Improved arthritic knee health in a pilot RCT of phytotherapy

Abstract

Although practitioner-prescribed 'western' herbal medicine (phytotherapy) is a popular complementary therapy in the UK, no clinical studies have been reported on patient-orientated outcomes. The objective of this pilot study was to investigate the effects of phytotherapy on symptoms of osteoarthritis of the knee. A previous study of Chinese herbal medicine for the treatment of irritable bowel syndrome, published in the Journal of the American Medical Association, acted as a model in the development of the protocol of this investigation. Twenty adults, previously diagnosed with osteoarthritis of the knee, were recruited from two Inner London GP practices into this randomized, double-blind, placebo-controlled, pilot study carried out in a primary-care setting. All subjects were seen in consultation three times by a herbal practitioner who was blinded to the randomization coding. Each subject was prescribed treatment and given lifestyle advice according to usual practice: continuation of conventional medication where applicable, healthy-eating advice and nutrient supplementation. Individualized herbal medicine was prescribed for each patient, but only dispensed for those randomized to active treatment-- the remainder were supplied with a placebo. At baseline and outcome (after ten weeks of treatment), subjects completed a food frequency questionnaire and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee health and Measure Yourself Outcome Profile (MYMOP) wellbeing questionnaires. Subjects completing the study per protocol (n = 14) reported an increased intake of wholegrain foods (p = 0.045) and oily fish (p = 0.039) compared to baseline, but no increase in fruit and vegetables and dairy products intakes. There was no difference in the primary outcome measure of knee health assessed as the difference in the mean response (baseline-week 10) in WOMAC score between the two treatment groups. However, there was, compared with baseline, improvement in the active group (n = 9) for the mean WOMAC stiffness sub-score at week 5 (p = 0.035) and week 10 (p = 0.060) but not in the placebo group (n = 5). Furthermore, for the active, but not the placebo group, the mean WOMAC total and sub-scores all showed clinically significant improvement (> or = 20%) in knee symptoms at weeks 5 and 10 compared with baseline. Moreover, the mean MYMOP symptom 2 sub-score, mostly relating to osteoarthritis (OA), showed significant improvement at week 5 (p = 0.02) and week 10 (p = 0.008) compared with baseline for the active, but not for the placebo group. This pilot study showed that herbal medicine prescribed for the individual by a herbal practitioner resulted in improvement of symptoms of OA of the knee.

Efficacy and safety of ginger in osteoarthritis patients: a meta-analysis of randomized placebo-controlled trials

“…From the retrieved 122 references, 115 were discarded for the following reasons: Reviews or outreach papers like editorials, letters etc (72), in vitro studies 5, animal studies (8), not concerning OA (9), no placebo or not a controlled study (6), and finally not concerning oral ginger intake (15). Seven references were read in full-text, and two of those were discarded; one due to no oral ginger intake 39 , and one due to no placebo 40 . Five studies were finally included in the meta-analysis 41e45 .…”

Plant Food Supplements with Anti-Inflammatory Properties: A Systematic Review (II)

“…Standardized preparation of C3 curcuminoids (curcumin, demethoxycurcumin, and bisdemethoxycurcumin) 600 mg/day (Kositchaiwat et al, 1993) Capsules (250 mg each) containing Curcuma longa powder NR 250 mg/day (Hamblin et al, 2008) Tincture 1:5 from Curcuma longa NR 930 mg/day (Satoskar and Shenoy, 1986) Capsules containing curcumin…”

Oral herbal therapies for treating osteoarthritis

“…Reasons for excluding studies were: (a) not a randomised controlled trial (Grahame 1981; Guyader 1984; Kagore 2011; Linsheng 1997; Loew 1996;Mishra and Singh 2003;Myers 2010; Saley 1987; Srivastava 1989; Wang 1985; Wegener 2003; Xu 2005; Yuelong 2011; Zell 1993), (b) review or discussion paper (Anonymous 1993; Brien 2006; Chrubasik 1998; Dharmananda 1985; Falch 1997; Gendo 1997; Kielczynski 1997; Long 2001; Reuss 1981), (c) not a herbal intervention (Belcaro 2010; Levy 2009; Park 2009), (d) unable to identify the herbal components of the intervention (Jacquet 2009; Kulkarni 1991), (e) individualised treatments thus not a standardised herbal intervention (Fang 2008; Hamblin 2008), (f) mixed sample and unable to extract data for participants with OA only (Biswas 1998;Du 2006; Lechner 2011; Schaffner 1997), (g) duplicate publication or part thereof (Chantre 2000; Lung 2004; Rein 2004b; Schmid 2001; Winther 2004), (h) abstract publication only (Biswas 1997; Schmid 1998a), or (i) did not include functional or clinical outcomes (Zeng 2008). Sub-analyses of two studies (Jung 2004; Rein 2004a) were identified in other publications (Lung 2004; Rein 2004b; Winther 2004) and were excluded from this review to avoid repetition of data.…”