Warm needle acupuncture for osteoarthritis: A systematic review and meta-analysis

Background: Warm needle acupuncture (WA) is considered a potential intervention in the treatment of osteoarthritis (OA). Purpose: To systematically evaluate the clinical efficacy and safety of WA in the treatment of OA. Study design: Systematic review and meta-analysis Methods: Fourteen databases were searched from their inception until May 2022. Randomized controlled trials (RCTs) of WA for treating OA were identified. Study selection and data extraction were performed by two independent reviewers. The Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development and Evaluation program were used to assess all included RCTs. Results: A total of 66 RCTs met the inclusion criteria for this review. Most of the included studies had an unclear risk of bias, and the certainty of the evidence was very low. Twenty-four RCTs compared the effects of WA with those of oral drug therapies. Meta-analysis showed superior effects of WA for the total effective rate (risk ratio (RR): 1.22, 95% confidence interval (CI): 1.17 to 1.27, I-2 = 26%, p < 0.001, 24 studies, n = 2278), pain, and function. Eight RCTs compared the effects of WA+drug therapy, and meta-analysis showed favorable effects for the total effective rate (RR: 1.27, 95% CI: 1.18 to 1.35, I-2 =0%, p < 0.001, 8 studies, n = 646). Eight RCTs compared the effects of WA and intra-articular sodium hyaluronate (IASH) injection on OA and found equivalent effects of WA on the symptoms of OA. Twenty-eight RCTs compared the effects of WA+IASH injection with those of IASH injection, and meta-analysis showed superior effects of WA+IASH in terms of the total effective rate (RR: 1.15, 95% CI: 1.11 to 1.19, I-2 =27.3%, p < 0.001, 25 studies, n = 2208), pain, and function. None of the RCTs reported serious adverse events. Conclusions: WA may have some distinct advantages in the treatment of OA. However, well-designed RCTs with larger sample sizes are needed.

Automated summary

This study systematically evaluated the clinical efficacy and safety of warm needle acupuncture (WA) in the treatment of osteoarthritis (OA) through a systematic review and meta-analysis. The results showed that WA may have advantages in improving the symptoms of OA and can achieve better treatment outcomes compared to oral drugs or intra-articular injections. However, studies on this therapy still have issues of bias risk and low certainty of evidence, and further well-designed randomized controlled trials are needed for validation.