Alternative therapies offer mild benefit, ‘lousy data’ for OA
MAUI, Hawaii — Among patients with osteoarthritis, the use of alternative therapy interventions such as acupuncture or cupping demonstrated mild benefit for pain or function, yet often present with poor evidence of efficacy, according to a presenter at the 2020 Rheumatology Winter Clinical Symposium.
“Surprisingly, or perhaps not so surprisingly, there is quite a bit of data for acupuncture,” Eric M. Ruderman, MD, associate chief for clinical affairs of the division of rheumatology at Northwestern University Feinberg School of Medicine, told attendees. “Unlike some of the other interventions, the overall quality of evidence for acupuncture was moderate to low and in the end, it was superior to Western medicine for short-term efficacy — mostly pain — and total efficacy.”
Ruderman noted that, in a 2019 review of 12 different systematic reviews of all the different randomized clinical trials, acupuncture may offer some benefit in knee OA, at least in terms of pain, and does so without significant adverse events. Cupping, on the other hand, Ruderman said, “is out there.”
In a 2017 meta-analysis of seven randomized clinical trials evaluating the use of cupping to manage symptoms of knee OA — “all pretty lousy, with no blinding in any of them,” Ruderman said — researchers found only weak evidence of benefit for function.
“I won’t get into the relative merits of dry cupping vs. wet cupping – you can each figure that out on your own,” Ruderman said. “In terms of the data, there was maybe some benefit for dry cupping, but again with some pretty lousy trials. There is data out there, just not good data.”
Another intervention that patients with osteoarthritis repeatedly ask about is the use of lateral wedge insoles, Ruderman noted. “There has been a lot of interest in this in the last 10 years or so,” he said. “The idea behind the lateral wedge insole is that it unloads the medial aspect to the knee where most of the osteoarthritis is coming from. The hope is that maybe you will be symptomatically better, and perhaps down the road you will be structurally better; however, this has yet to be proven.”
In a recent systematic review and meta-analysis focusing on biomechanical outcomes from lateral wedge insoles, Arnold and colleagues determined that, although insoles caused small reductions in external knee adduction moment and knee adduction angular impulse, they were largely ineffective at attenuating structural changes in patients with medial knee OA.
“The main takeaway is that there was a slight benefit to the insole, but when you look specifically at the outcomes in terms of WOMAC, stiffness and function, there really was no benefit at all,” Ruderman said. “Moreover, in terms of pain, which is what all of our patients ask about, there was zero benefit. Perhaps these insoles have some impact on the biomechanical aspects of knee OA, but in terms of treating symptoms, there just doesn’t seem to be any value.” – by Robert Stott
- Arnold JB. Arthritis Care Res. 2016; doi: 10.1002/acr.22797.
- Ruderman E. Evidence Based Medicine: Osteoarthritis – newer concepts in etiology and therapy. Presented at RWCS Annual Meeting; Feb. 12-15, 2020; Maui, Hawaii.
Disclosure: Ruderman reports consultant relationships with Pfizer.