Nutraceutical supplements in management of pain and disability in osteoarthritis: a systematic review and meta-analysis of randomized clinical trials

Abstract

This study designed to evaluate the effect of nutraceutical supplementation on pain intensity and physical function in patients with knee/hip OA. The MEDLINE, Web of Science, Cochrane Library, Scopus, EMBASE, Google Scholar, Science direct, and ProQuest in addition to SID, Magiran, and Iranmedex were searched up to March 2020. Records (n = 465) were screened via the PICOS criteria: participants were patients with hip or knee OA; intervention was different nutritional supplements; comparator was any comparator; the outcome was pain intensity (Visual analogue scale [VAS]) and physical function (Western Ontario and McMaster Universities Arthritis [WOMAC] index); study type was randomized controlled trials. The random effects model was used to pool the calculated effect sizes. The standardized mean difference (SMD) of the outcome changes was considered as the effect size. The random effects model was used to combine the effect sizes. Heterogeneity between studies was assessed by Cochran's (Q) and I2 statistics. A total of 42 RCTs were involved in the meta-analysis. Nutritional supplementation were found to improve total WOMAC index (SMD = − 0.23, 95% CI − 0.37 to − 0.08), WOMAC pain (SMD = − 0.36, 95% CI − 0.62 to − 0.10) and WOMAC stiffness (SMD = − 0.47, 95% CI − 0.71 to − 0.23) subscales and VAS (SMD = − 0.79, 95% CI − 1.05 to − 0.05). Results of subgroup analysis according to the supplementation duration showed that the pooled effect size in studies with < 10 months, 10–20 months and > 20 months supplementation duration were 0.05, 0.27, and 0.36, respectively for WOMAC total score, 0.14, 0.55 and 0.05, respectively for WOAMC pain subscale, 0.59, 0.47 and 0.41, respectively for WOMAC stiffness subscale, 0.05, 0.57 and 0.53, respectively for WOMAC physical function subscale and 0.65, 0.99 and 0.12, respectively for VAS pain. The result suggested that nutraceutical supplementation of patients with knee/hip OA may lead to an improvement in pain intensity and physical function.

Interactions of the microbiome with pharmacological and non-pharmacological approaches for the management of ageing-related musculoskeletal diseases

“… 88 , 89 Studies investigating their efficacy on disease-related outcomes have yielded mixed results, with a recent meta-analysis suggesting improvements in pain intensity and physical function post-supplementation in patients with hip or knee osteoarthritis. 88 , 90 Several lines of evidence suggest that the gut microbiome plays a significant role in the bioavailability of both supplements. Chondroitin is poorly absorbed in the small intestine and requires degradation to its component disaccharides by gut bacteria before it can be absorbed.…”

Intra-articular hyaluronic acid injections and oral collagen supplementation for knee OA: A case report of an elite female soccer player

“…Oral collagen supplementation was found to lead to significant improvements in patients with moderate knee OA after short daily treatments with oral HA preparations, compared to placebo-treated controls (Guadagna et al, 2018). Current clinical data on oral HA products for the treatment of mild to moderate knee OA are promising, and cumulative findings appeared to support a more favourable role than not for collagen supplements in efforts to safely reduce mild to moderate OA pain of the hand, hip or knee and to improve physical function at short term (Aghamohammadi et al, 2020;Honvo et al, 2020;Liu et al, 2018;Marks, 2020), although the quality of evidence is very low (Liu et al, 2018).…”

Nutraceutical Approach to Chronic Osteoarthritis: From Molecular Research to Clinical Evidence

“…In particular, the WOMAC index is widely used in the evaluation of hip and knee osteoarthritis based on a self-administered questionnaire consisting of items regarding pain, stiffness, and physical function. In this regard, a recent meta-analysis of 42 random clinical trials (RCTs) utilizing nutraceuticals (such as chondroitin sulphate, glucosamine sulphate, collagen, and hyaluronic acid) found improvements across all OA measurement parameters expressed through the total WOMAC index, WOMAC pain and WOMAC stiffness subscales,and VAS [ 10 ]. Among the most used nutraceuticals in OA, chondroitin sulphate, glucosamine sulphate, collagen, hyaluronic acid, and methylsulfonylmethane were shown to be impressive in the improvement of clinical symptoms and in decreasing inflammatory indices in subjects with OA [ 11 ].…”