Effects of Warm-Needling Acupuncture Plus Tuina on Inflammatory and Cartilage Biomarkers in Knee Osteoarthritis: A Systematic Review and Meta-Analysis
In brief
Acupuncture plus Tuina lowered five inflammation markers in knee osteoarthritis trials
Across 19 randomized trials, warm-needling acupuncture plus Tuina was linked to lower levels of five blood inflammation markers than control treatments, as well as lower levels of two markers in joint fluid and the cartilage-degradation marker MMP-3. These biomarker changes do not establish symptom relief or cartilage repair, and evidence certainty was very low to low, so larger, stronger trials are needed.
- Journal
- Journal of pain research (Q1)
- Published
- 23 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Yanchen Dong, Kaojuan Zeng, Yongyuan Liu, Donghui Liang, Guoping Xie
- PMID
- 42802793
- DOI
- 10.2147/JPR.S636990
Why clinicians should know about it
- Picked for Complementary and Alternative Medicine (top studies of the week, 4 October 2026): Warm‑needling acupuncture + Tuina meta‑analysis of RCTs
- Picked for Biochemistry (medical) (top studies of the week, 4 October 2026): Warm‑needling acupuncture plus Tuina effects on knee osteoarthritis biomarkers
Abstract
BACKGROUND: Knee osteoarthritis (KOA) involves cartilage degeneration and synovial inflammation. Warm-needling acupuncture (WNA) plus Tuina is used clinically, but its systemic and local anti-inflammatory effects, as well as its potential benefits in modulating cartilage metabolism, lack robust evidence. OBJECTIVE: To systematically evaluate WNA plus Tuina's effects on inflammatory cytokines and cartilage biomarkers in KOA. METHODS: We searched 8 databases (PubMed, Embase, Web of Science, Cochrane, CNKI, Wanfang, VIP, SinoMed) to March 2026 for RCTs comparing WNA plus Tuina against single or conventional therapies. Outcomes included IL-1/IL-1β, TNF-α, IL-6, CRP, IL-17, and MMP-3. We used the Cochrane RoB 2.0 tool and GRADE system. RESULTS: A total of 19 RCTs were included. Meta-analysis revealed that compared with the control group, WNA combined with Tuina was associated with reduced systemic inflammation levels, including serum CRP (standardized mean difference [SMD] -2.58, 95% confidence interval [CI] [-4.49, -0.67]), IL-1/IL-1β (SMD -1.73, 95% CI [-3.00, -0.47]), IL-6 (SMD -2.19, 95% CI [-3.38, -0.99]), TNF-α (SMD -1.63, 95% CI [-2.92, -0.34]), and IL-17 (SMD -2.06, 95% CI [-3.49, -0.62]). Within the local joint microenvironment, the combined therapy also showed a greater decrease in synovial fluid IL-1/IL-1β (SMD -0.93) and TNF-α (SMD -1.60). Furthermore, the serum level of MMP-3, a cartilage degradation marker, appeared to be downregulated (SMD -2.77, 95% CI [-3.22, -2.31]). Sensitivity analyses confirmed the robustness of these results. GRADE assessment indicated that the certainty of the evidence ranged from very low to low. CONCLUSION: WNA combined with Tuina shows potential in reducing local and systemic inflammatory markers in KOA patients and may offer potential benefits in modulating cartilage metabolism. However, limited by the low certainty of current evidence, these findings should be interpreted with caution, and future validation through high-quality, large-scale RCTs is still required.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.