Evaluation of the efficiency and safety of magnet therapy for osteoarthritis. Results of the multicenter blind placebo-controlled study COSMO (Clinical Evaluation of Current Magnet Therapy for Osteoarthritis)

Magnet therapy (Mt) is a well-known physiotherapy technique that is widely used to treat knee osteoarthritis (OA). Objective: to determine the efficiency and safety of Mt for knee OA.

Subjects and methods. A study group consisted of 231 patients with knee OA (77.9% were women; mean age,

61.9+12.2 years; body mass index, 30.6+5.8 kg/m2; median disease duration, 5.0 [2, 0; 10.0] years). The patients were randomly assigned to two groups. Group 1 patients received Mt with an ALMAG+ device for 14 days; Group 2 had false Mt with a completely imitating ALMAG+ device that failed to create a magnetic field. The investigators evaluated the changes of the WOMAC index, pain intensity at rest and during movement on a 100 mm visual analogue scale (VAS), the need for nonsteroidal anti-inflammatory drugs (NSAIDs), and the degree of improvement, as assessed by patients (on a 5-point scale).

Results and discussion. During the therapy, there was a statistically significant pain and stiffness reduction and functional improvement. Thus, there were decreases in the median WOMAC pain scores from 231 [180; 290] to 110 [60; 166.3] (p<0.001) in Group 1, from 212.4 [145; 260] to 143 [76.5; 200] (p<0.001) in Group 2, in pain intensity at rest from 47 [27.8; 60] to 20 [10; 30] mm (p<0.001) in Group 1; from 40 [20; 57.5] to 20 [7.5; 40] mm (p<0.001) in Group 2. During the therapy, there was also a reduction in the need for NSAIDs: the drug was discontinued or its dose reduced in 33.1% and 16.8% of the patients in Groups 1 and 2, respectively (p=0.006). The changes of all parameters were statistically more significant in Group 1 than in Group 2. Treatment results were assessed as good and excellent by 58.5% and 39.8% patients in Groups 1 and 2, respectively (p<0.001). No serious adverse events to true and false Mt were observed. Therapy was discontinued due to increase of joint pain in two patients who received false Mt.

Conclusion. Short-term Mt provides a significant improvement in patients with knee OA. Mt is well tolerated and causes no serious complications.

1. Nasonov EL, editor. Rossiiskie klinicheskie rekomen-datsii. Revmatologiya [Russian clinical recommendations. Rheumatology]. Moscow: GEOTAR-Media; 2017. 446 p. (In Russ.). ISBN 978-5-9704-4261-6

2. Alekseeva LI, Taskina EA, Kashevarova NG. Osteoarthritis: epidemiology, classification, risk factors, and progression, clinical presentation, diagnosis, and treatment. Sovremennaya Revmatologiya = Modern Rheumatology Journal. 2019;13(2):9-21 (In Russ.). doi: 10.14412/1996-7012-2019-2-9-21

3. Geenen R, Overman CL, Christensen R, et al. EULAR recommendations for the health professional's approach to pain management in inflammatory arthritis and osteoarthritis. Ann Rheum Dis. 2018 Jun;77(6):797-807. doi: 10.1136/annrheumdis-2017-212662. Epub 2018 May 3.

4. Ganesan K, Gengadharan AC, Balachandran C, et al. Low frequency pulsed electromagnetic field — a viable alternative therapy for arthritis. Indian JExp Biol. 2009 Dec;47(12):939-48.

5. Pittler MH. Static magnets for reducing pain. MMW Fortschr Med. 2009 Jan 22;151(3-4):33, 35.

6. Redeker JI, Schmitt B, Grigull NP, et al. Effect of electromagnetic fields on human osteoarthritic and non-osteoarthritic chondrocytes. BMC Complement Atern Med. 2017 Aug 14;17(1):402. doi: 10.1186/s12906-017-1868-z

7. Yang X, He H, Zhou Y, et al. Pulsed electromagnetic field at different stages of knee osteoarthritis in rats induced by low-dose monosodium iodoacetate: Effect on subchondral trabecular bone microarchitecture and cartilage degradation. Bioelectromagnetics. 2017 Apr;38(3):227-38. doi: 10.1002/bem.22028. Epub 2016 Dec 27.

