title: Assessment of leech therapy for knee osteoarthritis: a randomized study.
abstract: OBJECTIVE
  Symptomatic treatment of osteoarthritis of the knee with leeches is presently undergoing a renaissance. Previous studies have shown methodical weaknesses. In the present study patients were blinded regarding the treatment, and a control group was included to explore possible differences in various subjective clinical scores and intake of pain medication over time between leech therapy and placebo control.
  
  
  METHODS
  113 patients with advanced osteoarthritis of the knee were included. The patients were randomized to a single treatment group, group I (single leech application, n = 38), a double treatment group, group II (double application, n = 35), and a control group (n = 40). The second treatment in group II took place after an interval of 4 weeks. The treatment in the control group was simulated with the help of an "artificial leech". Results were documented with the KOOS and WOMAC scores and also a visual analog scale (VAS) for pain. Changes in the use of pain medication were monitored over 26 weeks.
  
  
  RESULTS
  An improvement in KOOS and WOMAC scores, and also in VAS, was found in all 3 groups following treatment. These improvements were statistically significant for treatment groups I and II during the complete follow-up period. The reduction in individual requirements for pain medication was also statistically significant. The greatest improvement was seen in the group treated twice with the leeches, with a long-term reduction of joint stiffness and improved function in the activities of daily living.
  
  
  CONCLUSIONS
  Leech therapy can reduce symptoms caused by osteoarthritis. Repeated use of the leeches appears to improve the long-term results. We have not determined whether the positive outcome of the leech therapy is caused by active substances released during the leeching, the placebo effect, or the high expectations placed on this unusual treatment form.
authors.affiliation: Department of Orthopaedic Surgery, Univresity Hospital of the RWTH Aachen, Annastift Hanover, Germany. sandereya@ukaachen.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Andereya
authors.forename: Sven
authors.initials: S
authors.lastname: Stanzel
authors.forename: Uwe
authors.initials: U
authors.lastname: Maus
authors.forename: Ralf
authors.initials: R
authors.lastname: Mueller-Rath
authors.forename: Torsten
authors.initials: T
authors.lastname: Mumme
authors.forename: Christian H
authors.initials: CH
authors.lastname: Siebert
authors.forename: Friedrich
authors.initials: F
authors.lastname: Stock
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schneider
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D024763:Leeching / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000628:therapy*; D016896:Treatment Outcome