Clinical Efficacy of Acupuncture for Knee Osteoarthritis and Associated Changes in Serum Lipidomics: A Prospective Observational Cohort Study

Purpose: Knee osteoarthritis (KOA) is a chronic degenerative joint disease causing pain, stiffness, and dysfunction. Acupuncture is widely used in the management of KOA, but its metabolic mechanisms remain unclear. In this study, we evaluated the clinical efficacy of acupuncture in KOA and explored its potential mechanisms via serum lipidomics. Patients and Methods: Fifty-eight KOA patients received standardized acupuncture at Dubi (ST35), Neixiyan (EX-LE4), Zusanli (ST36), Yanglingquan (GB34), Xuehai (SP10), Liangqiu (ST34), contralateral Quchi (LI11), Taixi (KI3), and Sanyinjiao (SP6), six sessions per week for four consecutive weeks; 22 healthy subjects served as controls. We assessed clinical efficacy using WOMAC and VAS scores, analyzed serum lipid profiles before and after treatment with LC-MS/MS and performed KEGG pathway enrichment. Results: After treatment, WOMAC and VAS scores significantly decreased (P < 0.05). Lipidomics identified 538 differential metabolites between KOA patients and controls, primarily involved autophagy and glycerolipid metabolism . 218 metabolites changed after acupuncture, including PE (20:1_18:1), LPC (16:0/0:0), and LPE (0:0/18:0), related to neuroactive ligand-receptor interaction and glycerophospholipid metabolism . 68 lipids showed reversed trends post-treatment. Conclusion: Acupuncture significantly improved pain and function in KOA and modulated serum lipid metabolism. Regulation of phosphatidylethanolamine (PE), lysophosphatidylcholine (LPC), lysophosphatidylethanolamine (LPE), and triglycerides (TG), together with enrichment of related pathways, suggests that acupuncture restores lipid homeostasis and alleviates inflammation, supporting its metabolic therapeutic role in KOA. Keywords: knee osteoarthritis, acupuncture, lipid metabolism, lipidomics