Electroacupuncture, Knee Osteoarthritis, and the Gut Microbiota

November 10, 2021   |   Evidence in Integrative Healthcare

New research suggests that electroacupuncture not only alleviates osteoarthritic knee pain, but it may do so, in part, by enhancing the gut microbiota to modulate inflammation.¹Wang TQ, et al. Effect of Electroacupuncture on Gut Microbiota in Participants With Knee Osteoarthritis. Front Cell Infect Microbiol. 2021;11:597431.

Background

There is a growing body of evidence that suggests osteoarthritis (OA) is not only a ‘wear and tear’ condition, but that systemic inflammation may be a key contributor. For example, a large (N=1,427) population based study from the Netherlands found that an abundance of Streptococcus species causes an imbalance in the gut-microbiome which contributes to low-grade systemic and local inflammation and leads to increased OA knee pain.²Boer CG, et al. Intestinal microbiome composition and its relation to joint pain and inflammation. Nat Commun. 2019;10(1):4881. This mounting evidence is summarized in a recent consensus statement, which strongly suggests that the prevalence of OA increases not only because of wear and tear but also from our current lifestyles, “in particular physical inactivity and diets low in fiber and rich in sugar and saturated fats, which promote chronic low-grade inflammation and obesity.”³Biver E, et al. Gut microbiota and osteoarthritis management: An expert consensus of the European society for clinical and economic aspects of osteoporosis, osteoarthritis and musculoskeletal diseases (ESCEO). Ageing Res Rev. 2019;55:100946.

New Acupuncture Research

Building off this emerging evidence, an exploratory study assessed the effects of electroacupuncture on knee OA and the gut microbiota.⁴Wang TQ, et al. Effect of Electroacupuncture on Gut Microbiota in Participants With Knee Osteoarthritis. Front Cell Infect Microbiol. 2021;11:597431 In this trial, a small cohort of participants (N=60) were observed from within a larger trial (N=480).⁵Tu JF, et al. Efficacy of Intensive Acupuncture Versus Sham Acupuncture in Knee Osteoarthritis: A Randomized Controlled Trial. Arthritis Rheumatol. 2021;73(3):448-58 (Results of that larger trial suggest electroacupuncture outperforms manual acupuncture and sham acupuncture controls for the treatment of knee OA). The small exploratory study focused on the gut microbiome and suggested that electroacupuncture not only improved knee OA, but modified the composition of the gut microbiome too.

Study Details

Wang TQ, et al. Effect of Electroacupuncture on Gut Microbiota in Participants With Knee Osteoarthritis. Front Cell Infect Microbiol. 2021;11:597431.

• Design: Exploratory randomized controlled trial (N=60), with a matched cohort of healthy controls; Overweight participants (BMI: ~26) from the Beijing area in China, aged 59 to 73 and diagnosed with Knee OA

• Interventions: 3 groups:

• 1. Electroacupuncture (24 Tx’s, 3x/wk for 8wks);
  2. Sham acupuncture at non-acupoint zones (24 Tx’s, 3x/wk for 8wks)
  3. *Matched healthy controls for microbiome comparison (N=30; No Tx)

• Outcomes: Exploratory trial; Fecal microbial analyses at end of Tx (6S ribosomal RNA gene sequencing)
  • Original RCT assessed Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Numerical Rating Score (NRS) of Pain

• Results: Electroacupuncture reversed more knee OA-related bacteria including Bacteroides, [Eubacterium] hallii group, Agathobacter and Streptococcus.
  • The number of significantly different gut genera between OA patients and healthy controls were less after electroacupuncture compared to sham; suggesting that “…electroacupuncture can modify the composition of the microbiome to more reflect that of the healthy controls.”
• Conclusion: Based on these findings, the authors suggested that in addition to electroacupuncture significantly reducing OA knee pain it may in part impart these inflammatory effects “by changing serval genera in gut microbiota. In particular…the abundance of pathogenic bacteria, such as Streptococcus and [an] increased abundance of beneficial bacteria including Agathobacter and Bacteroide…”

For Providers

Although this message is not new to acupuncture providers, a reminder that lifestyle is foundational, even for patients with knee OA. If you have patients with knee OA, it may be beneficial to ask them about their diet and recommend modifications such as adding pre/pro-biotic foods, increasing fiber and decreasing sugars and saturated fat. If you are using manual acupuncture, try electroacupuncture as this new research suggests it may enhance the effects (100/2Hz: LR-8 : GB-33 & 2 ashi adjacent points; see study for details.