[BBC News] Exercise is good for joints with wear-and-tear arthritis

Given the uncertainty in the results compared with sham and potential for a large resource impact, the committee decided not to recommend standard acupuncture or electroacupuncture.
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Someone let the ginger indirect moxibustion researchers know that there may be some demand for their research skills as the UK acupuncturists seek to diversify.

The committee decided that the benefits of acupuncture weren't convincing, given the potential harms, and slammed research that didn't have a sham treatment as low or very low quality. Electroacupuncture nearly got a look in, given the lesser potential for harm, but it was decided the evidence base wasn't sufficient. Still, it looks like they are suggesting more research. And of course, this is a draft, so the acupuncture lobby still has a chance.

Here are some of the bits I thought were interesting

It's good to see the committee acknowledging the importance of an active control:
As with sham acupuncture, the committee noted the limitations of examining acupuncture against no treatment. They agreed that given the complex nature of the intervention, there was likely to be a more pronounced benefit from acupuncture when compared to no treatment in comparison to sham, and that this benefit will include factors beyond the insertion of needles. This was further complicated by the variety of definitions of no treatment included for this comparison, ranging from supervised exercise therapy available to both study arms to waiting list controls. The committee noted that the presence of health care professional input, in particular the relationship between the practitioner and the participant, may lead to a substantial effect and so studies that do not include this in the control arm are likely to see larger benefits from acupuncture.
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The evidence varied from high to very low quality. The majority of evidence when compared to sham procedures was of moderate quality, while the majority of evidence when compared to no treatment was of very low quality. Outcomes were commonly downgraded for inconsistency and imprecision. When compared to no treatment, outcomes were commonly downgraded for risk of bias (in particular for risk of performance bias
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I may well be imagining it, but I like to think there is a pregnant pause after noting that the low back pain and management of chronic pain guidelines just required that acupuncture show a benefit compared to usual care when assessing cost-effectiveness, rather than requiring, as the committee for this guideline has required, that there is also a clinical benefit compared with sham treatments.
1.1.12.4 Cost effectiveness and resource use
The committee discussed the correct comparator for evaluations of acupuncture. In economic evaluations, comparisons with usual care or no treatment or an alternative active comparator are usually considered most relevant for assessing the real-world impact of an intervention on resource use and QALYs.
It was decided that for acupuncture to be recommended there should be:
  • a clinical benefit compared with both sham and usual care, and
  • cost effectiveness compared with usual care.
Comparing acupuncture to usual care is the most common approach to assessing its cost-effectiveness and this approach has been taken on the NICE guidelines on low back pain
(NG59) and management of primary chronic pain (NG193).
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Walking is strongly encouraged for knee arthritis (up to a point, that pain shouldn't continue after the two-hour point post walking).

This activity stimulates synovial fluid lubricating the joint, the light pounding or weight bearing of walking stimulates fluid release.

I have found that my knee hurts less when I walk during the week, in that the sudden pain getting up from being immobile is much less or disappeared if I have done my walks vs 4 days without a walk

However, key is the amount, no downhill walking, no overdoing. And it is complicated by fibromyalgia muscle pain. And my knee osteo-arthritis is likely still on the mild side.
 
I saw a front page with it. Headline says "will save billions".

I'm not sure at this point how the point isn't made directly: if we just don't treat anyone, we can save 100% of the money. Well, 100% of the money that goes to direct healthcare expenditures anyway. It's seriously as if healthcare authorities don't understand that sick people aren't productive.

Late stage capitalism mixed in with late stage medicine. Oh boy. It's going to be rough years while this nonsense plays itself out.
 
shak8 said:
Walking is strongly encouraged for knee arthritis (up to a point, that pain shouldn't continue after the two-hour point post walking).

This activity stimulates synovial fluid lubricating the joint, the light pounding or weight bearing of walking stimulates fluid release.
Click to expand...

I have not looked at this in detail but I have a strong sense that this draft guideline is CRAP.

That statement about synovial fluid is pure bullshit. We know absolutely nothing about any beneficial effects of exercise mediated by changes in synovial fluid. It is just made up pseudo physiology.

It sounds as if they have said no to acupuncture but I wonder what the evidence for topical NSAI is? I find it inconceivable that topical NSAI should penetrate a local painful area adequately. If you rub stuff on a solid lump of biological material it will take weeks for anything to diffuse through. Unless of course it is spread by blood flow - I which case it will go off to the liver and so on.

Right fro the start the whole guideline looks like noddy medicine.
Why would one want to diagnose 'osteoarthritis' which is a pretty meaningless term. What does the patient gain by being told they have 'osteoarthritis'. Why can't we tell them what is actually wrong - which of course would require some imaging to see what is wrong.

It looks like the sort of rheumatology that was standard in the 1970s before some of us tried to make it a proper medical discipline - what used to be called 'physical medicine', otherwise known as 'slap and tickle medicine' since it was mostly physio.

It makes me think the ME guideline was quite an achievement.
 
I did not read the generic article or what it refers to. I was reacting to what I thought I knew about knee arthritis.

What I base my decisions on what to do, what meds to take is the 2019 OARSI guidelines.

But surely you are right that it's mere clinical hearsay about synovial lubrication.

I'll go to pubmed and look up some studies.
 
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