BERLIN, Germany—Acupuncture combined with usual medical care reduces pain and improves quality of life among patients with chronic knee or hip osteoarthritis (OA), according to a new study in the November issue of Arthritis & Rheumatism.1

"The present results show that in patients with chronic pain due to OA of the knee or hip who were receiving routine primary care, addition of acupuncture to the treatment regimen resulted in clinically relevant and persistent benefit." —Claudia M. Witt, MD
The randomized, controlled trial compared outcomes in patients with hip or knee OA treated with routine medical care plus 15 sessions of acupuncture to those who had routine care alone. The improvements occurred immediately after completing a 3-month course of acupuncture and lasted for at least another 3 months, report researchers led by Claudia Witt, MD, deputy administrative director of the Institute of Social Medicine, Epidemiology, and Health Economics of Charite' University Medical Centre in Berlin, Germany.

Add needles, reduce pain

"The present results show that in patients with chronic pain due to OA of the knee or hip who were receiving routine primary care, addition of acupuncture to the treatment regimen resulted in clinically relevant and persistent benefit," Dr. Witt concludes. "Acupuncture should be considered as a treatment option for patients with knee or hip OA-associated chronic pain."

In fact, the German Federal Committee of Physicians and Health Insurers proposed that acupuncture be reimbursed by statutory health insurance funds based in part on the results of this study and pending a final decision by the German Ministry of Health. It seems likely that acupuncture may be provided as part of routine care for the treatment of OA-related pain.

WOMAC, SF36 improvements

Patients with chronic hip or knee OA were randomized to undergo 15 sessions of needle acupuncture with manual stimulation over a 3-month period or to a control group receiving no acupuncture. Another group of patients who did not consent to randomization also underwent acupuncture treatment. Moreover, all patients were allowed to receive usual medical care in addition to acupuncture. Researchers assessed clinical OA severity via the Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] and health-related quality of life with the Short Form 36 (SF36) at baseline and after 3 months and 6 months.

In the study, 357 were randomized to the acupuncture group and 355 to the control group, and 2921 were included in the nonrandomized acupuncture group. The initial cohort comprised 3633 patients with a mean age of 61.8.

WOMAC scores improved by a mean of 17.6 in the acupuncture group compared to 0.9 in the control group at 3 months; also, quality of life improvements were more pronounced in the acupuncture group versus the control group (P <.001). The results lasted through 6 months.

Moreover, treatment outcomes were similar among patients who consented to randomization and those who did not, the study showed. Physicians performed acupuncture in the new study, but their formal qualification and degree of training did not affect treatment outcome.

"Given that the biologic mechanism of acupuncture is still unclear, the study by Witt et al furthers our understanding of acupuncture and adds to the accumulated evidence supporting its efficacy; such evidence warrants extensive use of acupuncture in various pain conditions," write Tao Liu, MD, and Chen Liu, MD, of Jilin University in the People's Republic of China, in an accompanying editorial.2

Should US insurers follow Germany's lead?

Tim Rhudy, an acupuncturist at the Cleveland Clinic in Ohio, agrees. "The benefits in the study lasted for an additional 3 months and a lot of critics say that acupuncture only feels good at the time and it doesn't last, but if you give it enough of a go, people get pretty good results, and this study proves that. In my world where people pay out of pocket, you never find people coming in for as long as they did in the study, so we have to make progress in shorter periods of time, but if it were covered by insurance, we would have a lot more success in treating arthritis," he told CIAOMed. In the US, insurance does not typically cover the cost of acupuncture.


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References

1. Witt CM, Jena S, Brinkhaus B, et al. Acupuncture in patients with osteoarthritis of the knee or hip. Arthritis Rheum. 2006;54:3485-3493.
2. Liu T, Liu C. Acupuncture for treating osteoarthritis of the knee and the hip (editorial). Arthritis Rheum. 2006;54:3375-3377.