Efficacy of knee-balancing manipulation plus heat-sensitive moxibustion for knee osteoarthritis and its influence on CTX-Ⅰ, TRACP-5b, ADAMTS-4, and MMP-3 / 针灸推拿医学（英文版）

ABSTRACT

Objective: To observe the efficacy of knee-balancing manipulation plus heat-sensitive moxibustion in treating knee osteoarthritis (KOA) and its impact on the expression of C-telopeptide of type Ⅰ collagen (CTX-Ⅰ), tartrate-resistant acid phosphatase 5b (TRACP-5b), A disintegrin and metalloproteinase with thrombospondin motifs 4 (ADAMTS-4), and matrix metalloproteinase 3 (MMP-3). Methods: A total of 134 unilateral KOA patients were randomized into a knee-balancing group, a heat-sensitive moxibustion group, and a joint intervention group. The knee-balancing group received knee-balancing Tuina (Chinese therapeutic massage) manipulation for treatment. The heat-sensitive moxibustion group received heat-sensitive moxibustion treatment. The joint intervention group received the heat-sensitive moxibustion in addition to the knee- balancing manipulation. The intervention period lasted for four weeks. After the treatment, and at the 2-week and 6-week follow-ups, the three groups were assessed using the visual analog scale (VAS) for knee joint pain and Western Ontario and McMaster Universities arthritis index (WOMAC), and clinical efficacy was also evaluated. The enzyme- linked immunosorbent assay was adopted to detect the expression levels of serum CTX-Ⅰ, TRACP-5b, ADAMTS-4, and MMP-3. Results: The knee-balancing group had 44 participants, but one dropped out; there was no dropout case among the 44 participants in the heat-sensitive moxibustion group; among the 46 participants in the joint intervention group, two cases dropped out. After the treatment, and at the 2-week and 6-week follow-ups, the total effective rate was found higher in the joint intervention group than in the knee-balancing and heat-sensitive moxibustion groups (P<0.05). Compared with the baseline, the VAS and WOMAC scores and the serum levels of CTX-Ⅰ, TRACP-5b, ADAMTS-4, and MMP-3 decreased significantly in all three groups after treatment and at the 2-week and 6-week follow-ups (P<0.05). At the same three time points, the VAS and WOMAC scores and serum levels of CTX-Ⅰ, TRACP-5b, ADAMTS-4, and MMP-3 were lower in the joint intervention group than in the knee-balancing and heat-sensitive moxibustion groups (P<0.001). Conclusion: Either used alone or combined, the knee-balancing manipulation and heat-sensitive moxibustion therapy can improve the symptoms and down-regulate the serum levels of CTX-Ⅰ, TRACP-5b, ADAMTS-4, and MMP-3 in KOA patients, producing durable efficacy; nevertheless, a more significant efficacy can be achieved by combining the two methods.