Background: Osteoarthritis of the knee is a major cause of disability with treatment focused only on control of symptoms. The conservative non surgical management of knee osteoarthritis is to control the signs and symptoms. However, knee replacements are common for knee osteoarthritis. Despite the popularity of both acupuncture and homeopathy, evidence of their efficacy for treatment of osteoarthritis remains controversy. Aim of the work: To assess the efficacy of Acupuncture compared with Homeopathy and with the usual conservative treatment (analgesics and physiotherapy) in patients with knee osteoarthritis.
Patients and Methods: Seventy-five patients who had had chronic pain for at least 6 months due to osteoarthritis of the knee (American College of Rheumatology [ACR] criteria and Kellgren-Lawrence score of 2) were admitted to the study. During the study, all of the subjects continued on their conservative therapy, which remained unchanged throughout the study. The subjects were randomly divided into three groups. Group I (Acupuncture group): Included 25 patients who were subjected to acupuncture at the standardized acu-point stimulation treatment without electrical stimulation. Sessions were done twice weekly from base line visit to week six. Group II (Homeopathy group): Included 25 patients who were given oral doses of homeopathic remedies that were commonly used for the treatment of osteoarthritis (Arnica Montana, Ruta graveolans and Rhus toxicodendron). Group III (Control group): Included 25 patients who continued only on their pre-study medications. Pain intensity on visual analog scale (VAS), the Health Assessment Questionnaire (HAQ) score and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were recorded for each patient before the beginning of treatment, during each visit and at the end of the sessions. The results were statistically analyzed.
Results: Pain was significantly improved on both VAS and pain subscale of the WOMAC in group I. Also, the number of tender points decreased significantly and there was a significant decrease in the number of patients receiving analgesics for pain control at the end of the study (p<0.05). In addition, a statistically significant improvement in knee function was detected (p<0.05) on the total WOMAC score for knee osteoarthritis and both the function and stiffness subscales of the WOMAC, in addition a statistically significant decrease in knee swelling (knee circumference) was detected in group I. There was also a significant increase in patient quality of life assessed by the HAQ score for group I and this gain was significantly greater than the gain in the control group. There was a statistically significant improvement in the total WOMAC score, (both VAS and pain subscale of the WOMAC) and a significant reduction in the number of tender points in group II. Moreover, a significant decrease in the number of patients receiving analgesics for pain control was reported in this group (p<0.05). In addition, the improvement of pain and function was statistically greater (p<0.05) in comparison to the control group (group III).
Conclusions: Both Acupuncture and Homeopathy were effective in reducing pain and improving function of the knee compared to the usual care group but acupuncture was significantly more effective than homeopathy. Moreover, Acupuncture significantly decreased the knee circumference (swelling) while homeopathy and usual care did not significantly decrease the swelling.