Effectiveness and multidimensional mechanisms of close-to-bone needling in knee osteoarthritis: a randomized controlled trial.

OBJECTIVES: To evaluate the clinical efficacy of close-to-bone needling (CBN) in patients with knee osteoarthritis (KOA) and to explore its underlying mechanisms. METHODS: Seventy patients with KOA were randomized to receive either CBN (n=35) or oral celecoxib (Drug Group, DG, n=35) for a 4-week intervention period, followed by a 2-week follow-up. Additionally, 35 healthy controls (HC) were enrolled. Clinical outcomes were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Index of Severity for Osteoarthritis of the Knee (ISOA), and the 36-Item Short Form Health Survey (SF-36). Structural alterations were evaluated by magnetic resonance imaging (MRI)-based Whole-Organ Magnetic Resonance Imaging Score (WORMS) and musculoskeletal ultrasound. Molecular changes were assessed by quantifying plasma and synovial fluid levels of miR-140, miR-30, interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α). Neural correlates were assessed via resting-state electroencephalography (EEG), including spectral power analysis and graph-theoretical analysis of brain network characteristics. RESULTS: Compared with the DG group, the CBN group showed significantly greater overall clinical efficacy at 6 weeks (P<0.05), with greater improvements in WOMAC, ISOA, and SF-36 scores, as well as greater reductions in cartilage degeneration, synovial thickening, and joint effusion (P<0.05). Furthermore, CBN produced stronger modulatory effects on miR-140, miR-30, IL-1β, and TNF-α levels (P<0.05). EEG analysis revealed reduced Delta and Theta power, increased Alpha, Beta, and Gamma power in frontoparietal regions, and normalization of abnormal prefrontal connectivity patterns in the Theta and Gamma frequency bands (P<0.05). CONCLUSION: CBN represents an effective non-pharmacological intervention for KOA, with advantages over celecoxib in symptom relief, joint structure improvement, molecular regulation, and central neural normalization. The proposed "brain-molecule-clinic" assessment framework provides multidimensional evidence supporting the potential mechanisms of acupuncture-based interventions in KOA.