Effect of electroacupuncture combined with Tuina therapy on gut microbiota in patients with knee osteoarthritis.

BACKGROUND

Knee osteoarthritis (KOA) is a chronic condition characterized by joint pain and dysfunction, driven by aging and obesity. Research indicates that the gut microbiota significantly influences KOA, potentially affecting inflammation and disease progression through the gut-joint axis. Traditional treatments like non-steroidal anti-inflammatory drugs offer symptom relief but have adverse effects. Emerging therapies like electroacupuncture (EA) and Tuina (TN) have shown promise in alleviating pain and improving joint function by targeting the gut microbiota.

AIM

To clarify the efficacy of EA with TN in treating KOA and its effect on gut microbiota regulation.

METHODS

Sixty patients with KOA were allocated to EA or EA + TN (ET) group ( = 30 each). Seven acupoints were punctured. The ET group received TN after each EA session. Both groups completed 12 sessions. The visual analog scale (VAS) for assessing pain and the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) for measuring pain intensity, joint stiffness, and functional capacity were employed to assess clinical outcomes. Pre- and post-treatment fecal specimens underwent 16S ribosomal RNA sequencing to analyze the gut microbiota.

RESULTS

The ET group showed higher rates of "effective" and "markedly effective" outcomes. The VAS score of the ET group remained significantly lower than that of the EA group ( 0.001) immediately after treatment and 1 week post-treatment. The total WOMAC score ( 0.001), pain ( = 0.191), stiffness ( = 0.015), and function scores ( < 0.001) decreased significantly in the ET group post-treatment. The gut microbiota analysis revealed no significant changes in alpha diversity in either group. Beta-diversity analysis indicated distinct patterns in the ET group before and after treatment. Significant changes in microbial abundance were detected in both groups, highlighting variations in Firmicutes, Actinobacteria, Proteobacteria, and Bacteroidetes.

CONCLUSION

ET outperforms EA alone in improving KOA pain, stiffness, and function, potentially gut microbiota modulation, intestinal barrier protection, and inflammation reduction.