Warm Needling Moxibustion for Knee Osteoarthritis: A Randomized Controlled Trial

Li Xin-wei Wang Lei Yang Yan

1 Department of Acupuncture, Haiyan Hospital of Traditional Chinese Medicine, Zhejiang 314300, China

2 Department of Acupuncture, Tongde Hospital of Zhejiang Province, Zhejiang 310012, China

SPECIAL TOPIC STUDY

Warm Needling Moxibustion for Knee Osteoarthritis: A Randomized Controlled Trial

Zhou Jin-feng1,2, Zhao Jun-chao1, Li Xin-wei2, Wang Li-shu1, Wang Lei1, Yang Yan1

1 Department of Acupuncture, Haiyan Hospital of Traditional Chinese Medicine, Zhejiang 314300, China

2 Department of Acupuncture, Tongde Hospital of Zhejiang Province, Zhejiang 310012, China

Author:Zhou Jin-feng, master degree candidate, attending physician.

E-mail: jinfengming.zhou@163.com

Objective: To observe the clinical effect of warm needling moxibustion for knee osteoarthritis (KOA) by a randomized controlled trial.

Methods: Sixty cases with KOA were randomly divided into an observation group and a control group, 30 cases in each group. The observation group was treated by warm needling moxibustion. The control group was treated by simple acupuncture. Ten sessions made one course and the two groups were treated for two courses. The scores of knee joint pain, stiffness and knee functions before and after the treatment were observed.

Results: The scores of Western Ontario and McMaster Universities osteoarthritis index (WOMAC) on pain, stiffness and joint functions before and after treatment in both groups were statistically different (allP＜0.05). The comparisons of the scores in pain, stiffness and joint function after treatment between the two groups were all statistically different (allP＜0.05). The total effective rate was 93.3% in the observation group and 80.0% in the control group. The differences of the clinical effects between the two groups were statistically significant (P＜0.05).

Conclusion: Warm needling moxibustion can improve the clinical symptoms and functions of the patients with KOA, and is better than ordinary acupuncture in the therapeutic effect.

Acupuncture Therapy; Moxibustion Therapy; Warm Needling Therapy; Osteoarthritis, Knee; Randomized Controlled Trial

With the advent of an aging society, the incidence of knee osteoarthritis (KOA) goes up increasingly[1]. The incidence of osteoarthritis in the population over 50 years old in China is about 5%, with KOA accounting for 9.56%. The incidence of osteoarthritis in the population over 60 in China is about 20%, with KOA accounting for 78.5%[2]. The author treated 30 cases of KOA with the warm needling moxibustion in 2012, in comparison with the ordinary acupuncture group. Now, the report is given as follows.

1 Clinical Materials

1.1 Diagnostic criteria

The diagnostic criteria were based upon theGuideline for Diagnosis and Treatment of Osteoarthritis(2007 edition)[3]: recurrent knee joint pain over the recent three months; stenosis of joint space showed by X-ray film(standing or loading position), sclerosis and/or cystic change ofsubchondral bone, osteophyte formation at the joint margin; clear and tenacious synovial fluid (at least twice), white blood count (WBC)＜2 000/mL; middle-aged and elderly patients (≥40 years old); morning stiffness ≤30 min; bony crepitus (feeling) in movement.

In combination of clinical, laboratory and X-ray examinations, KOA can be diagnosed when the previous two items or first, third, fifth and sixth item or first, fourth, fifth and sixth item are conformed.

1.2 Inclusion criteria

Those in conformity with the above diagnostic criteria; able to accept and continue two courses of acupuncture treatment, able to cooperate with this study; at the age not less than 40 years old.

1.3 Exclusion criteria

Those complicated with severe cardiac and pulmonary diseases, hypertension, mental disorders, and dermal diseases in the whole body; pregnant women or women during period, in allergic and weak constitution, and with severe joint deformity of later stage; those with cardiac, hepatic and renal insufficiency, severe tuberculosis, acute and suppurative, infectious diseases and chronic dermal diseases, and reduced arterial pressure.

1.4 Statistical methods

Data were processed by the SPSS 10.0 version software. The measurement data were expressed by mean ± standard deviationthe paired samplet-test was adopted for comparison within the group, and the independent samplet-test was adopted for comparison between the groups. The grading data were processed by Kruskal-Wallis rank-sum test.P＜0.05 was used to express statistical significance in differences.

1.5 General data

Totally, 60 patients with KOA were randomly divided into an observation group and a control group by their visit order, 30 cases in each group. The gender, age and duration between the two groups were not statistically different (allP＞0.05), indicating that the two groups were comparable (Table 1).

Table 1. Comparison of general data between the two groups

2 Therapeutic Methods

2.1 Observation group

Acupoints: Yinlingquan (SP 9), Yanglingquan (GB 34), Neixiyan (EX-LE 4), Dubi (ST 35), Xuehai (SP 10) and Liangqiu (ST 34).

Operation: The filiform needles of 0.30 mm in diameter and 40 mm in length were selected. After routine disinfection, the needles were quickly inserted to the stipulated depth. After arrival of the needling sensation, a piece of pure moxa roll in length of 1.5 cm was put on the needle handle and ignited from its bottom. The patient had a warm sensation in the local area, without burning and painful sensation. After moxa was completely burnt down and cooled down, the needles were taken out. The treatment was given for 20 min every time, once per day. Ten sessions constituted one course, and totally two courses were given.