8. Yang X, He H, Gao Q, He C. Pulsed electromagnetic field improves subchondral bone microstructure in knee osteoarthritis rats through a Wnt/p-catenin signaling-associated mechanism. Bioelectromagnetics. 2018 Feb;39(2):89-97. doi: 10.1002/bem.22106. Epub 2017 Dec 18.

9. Li S, Yu B, Zhou D, et al. Electromagnetic fields for treating osteoarthritis. Cochrane Database Syst Rev. 2013 Dec 14;(12):CD003523. doi: 10.1002/14651858.CD003523.pub2

10. Ryang We S, Koog YH, Jeong KI, Wi H. Effects of pulsed electromagnetic field on knee osteoarthritis: a systematic review. Rheumatology (Oxford). 2013 May;52(5):815-24. doi: 10.1093/rheumatology/kes063. Epub 2012 Apr 13.

11. Wu Z, Ding X, Lei G, et al. Efficacy and safety of the pulsed electromagnetic field in osteoarthritis: a meta-analysis. BMJ Open. 2018 Dec 14;8(12):e022879. doi: 10.1136/bmjopen-2018-022879

12. Byalovskii Yu, Ivanov A, Lyakina O, Rakitina I. Efficiency of pulsed magnetotherapy with the ALМAG + device in the complex treatment of patients with knee osteoarthritis. Vrach. 2019;30(6):67-71 (In Russ.). doi: 10.29296/25877305-2019-06-16

13. Byalovskii Yu, Sekirin A, Smirnova S. Efficiency of low-frequency magnetotherapy with a running magnetic field in the complex treatment of coxarthrosis. Vrach. 2018;29(3):75-9 (In Russ.). doi: 10.29296/25877305-2018-03-19

14. Larinskii N, Larinskaya I, Byalovskii Yu, Ivanov A. Evaluation of the effectiveness of low-frequency magnetotherapy from the ALMAG+ apparatus in the complex treatment of dorsopathy (spinal osteochondrosis, herniated discs). Vrach. 2019;30(4):69-73 (In Russ.). doi: 10.29296/25877305-2019-04-13

15. Bagnato GL, Miceli G, Marino N, et al. Pulsed electromagnetic fields in knee osteoarthritis: a double blind, placebo-controlled, randomized clinical trial. Rheumatology (Oxford). 2016 Apr;55(4):755-62. doi: 10.1093/rheumatology/kev426. Epub 2015 Dec 24.

16. Wuschech H, von Hehn U, Mikus E, Funk RH. Effects of PEMF on patients with osteoarthritis: Results of a prospective, placebo-controlled, double-blind study. Bioelectromagnetics. 2015 Dec;36(8):576-85. doi: 10.1002/bem.21942. Epub 2015 Nov 12.

17. Nelson FR, Zvirbulis R, Pilla AA. Non-invasive electromagnetic field therapy produces rapid and substantial pain reduction in early knee osteoarthritis: a randomized double-blind pilot study. RheumatolInt. 2013 Aug;33(8):2169-73. doi: 10.1007/s00296-012-2366-8. Epub 2012 Mar 27.

18. Altman RD, Devji T, Bhandari M, et al. Clinical benefit of intraarticular saline as a comparator in clinical trials of knee osteoarthritis treatments: A systematic review and meta-analysis of randomized trials. Semin Arthritis Rheum. 2016 Oct;46(2):151-9. doi: 10.1016/j.semarthrit.2016.04.003. Epub 2016 Apr 27.

19. Huang Z, Chen J, Hu QS, et al. Meta-analysis of pain and function placebo responses in pharmacological osteoarthritis trials. Arthritis Res Ther. 2019 Jul 15;21(1):173. doi: 10.1186/s13075-019-1951-6

20. Zhang W. The powerful placebo effect in osteoarthritis. Clin Exp Rheumatol. 2019 Sep-Oct;37 Suppl 120(5):118-23. Epub 2019 Oct 15.