Diagnostic dilemma: Woman's severe knee pain reveals 'golden threads' in her joints

The patient: A 65-year-old woman in South Korea

The symptoms: The patient had a prior diagnosis of osteoarthritis of the knee — a degenerative joint condition that causes pain and stiffness. She had previously sought medical attention, and was treated with painkillers and nonsteroidal anti-inflammatory drugs for the condition. She had also previously received steroid injections directly into her knees, but her pain remained.

She then started to get bad stomach pain from the medications, so she had stopped them altogether.

What happened next: The woman decided to seek alternative treatments to ease her joint pain and began having weekly acupuncture. She increased the frequency to multiple times a week when the pain was particularly bad.

She later went to the hospital because her knees were very sore. X-rays of her left knee revealed that the shinbone in the inner part of the joint had thickened and hardened. There were also bony growths, called spurs, on the inner portions of the shinbone and thigh bone by the knee joint.

The doctors also saw hundreds of flecks on the X-ray around the knee joint, which turned out to be tiny gold threads.

The diagnosis: The doctors learned that the threads had been inserted as part of the woman's acupuncture treatments. These short, sterile golden threads were purposefully left in the tissue to provide continued stimulation.

The treatment: The doctors did not report whether the gold threads were removed from the patient, but in previous cases, the threads have been left in place.

Leaving the threads in place is not risk-free, as it has led to cysts forming in past cases.

What makes the case unique: Gold-thread acupuncture is commonly used to treat both osteoarthritis and rheumatoid arthritis in Asia, the doctors wrote in a report of her case. However, there is no evidence the practice works, and some cases suggest it can indirectly worsen arthritis by keeping people from getting appropriate, timely treatment.

For instance, in another case, a 58-year-old South Korean woman had received gold-thread acupuncture in an attempt to ease rheumatoid arthritis pain in her wrists. The patient's condition had gotten particularly severe by the time she sought medical attention, and the doctors in that case believed her disease had progressed so far because she had not taken anti-rheumatoid medications early enough and had instead relied on the alternative medicine approach.

Also, the threads can migrate within the body, and fragments can damage neighboring tissue. For example, gold threads inserted into a 75-year-old South Korean woman's back migrated to her lower right leg over a 10-year period, causing cellulitis — a deep skin infection.

In their report of the knee case, the doctors noted that gold threads inserted during acupuncture can make it challenging to read X-rays.

Others have warned that these embedded gold strands stop people from being able to have MRIs because of the risk of the metal moving and damaging an artery.

As such, doctors have noted that health care providers should be aware of the potential risk factors associated with gold-thread acupuncture. However, the fact that they are easy to identify on X-rays ensures that their location can be tracked over time if necessary.