2.2 Control group

3 Observation on Therapeutic Effects

3.1 Observed indexes

Western Ontario and McMaster Universities osteoarthritis index (WOMAC) was used[4]. This scale includes three aspects of pain, morning stiffness, and daily activities, totally 24 items. Among them, there were five items on pain, two items on stiffness, and seventeen items on joint function. The assessment was processed by questionnaire. The patients were asked to fill in the questionnaire according to their own body condition, to tick one point for the mildest degree or no influence from this disease, and to tick five points for the most severe or severely restricted activity by this disease. The total scores were obtained after the points were summed up. The higher the total score, the more severe the pathologic condition.

3.2 Criteria of therapeutic effects[5]

In accordance with WOMAC score, the scorereducing rate was calculated by Nimodipine formula.

The score-reducing rate ＝ (Score before treatment － Score after treatment) ÷ Score before treatment ×100%.

Basic cure: The score-reducing rate ≥80%.

Remarkable effect: The score-reducing rate ≥50%, but ≤79%.

Effect: The score-reducing rate ≥25%, but≤49%.

Failure: The score-reducing rate ≤24%.

3.3 Results

3.3.1 Comparison of WOMAC score of knee joint before and after treatment between the two groups

After two-course treatments, the scores were obviously decreased in pain, stiffness and functions of the joint between the two groups and were statistically different in comparison with the same group before the treatment (allP＜0.01). In comparison of the scores of pain, stiffness and joint function after the treatment between the two groups, the differences were statistically significant (allP＜0.05), (Table 2).

3.3.2 Comparison of the therapeutic effects between the two groups

By Kruskal-Wallis rank-sum test, the differences between the therapeutic effects of the two groups were statistically significant (P＜0.05), indicating that the therapeutic effect in the observation group was better than that in the control group (Table 3).

Table 2. Comparison of knee joint WOMAC before and after treatment between the two groups (point)

Table 2. Comparison of knee joint WOMAC before and after treatment between the two groups (point)

Note: Compared with the same group before treatment, 1) P＜0.01; compared with the control group after treatment, 2) P＜0.05

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Table 3. Comparison of therapeutic effects between the two groups (case)

4 Discussion

Osteoarthritis is a commonly encountered disease across the world and is a chronic osteoarthropathy manifested by cartilage degeneration and secondary hyperosteogeny, involving movable joints all over the body, weight-loading joint in particular, such as knee, spinal column, wrist, and hand joint. Among them, the knee joint is one of the susceptible joints for osteoarthritis, termed KOA[6]. The pathological changes of KOA are mainly cartilage damage and periarticular hyperosteogeny, manifested predominantly by cartilage damage in the early stage, and joint deformity due to sabotage of bone structure in the later stage[7]. Clinically, there are many therapeutic methods, but the therapeutic effects are difficult to be determined, and high recurrent rate exists[8].

It is believed in traditional Chinese medicine that the etiology and pathogenesis of KOA are mainly related to deficiency of the liver and kidney and over fatigue in the old patients, leading to poor functions of the tendons and bones and malnutrition of the tendons and bones. When healthy qi is deficient, the pathogenic wind, cold and dampness would take the chance to invade the tendon and bone of the joint and block the meridians and collaterals, causing local qi-blood stagnation and obstruction of the meridians[9]. Acupuncture therapy has the effects to circulate qi, activate blood and dredge the meridians and has better effect for pain and tumefaction. By the heating power, warm needling moxibustion can produce a warm stimulation to the acupoints of the human body, to realize the effects to treat and prevent diseases by the functions of the meridians and acupoints and to circulate qi, activate blood, warm the meridians, dredge the collaterals, expel dampness and cold, restore yang for resuscitation, diminish swelling and disperse the accumulation[10]. It has been proven by the results in the study that the therapeutic measures are effective for both groups. After the treatment for two courses, the total effective rates are 93.3% in the observation group and 80.0% in the control group. The differences of the total effective rate and clinical effect between the two groups are statistically significant (bothP＜0.05). In comparison of scores in various WOMAC items intra-group before and after treatment in the two groups, the results are statistically different (allP＜0.01). After treatment, the differences in thescores of various WOMAC items are all statistically significant between the two groups (allP＜0.05).

It has been proven by the results in this study that warm needling moxibustion and ordinary acupuncture are both effective for KOA, but warm needling moxibustion is better than single acupuncture in the overall therapeutic effect, and also obviously better than single acupuncture in improving joint pain, stiffness and joint activities. Therefore, it needs to be clinically popularized.

Conflict of Interest

The authors declared that there was no potential conflict of interest.

Acknowledgments

This work was supported by 2012 Science and Technology Program of Health System of Haiyan County (No. 2012WSYB07).

Statement of Informed Consent

All of the patients in the study signed the informed consent.

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Translator:Huang Guo-qi

Received Date:July 20, 2014

R246.2

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nts in the control group only

acupuncture treatment, and the acupoints and needling operation were as same as those in the observation group, but without moxibustion. The treating time and courses were as same as those in the observation group.