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A three-armed randomized trial. Conclusions: "Compared with physiotherapy and as-needed anti-inflammatory drugs, addition of either TCA (traditional Chinese acupuncture) or sham acupuncture led to greater improvement in WOMAC score at 26 weeks. No statistically significant difference was observed between TCA and sham acupuncture, suggesting that the observed differences could be due to placebo effects, differences in intensity of provider contact, or a physiologic effect of needling regardless of whether it is done according to TCA principles." Annals of Internal Medicine (July 2006)