March 2008

Arthritis of the Knee

By Elliot Wagner, O.M.D., L.Ac., Doctor of Oriental Medicine

Osteoarthritis is the most common joint disease, affecting more than 20 million people in this country. It is commonly referred to simply as arthritis. Osteoarthritis of the knee occurs more often than any other form of this disabling problem. It takes place due to the breakdown of cartilage in the affected joint, and develops gradually over years, which is why 2/3 of sufferers are over 50. Its primary symptoms are pain in the knee, weakness and, in older patients, instability.

While researching this column, I came across a study on the acupuncture treatment of knee arthritis that is large, well-designed, and whose conclusions are strikingly representative of the experience at our clinic. The study, conducted by medical researchers at the University of Maryland School of Medicine, and published in the Annals of Internal Medicine, was designed to reproduce a real-life clinical treatment strategy, much like that used by an acupuncturist in private practice. The study was the largest randomized phase III (large, multicentered, designed to be definitive) trial on acupuncture ever conducted. It studied patients over a period of six months, and tested both functional limitation and pain levels.

To be eligible for the study participants were required to have had moderate, severe, or extreme arthritic pain in one or both knees for most of the days of the past month. Their average age was 65. 64% were women. 50% had suffered arthritic pain for more than five years, and 50% for five years or less. No restrictions were placed on the ongoing medical care of the patients, and they were permitted to continue with prescribed medications. At the start of the study, for example, 76% of the participants were taking one or more analgesic or anti-inflammatory medications. This element of the study permitted researchers to see whether or not acupuncture could be helpful used in addition to the pain-killing medications osteoarthritis sufferers regularly take.

What were the results of this ground-breaking study? Although researchers found that pain and functional limitation decreased steadily among participants for the entire duration of the study, they could not say unequivocally that acupuncture was effective for treating functional limitation until week eight, and for treating pain until week 14. At week 14 both pain and functional limitation had decreased an average of 40%. Pain then continued to decrease and function to improve throughout the treatment reduction period that lasted an additional 12 weeks.

What does this mean for someone with knee arthritis? It means that the average patient — 65, female, with symptoms of arthritis for five years — can expect a significant gain in function and a marked decrease in pain within 3 months (and most likely earlier) after beginning a course of two acupuncture treatments per week. They can expect that improvement to be maintained, perhaps indefinitely, by continued regular treatments of approximately twice a month. Some factors can improve or impair the outcome: the age of the patient, their general level of health, an increase or reduction in the number or consistency of treatments, and the level of experience of the acupuncturist.