Effectiveness of Leech Therapy in Osteoarthritis of the Knee

A Randomized, Controlled Trial

4 November 2003 | Volume 139 Issue 9 | Pages 724-730

Background: Leech therapy was commonly used in traditional medicine for treating localized pain. Clinically significant pain relief after leech therapy for osteoarthritis of the knee has been demonstrated by preliminary data.

Objective: To evaluate the effectiveness of leech therapy for symptomatic relief of osteoarthritis of the knee.

Design: Randomized, controlled trial.

Setting: Outpatient department for integrative medicine of an academic teaching hospital.

Patients: 51 patients with osteoarthritis of the knee (leech therapy: 24 patients, mean age [±SD], 62.5 ± 10.2 years; topical diclofenac therapy: 27 patients, mean age [±SD], 65.5 ± 6.7 years).

Intervention: A single treatment with 4 to 6 locally applied leeches (leech therapy group) or a 28-day topical diclofenac regimen (control group).

Measurements: Mean of the pain, function, and stiffness subscores of the Western Ontario and McMaster Universities Osteoarthritis Index and physical sum score of the Medical Outcomes Study 36-Item Short-Form Health Survey with group comparisons at days 3, 7, 28, and 91.

Results: The primary end point, pain at day 7, was reduced from a mean (±SD) of 53.5 ± 13.7 to 19.3 ± 12.2 after leech therapy compared with 51.5 ± 16.8 to 42.4 ± 19.7 with topical diclofenac (estimated group difference, –23.9 [95% CI, –32.8 to –15.1]; P < 0.001). Although the difference between group pain scores was no longer significant after day 7, differences for function, stiffness, and total symptoms remained significant in favor of leech therapy until the end of study and for quality of life until day 28. Results were not affected by outcome expectation.

Conclusions: Leech therapy helps relieve symptoms in patients with osteoarthritis of the knee. The potential of leech therapy for treating osteoarthritis and the pharmacologic properties of leech saliva remain to be clarified.

Editors' Notes Context Osteoarthritis causes pain and disability, but conventional therapies offer limited relief for many patients. Leech saliva contains anti-inflammatory substances, and leeches showed promise as an osteoarthritis therapy in a nonrandomized study. Contribution This randomized trial compared a single application of 4 to 6 leeches to the affected knee with 28 days of topical diclofenac treatment. Patients with leech therapy had less pain through day 7 than those receiving diclofenac. The leech therapy group showed benefits in function, stiffness, and total arthritis symptoms through the 91 days of follow-up. Cautions Future studies should evaluate leeches and the substances in their saliva against various conventional therapies in blinded studies with long-term follow-up. –The Editors

 

Author and Article Information

From the Kliniken Essen-Mitte, Academic Teaching Hospital of the University of Duisburg-Essen, Karl and Veronica Carstens Foundation, and Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany.

Grant Support: By a research grant from the Karl and Veronica Carstens Foundation, Essen, Germany.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Gustav J. Dobos, MD, Kliniken Essen-Mitte, Department of Internal Medicine V, Am Deimelsberg 34 a, 45276 Essen, Germany; e-mail, gustav.dobos{at}uni-essen.de.

Current Author Addresses: Drs. Michalsen, Spahn, and Dobos and Ms. Klotz: Kliniken Essen-Mitte, Department of Internal Medicine V, Am Deimelsberg 34 a, 45276 Essen, Germany.

Dr. Lüdtke: Karl and Veronica Carstens Foundation, Am Deimelsberg 36, 45276 Essen, Germany.

Dr. Moebus: Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Essen, Hufelandstrasse 55, D-45147 Essen, Germany.

Author Contributions: Conception and design: A. Michalsen, R. Lüdtke, G.J. Dobos.

Analysis and interpretation of the data: A. Michalsen, R. Lüdtke, S. Moebus, G.J. Dobos.

Drafting of the article: A. Michalsen, G. Spahn.

Critical revision of the article for important intellectual content: S. Moebus, G. Spahn, G.J. Dobos.

Final approval of the article: A. Michalsen, G.J. Dobos.

Statistical expertise: R. Lüdtke.

Obtaining of funding: G.J. Dobos.

Administrative, technical, or logistic support: A. Michalsen, S. Klotz, G. Spahn.

Collection and assembly of data: S. Klotz, S. Moebus.