Editor’s Note: This is the latest column from the Society for Acupuncture Research (www.acupunctureresearch.org). Visit the SAR online columnist page for access to previous articles.
Knee osteoarthritis (KOA) commonly causes persistent pain, stiffness and functional limitation. Although electroacupuncture (EA) is used to manage KOA symptoms, its potential effects on joint structure are less clear. This multicentre, randomized trial published in The Lancet’s journal eClinicalMedicine compared EA with sham acupuncture and assessed both clinical outcomes and exploratory MRI measures.
Study Overview
The trial enrolled 480 adults ages 50–75 with radiologically confirmed, moderate KOA, at least six months of knee pain, and a pain score greater than four and up to seven on a 10-point visual analogue scale. Participants were randomized equally to EA or sham acupuncture at six hospitals in Shanghai. Both groups received treatment three times weekly for six weeks, followed by assessments through week 30.
The EA protocol used Xuehai (SP 10), Liangqiu (ST 34), Dubi (ST 35), Neixiyan (EX-LE 4), Zusanli (ST 36), Yanglingquan (GB 34), Sanyinjiao (SP 6), and Xuanzhong (GB 39). Needles were inserted to depths of 13-30 mm and manually stimulated to elicit de qi. Electrical stimulation consisted of a 2 Hz continuous wave for five minutes, followed by a 2 Hz sparse-dense wave for 20 minutes.
The sham group received nonpenetrating needles at the same points with identical electrical-device settings. The primary outcome was change in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) global score at week six.
Key Findings
At week six, EA produced significantly greater improvement in WOMAC global scores than sham acupuncture, with a large between-group effect. The adjusted mean improvement was 65.35 points with EA compared with 24.76 points with sham acupuncture. A clinically meaningful improvement was achieved by 92.9% of participants in the EA group vs. 67.9% in the sham group.
Benefits were also observed across WOMAC pain, stiffness, and function scores, visual analogue pain scores, the Lysholm score, the Lequesne index, and the six-minute walk test. Differences between groups were evident by week three and remained through the 30-week follow-up.
MRI outcomes were exploratory and assessed only at baseline and week six. EA was associated with reduced infrapatellar fat-pad signal intensity and effusion-synovitis depth, suggesting reduced local inflammatory activity. Some cartilage measures also favored EA, but the effects were small.
Because the trial was not powered specifically for structural outcomes and the imaging period was short, these findings should be considered preliminary signals rather than evidence that EA modifies disease progression.
No serious adverse events occurred. All reported adverse events were mild and resolved spontaneously.
Clinical Relevance for Acupuncture Practitioners
This large, multicentre trial supports a six-week course of EA, delivered three times weekly, for meaningful improvements in pain, stiffness and function in adults with moderate KOA. The protocol provides specific details regarding point selection, needle depth, de qi stimulation, and electrical parameters that may be useful when considering treatment intensity in clinical practice. The MRI findings are promising but should not yet be interpreted as proof of cartilage protection or disease modification. Longer trials designed specifically to assess structural change are needed.
Conclusion
In adults with moderate knee osteoarthritis, six weeks of electroacupuncture produced substantial improvements in pain and function compared with sham acupuncture, with benefits persisting through 30 weeks. Exploratory MRI findings suggested possible changes related to local inflammation and cartilage morphology, although these observations require confirmation in longer, adequately powered studies.
Reference
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