Knee osteoarthritis (KOA) is the most prevalent joint disease in the world, affecting more than 300 million people — and its prevalence grows with population aging. Conventional management combines analgesics, anti-inflammatory drugs, and physical therapy, with surgery reserved for advanced cases; however, chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) carries relevant cardiovascular and gastrointestinal risk. A meta-analysis published in Frontiers in Medicine addressed a critical gap in the literature: directly comparing the four main acupuncture techniques against each other, and not only against sham or usual care. With 52 RCTs and 4,339 patients, the results position electroacupuncture as the modality with the greatest clinical efficacy for KOA.
DIRECT COMPARISON: FOUR ACUPUNCTURE TECHNIQUES
Scope of the analysis
The researchers systematically searched RCTs in the Web of Science, EMBASE, PubMed, Scopus, and CNKI databases with publications through September 2024. A total of 52 trials with approximately 4,339 patients were included, distributed between electroacupuncture (11 studies), filiform acupuncture (19 studies), warming acupuncture (13 studies), and fire acupuncture (9 studies). The primary outcomes were the clinical efficacy rate (composite criterion of significant clinical improvement) and the pain score on the Visual Analogue Scale (VAS). Meta-regression analyses investigated moderators of therapeutic response.
Age and BMI as clinical moderators
Meta-regression analysis revealed that both the age and the body mass index (BMI) of patients negatively affect the efficacy rate of acupuncture techniques — that is, older patients and those with higher BMI presented lower response rates. Paradoxically, these same factors showed positive correlation with residual VAS scores: patients with higher BMI and age tended to report greater post-treatment pain even when there was objective clinical improvement. This finding has direct implications: for older patients with obesity and advanced KOA, medical acupuncture should be combined with weight-control interventions and muscle strengthening to maximize results.
Frequently Asked Questions
The RCTs included in the meta-analysis varied between 4 and 12 weeks of treatment, with typical frequency of 2 to 3 sessions per week. Clinical improvement generally becomes evident from the 3rd to 4th week. For cases of moderate to severe KOA, cycles of 8 to 12 weeks with periodic assessment are recommended, with the possibility of monthly maintenance after the intensive phase.
For many patients with mild to moderate KOA, electroacupuncture may allow reduction of NSAID dose when combined with other measures, under medical guidance — especially relevant in older adults with cardiovascular or renal risk. The meta-analysis did not directly study NSAID discontinuation; any dose reduction should be individualized by the attending physician. For severe KOA with acute inflammation, the combination of electroacupuncture with short-term pharmacologic therapy may be more appropriate. The decision should be individualized by the medical acupuncturist, considering radiographic stage, symptom intensity, and the patient’s comorbidity profile.
Fonte Original
Frontiers in Medicine(em inglês)Founded in 1989 by physicians trained at the University of São Paulo (USP) and specialized in China, CEIMEC is a Brazilian national reference in the teaching and practice of medical acupuncture. With more than 3,000 physicians trained over 35 years, it collaborates with HC-FMUSP and is recognized by the Brazilian Medical College of Acupuncture (CMBA/AMB).
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