense for the Arthritis Foundation to reconsider," Dr. Felson said, but 
he described the effects of acupuncture as "really tiny" compared with 
the sham treatment in the study.

A current Arthritis Foundation statement describes acupuncture as "an 
accepted arthritis treatment in many parts of the world for arthritis 
and related conditions." It describes acupuncture as safe and says it 
is "probably worth a try, especially if other treatments aren't working 
for you."

ACR 68th Annual Scientific Meeting: Abstract 1718. Presented Oct. 19, 
2004.

  Reviewed by Gary D. Vogin, MD
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