Effects of different acupuncture strategies on the prognosis and inflammatory factor levels associated with the treatment of knee osteoarthritis

Knee osteoarthritis is a degenerative condition that affects millions of people, especially the elderly, causing pain, stiffness, and significant functional limitation. This Brazilian study, conducted at Jiujiang People's Hospital, investigated the comparative efficacy of four distinct acupuncture modalities in the treatment of this condition. The work included 123 patients with diagnosed knee osteoarthritis, ages 39 to 75 years, distributed into four treatment groups: traditional acupuncture (35 patients), electroacupuncture (33 patients), warm acupuncture with moxa (30 patients), and fire acupuncture (25 patients). The treatment protocol followed traditional Chinese medicine, using main points such as Ashi, Xiyan, Liangqiu, and Yanglingquan, with complementary points selected according to syndrome differentiation.

Each patient received two weekly sessions over six weeks, totaling 12 sessions per treatment course. Electroacupuncture used 50 Hz electrical stimulation for 30 minutes, while warm acupuncture employed 2 cm moxa sticks heated over the needles. Fire acupuncture involved heating the needles until incandescent before insertion. Results were evaluated through multiple validated instruments: the SF-36 questionnaire for quality of life, the WOMAC form for knee function, the visual analog scale (VAS) for pain, the JOA score for joint function, and analysis of serum inflammatory markers including IL-6, TNF-α, and C-reactive protein.

The findings revealed that all acupuncture modalities provided significant improvements in patients' quality of life, but with different magnitudes. Electroacupuncture demonstrated consistent superiority across multiple domains, including physical health (58.9→74.0 points on SF-36), physical function, bodily pain reduction, vitality, and social functioning. On WOMAC assessment, electroacupuncture showed the best results for pain reduction (10.4→4.0 points), stiffness (5.4→1.6 points), and physical function improvement (30.0→18.0 points). VAS score analysis confirmed the superiority of electroacupuncture in pain reduction (5.3→2.7 points), followed by fire acupuncture (5.4→2.6 points), warm acupuncture (5.8→3.2 points), and traditional acupuncture (6.1→3.7 points).

Particularly impressive was the impact on inflammatory markers, where electroacupuncture significantly reduced IL-6 (3.9→0.6 ng/mL), TNF-α (42.9→9.0 fmol/mL), and C-reactive protein (20.9→5.7 mg/L), surpassing the other modalities. Despite differences in specific items, overall efficacy across treatments was comparable, with total effectiveness rates ranging from 71.3% (traditional acupuncture) to 76.3% (warm acupuncture). The proposed mechanism involves modulation of the neuroendocrine-immune system, with release of neurotransmitters such as acetylcholine and endogenous opioid substances, resulting in analgesic and anti-inflammatory effects. Electroacupuncture may offer additional advantages through controlled electrical stimulation, which potentiates the effects of traditional acupuncture.

Clinically, these results suggest that acupuncture represents a safe and effective alternative to conventional treatments, especially for patients who do not tolerate nonsteroidal anti-inflammatories or who prefer less invasive approaches. Electroacupuncture emerges as the preferred modality when available, offering superior benefits in pain, function, and inflammation.