A computerized search of databases (excluding Asian databases) of RCTs identified 157 that were potentially eligible for review. This number was reduced to 13, representing 2,362 patients. Studies were not limited to specific settings, and were conducted in North America (3), the Far East (2), and Europe (8).
The data were extracted from the selected studies independently by two of the authors. Quality, or internal validity, of each RCT was assessed. The review compared studies according to their short-term (25 weeks from randomization with the selected measurement being that nearest 12 weeks) and long-term (last measurement between 26 and 52 weeks) effects. Acupuncture was significantly superior to the comparison groups for short-term pain reduction and improvement of function. Assessment identified that one study contributed to high heterogeneity; when it was removed, results remained the same. Significant long-term effects of acupuncture were also found for both pain and function based on the analysis of three high-quality studies. The size of the effect on pain was 0.4 (small to moderate), and the 95% CIs were wide (0.1, 0.6).
While further evidence is needed before any clear claims regarding acupuncture’s use in treating chronic knee pain can be made, the findings suggest that it can be helpful. Its effect is noted as being comparable with taking NSAIDs. Because taking medicine is often associated with side effects, acupuncture may provide a good alternative treatment. Large, high-quality RCTs are needed to provide further evidence.
Until such studies are available to further guide the treatment of knee pain, I believe that the current evidence supports serious consideration for the use of acupuncture. The decision to use it should be made jointly by the patient and healthcare provider with consideration given to such factors as the patient’s desire to try an alternative treatment method, whether the patient is taking an anticoagulant or certain herbs, the availability of a well-qualified acupuncture practitioner, time commitment, and cost.
Infliximab in Giant Cell Arteritis and Polymyalgia Rheumatica
By Eric S. Schned, MD
Hoffman GS, Cid MC, Rendt-Zagar KE, et al. Infliximab for maintenance of glucocorticosteroid-induced remission of giant cell arteritis. Ann Intern Med. 2007;146:621-630.
Background: Tumor necrosis factor-a (TNF-a) is present in arteries in giant cell arteritis (GCA).
Objective: To evaluate the efficacy of infliximab, an anti-TNF-a agent, in GCA.
Design: Randomized, controlled trial.
Setting: Twenty-two sites in the United States, United Kingdom, Belgium, Italy, and Spain.