Bloodletting therapy, especially when combined with acupuncture or rehabilitation, may relieve knee osteoarthritis symptoms, but it may also increase adverse effects alongside acupuncture.
The authors systematically searched Chinese and English medical databases and a clinical trial registry for randomized controlled trials involving adults with knee osteoarthritis treated with bloodletting therapy alone or alongside medicines, rehabilitation, or acupuncture. They assessed pain, treatment response, quality of life, and adverse reactions, evaluated study bias using a standardized tool, combined comparable findings through meta-analysis, and graded the certainty of the evidence.
Across the included trials, bloodletting therapy appeared to improve treatment response compared with drug therapy, while combinations with rehabilitation or acupuncture were associated with better pain relief, response, and quality-of-life outcomes than comparison treatments. Fewer bloodletting sites appeared linked to greater pain relief. However, combining bloodletting with acupuncture may raise the risk of adverse reactions, and confidence in the findings was limited because most studies had methodological concerns and inconsistent results.
