OBJECTIVES: To compare the effects of filiform acupuncture, electroacupuncture (EA) and moxibustion on gastrocnemius inflammation and muscle atrophy related proteins in rats with knee osteoarthritis (KOA). METHODS: A total of 40 Wistar rats were randomly divided into blank control, model, filiform acupuncture, EA and moxibustion groups, with 8 rats in each group. The KOA model was established by intra-articular injection of sodium iodate into the right knee joint in the model group and treatment groups (filiform acupuncture, EA and moxibustion groups). Treatment groups received filiform acupuncture, EA and moxibustion on the right "Futu" (ST32) and "Housanli"(ST36) for 15 min each time, once every other day, for 4 weeks. The diameter of the right knee joint of rats in each group were measured and the structure of knee joint was observed by X-ray before modeling, after modeling, and after treatment. After treatment, the Pinnate angle, muscle thickness and cross-sectional area of right rectus femoris were measured by ultrasound, the ultrastructure of right gastrocnemius muscle was observed by transmission electron microscope, the contents of tumor necrosis factor-α (TNF-α), interleukin (IL)-6 and IL-10 in right gastrocnemius muscle were detected by enzyme-linked immunosorbent assay (ELISA), and the expression levels of sirtuin1(SIRT1), muscle-specific ringfinger protein 1(MuRF1), nuclear factor erythroid 2-related factor 2(NRF2) and recombinant transcription factor A(TFAM) in right gastrocnemius muscle were detected by Western blot in each group. RESULTS: Compared with the blank control group, the diameter of the right knee joint increased ( CONCLUSIONS: Filiform acupuncture, EA and moxibustion can improve knee joint swelling, ameliorate muscle ultrastructure and muscle fiber, regulate inflammatory cytokine level, improve KOA by modulating muscle atrophy related proteins SIRT1/MuRF1 and NRF2/TFAM. There was no significant difference in the efficacy among the three methods of acupuncture and moxibustion.