Abstract
A close relationship between knee osteoarthritis (KOA) and gut microbiota has recently been described. Herein, we aim to investigate the effect of electroacupuncture (EA) on gut microbiota in participants with KOA. We conducted a study of 60 participants with KOA and 30 matched healthy controls (HCs). Sixty participants were allocated to either EA group (n=30) or sham acupuncture (SA) group (n=30). Five obligatory acupoints and three adjunct acupoints were punctured in the EA group. Eight non-acupoints that were separated from conventional acupoints or meridians were used for the SA group. Participants in both groups received 24 sessions within eight weeks. Fecal microbial analyses by 16S ribosomal RNA gene sequencing were carried out after collecting stools at T 0 and T 8 weeks (Four samples with changed defecation habits were excluded). The results showed that both Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score (P=0.043) and NRS score (P=0.002) decreased more in EA group than those in SA group. Moreover, EA could reverse more KOA-related bacteria including Bacteroides, [Eubacterium]_hallii_group, Agathobacter and Streptococcus. The number of significantly different genera between KOA patients and HCs were less after EA treatment than that after SA treatment. This meant that EA modified the composition of the gut microbiome, making it closer to healthy people, while not significantly affecting the microbial diversity. Two genera including Agathobacter (P=0.0163), Lachnoclostridium (P=0.0144) were statistically increased than baseline in EA group (paired Wilcoxon rank sum test). After EA treatment, Bacteroides (P=0.0394) was more abundant and Streptococcus (P=0.0306) was significantly reduced in patients who demonstrated adequate response than in those with inadequate response (Wilcoxon rank-sum test). Spearman correlation test between gut microbe and KOA clinical outcomes indicated that Bacteroides and Agathobacter was negatively correlated with NRS score, WOMAC total score, and WOMAC pain, stiffness and pain scores (P<0.001 or 0.05 or 0.01), while Streptococcus was positively correlated with them (P<0.05 or 0.01). Our study suggests that EA contributes to the improvement of KOA and gut microbiota could be a potential therapeutic target.
Highlights
Knee osteoarthritis (KOA) is one of the most common chronic conditions and forms of arthritis worldwide, which features as a protracted course of disease, especially among elderly patients (Lawrence et al, 2008; Arc OGEN Consortium and arc OGEN Collaborators, 2012)
We evaluated the effect of EA as a complementary therapy of knee osteoarthritis, with respect to relieve pain and microbiome compared with sham acupuncture (SA)
Our study suggested that EA could significantly relieve KOA pain
Summary
Knee osteoarthritis (KOA) is one of the most common chronic conditions and forms of arthritis worldwide, which features as a protracted course of disease, especially among elderly patients (Lawrence et al, 2008; Arc OGEN Consortium and arc OGEN Collaborators, 2012). Osteoarthritis is anticipated to become the fourth leading cause of disability by the year 2020 (Hochberg et al, 2016). The most common symptom of KOA patients is chronic knee pain, which leads to a decrease in the amount of activity, and the body of KOA patients is in a low-grade inflammatory state. In healthy humans, these intestinal microbes interact to maintain the stability of the intestinal microecology. Follow-up studies suggested that the abundance of Streptococcus species was associated with increased knee pain, for this association was driven by local inflammation in the knee joint. The results indicated the microbiome is a possible therapeutic target for osteoarthritis-related knee pain (Boer et al, 2019)
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