Effects of Warm-Needling Acupuncture Plus Tuina on Inflammatory and Cartilage Biomarkers in Knee Osteoarthritis: A Systematic Review and Meta-Analysis.

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.