Effects of externally-applied, non-pharmacological Interventions on short- and long-term symptoms and inflammatory cytokine levels in patients with knee osteoarthritis: a systematic review and network meta-analysis

Abstract

BackgroundWith the continuous development of clinical medicine, an increasing number of non-pharmacological interventions have been applied for the treatment of knee osteoarthritis (KOA), with the results of several recent randomized controlled trials (RCTs) showing that a variety of externally-applied, non-pharmacological interventions (EANPI) can improve symptoms and inflammation in patients with KOA. However, the relative benefits and disadvantages of non-drug therapies remain uncertain, and an optimal treatment strategy has not yet been determined.ObjectiveThis study applied network meta-analysis (NMA) to compare and rank the effectiveness of EANPI on the short- and long-term clinical symptoms and inflammatory cytokine levels in patients with KOA.MethodsTwo independent researchers searched online databases and performed manual retrieval of related citations to identify RCTs that met the selection criteria for the network meta-analysis. These researchers retrieved studies indexed from database inception to August 2023 and performed data extraction and assessment of the risk of bias.ResultsThe analysis included 80 RCTs involving 8440 participants and nine externally-applied, non-pharmacological therapies, namely extracorporeal shock wave, radiofrequency, acupotomy, laser therapy, Tuina therapy, kinesio taping, electroacupuncture, platelet-rich plasma injection, and ozone therapy. The treatment courses ranged from 1 to 12 weeks, with follow-up periods ranging from 4 to 24 weeks. The results of the NMA indicated that each non-drug therapy was superior to sham intervention in improving all outcome indicators. Except for the visual analog scale (VAS) and Western Ontario MacMaster (WOMAC) pain outcomes, all non-drug therapies had better efficacy than pharmacological treatments. For short-term VAS and tumor necrosis factor-alpha (TNF-α), extracorporeal shock wave performed better than other therapies (90.2% and 85.2% respectively). Radiofrequency therapy may be the most promising method to reduce long-term VAS, short- and long-term WOMAC pain, and interleukin (IL)-1β level (84.8%, 97.8%, 90.1%, 94.8% respectively). Tuina therapy may be a significant choice for short- and long-term outcomes of WOMAC function and range of motion (ROM).ConclusionsThe results of the comprehensive comparison of the outcome indicators in 9 different EANPI indicated that radiofrequency and Tuina therapy were more effective and consistently ranked high in improving clinical symptoms in the short and long term. Radiofrequency is effective at relieving pain, and Tuina therapy can be given priority for treatment when hypofunction is the main symptom. EANPI to improve pain symptoms may be related to the regulation of inflammatory cytokine levels, which may be a potential mechanism of action.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?, identifier CRD42023464177.

Clinical research progress on acupuncture for the treatment of otogenic vertigo

“…At the deep layer is the vertebral artery. Studies have shown that electroacupuncture at the Fengchi and other points not only relieves the vertigo symptoms of patients with vertigo but also improves the blood flow of the vertebrobasilar artery, and the clinical effect is substantial[ 5 ]. Other studies have reported that cervical Jiaji acupuncture combined with the Fengchi, Hou Xi, and Shu gu points can relieve the symptoms of patients with vertigo, and these mechanisms may be related to the acceleration of the blood flow of the vertebrobasilar artery[ 6 ].…”

Exploring the causal relationship between inflammatory cytokines and immunoinflammatory dermatoses: a Mendelian randomization study

“…Furthermore, IL-4 may contribute to the risk of developing vitiligo. Studies have shown that changes in cytokine levels caused by targeted therapies alter disease symptoms ( 63 , 64 ). Our results provide insight into further understanding the mechanisms of chronic skin inflammation and offer new targets and strategies for the prevention and treatment of immunoinflammatory dermatoses.…”

Efficacy and safety of traditional Chinese manual therapy (Tuina) in patients with non-specific chronic low back pain: a study protocol for a randomised controlled trial

“…Numerous studies have indicated the potential benefits of Tuina for conditions such as lumbar disc herniation, 6 non-specific chronic neck pain 7 and knee osteoarthritis. 8 These effects may be attributed to mechanisms such as inflammation reduction, circulation enhancement and nerve function stimulation. [9][10][11] However, there is currently a shortage of clinical trials observing the effectiveness of Tuina on NSCLBP.…”