Evaluation Of Acupuncture Efficacy On Knee Osteoarthritis Comparing To Celecoxib

KOA(Knee Osteoarthritis)is one of the most prevalent forms of degenerative j oint disorders and most common form of arthritis in the elderly,which is associated with pain,functional impairment and a high economic cost,causing a decrease in the knee joint function and destruction of daily life.The disease process is associated with the focal loss of articular cartilage,subchondral bone thickening,new bone formation,that at last damages the entire joint.According to some researches around 10%of all people older than 60 years of age have radiological signs of knee Osteoarthritis,and about 50%of those complain of clinical symptoms.The prevalence of Knee Osteoarthritis is estimated as 27.3%in women and 21.0%in men.Knee OA is a multifactorial disease,concerning different risk factors including age,ethnicity,smoking,occupation,gender,and body mass index(BMI),presence of knee damages,metabolic diseases knee alignment,osteoporosis and hormones.Among them,it is believed that mechanical factors such as body weight,knee alignment,joint stability and bone mineral density may have a strong impact on the incidence and progression of knee OA.No blood tests are routinely indicated for workup of patients with OA unless symptoms and signs suggest inflammatory arthritis.Examination of the synovial fluid is often helpful.X-rays should be obtained if symptoms or signs are not typical of the disease,though correlate poorly with the presence and severity of pain and may be normal in early stage.Although MRI may reveal the extent of pathology in an osteoarthritic joint,it is not indicated as part of the diagnostic workup.Primary management of knee OA is conservative,and includes educational information,physical therapy,regular exercise,weight reduction,the use of acetaminophen(paracetamol)and/or NSAIDs(Non-steroidal anti-inflammatory drugs),opioids and intra-articular injections of corticosteroids or hyaluronate.If symptoms persist after the appropriate use of nonsurgical treatment,however,surgery can be recommended.In the paradigm of traditional Chinese medicine,a substantive energy called qi flows throughout our body in predestined channels called meridians.The typical symptoms of osteoarthritis in traditional Chinese medicine(TCM)are figured out as a joint Bi syndrome.Acupuncture(manual or Electro-acupuncture)may be considered as a natural effective treatment for osteoarthritis.Objectives:Evaluation of Acupuncture efficacy on knee osteoarthritis comparing to celecoxib.Methods and Materials:A pilot randomized clinical trial(RCT)done at my private Clinic Ahwaz,Iran,from June 2018 to November 2018,with the aim of evaluation of Acupuncture efficacy for Knee Osteoarthritis compared to conventional medication therapy.Qualified patients based on inclusion criteria enrolled,thereafter patients filled in the satisfaction form and entered the study.Totally 49 patients were evaluated and finally 42 participants of both genders,aged more than 45 years,who were not undergoing another treatment for knee osteoarthritis and suffered from knee pain more than three months,were included in the study.Participants,who completed a baseline evaluation,were randomly selected and divided into two separate groups of this study;Acupuncture group and Medication group,each consisted of 21.This study is a randomized clinical trial(RCT).All patients who had wanted to participate,filled in satisfaction form after being aware of details of the study and related schedule.They were interviewed and examined individually prior to initiating trial.Necessary instructions concerning the treatment process offered to them(e.g.possible complications),while each session was evolving,making maximum attempt they continue to attend treatment sessions,having enoughmind preparation.The steps of the trial were as follow.1st step:Taking medical history,physical exam and filling in VAS and WOMAC questionnaires by all the patients of two groups as baseline.2nd step:Initiating treatment procedure i.e.conventional medications(Celebrex 200mg-daily)for medication group,acupuncture for related group 2 sessions weekly.3rd step:WOMAC questionnaire was answered by the patients of both groups after two weeks of treatment(end of the two-week trial).VAS questionnaire was filled in before and after each session by the patients in Acupuncture group(totally 4 sessions,8 VAS questionnaires).4th step:All patients in both groups answered WOMAC questionnaire,one more time,after two weeks of treatment off,as "follow up".Using sterile filiform needles(0.30x40 mm),utilizing "even method" as manipulation technique and extracting needles after 30 minutes was the routine in the Acupuncture group.Points selected for needling were consisted of acupoints Biguan(ST31)-Liangqiu(ST34)-Dubi(ST35)-Xuehai(SP10)-Zusanli(ST36)-Yanglingquan(GB34)-Yinlingquan(SP9)-Xuanzhong(GB39)and extrapoint Xiyan(EX-LE-5).Results:The results showed age parameter in this study had normal distribution and there were no significant differences in age between,genders(P-value = 0.753).The results showed the distribution of VAS and WOMAC data before and after acupuncture and medication therapy was normal(P>0.05).The results showed there were no significant differences in WOMAC at baseline between two groups.That revealed no significant difference in WOMAC at posttest between two groups.WOMAC score is significantly lower in Acupuncture group than Medication group at follow-upIn Acupuncture group the results of repeated measure ANOVA test in pretest(Mean±SD =62.71±13.08),in posttest(Mean±SD=31.57±13.27),and in follow-up(Mean±SD=19.71±11.11)showed significant differences in WOMAC scores(P<0.001).In Medication group the results of repeated measure ANOVA test in pretest(Mean±SD=63.23± 17.63),in posttest(Mean±SD=36.42±13.07),and in follow-up(Mean±SD=26.90±8.33)showed significant differences in WOMAC scores(P<0.001).VAS score is significantly lower in Acupuncture group than Medication group at pretest.The results of ANCOVA showed that there were no significant differences in VAS parameter at posttest between medication and acupuncture groups(P=0.766).In Medication group the results of paired-sample t-test at pretest(Mean±SD=6.95±1.80)and after treatment(Mean±SD=2.90±1.48)demonstrated significant differences in VAS scores(P<0.001).In Acupuncture group the results of repeated measure ANOVA test in five times,baseline(Mean±SD=5.71±1.48),after first session(Mean±SD=4.90±1.75),after second session(Mean±SD=4.00±2.19),after third session(Mean±SD=2.95±1.07),and after fourth session(Mean±SD=2.76±1.04)showed significant differences in VAS scores(P<0.001).Conclusion:Acupuncture and Medication both are efficacious approaches in short-term control and management of KOA.However,Acupuncture is superior in that having longer duration of resolution in comparison with conventional medication.