Curcumin and Boswellia in knee arthrosis

These advantages exceeded the placebo effect after 12-week supplementation, and UES occasionally and slightly occurred.

All participants took 1 capsule (either curcumin, containing combination or placebo) for 12 weeks.

study parameters evaluated

The investigators assessed arthritis symptoms (Western Ontario and McMaster Universities Osteoarthritis Index [Womac]), physical performance (osteoarthritis research society International [Oarsi]), serum inflammation marker (erythrocyte sedimentation rate [ESR] and C reactive protein [CRP]) and BMI. Each parameter was rated at the beginning of the course after 4 weeks and after 12 weeks. To evaluate the security/side effects, they asked the participants to contact the investigators if they experienced side effects or illnesses during the study.

The Womac is a questionnaire that evaluates joint pain (0–20), morning stiffness (0–8) and physical functionality (0–68), whereby higher values ​​represent heavier OA symptoms. The Oarsi assessment of physical performance includes the following: maximum number of stool reverses (stool test [CST]) in 30 seconds (30S-CST); Walking time of 40 meters (40-meter-speed test [FPWT]); Time that is needed to get up from a chair, go 3 meters, go back to the chair and sit down ("Timed up and go" [Tug]); And the time that is needed to climb and descend a 9-stage staircase (staircase test [sct]).

Primary result measurements

The primary endpoints in relation to effectiveness included the Womac index score and the results of the Oarsi tests on physical performance. The primary measure of security was the reports of the participants about unwanted events (AES).

important knowledge

Only the combination curcumin/boswellia group showed a statistically significant decrease in the entire Womac scores compared to placebo; The index values ​​fell from an average of 33.06 to 26.49 after 12 treatment weeks. When the researchers analyzed the sub -sections of Womac, they found statistically significant reductions in the pain value in both treatment groups; The effect size compared to placebo was 0.50 for curcumin and 0.37 for the combination curcumin/boswellia. With regard to the morning stiffness and the physical function, the researchers found a statistically significant improvement in comparison within the group for the treatment groups, but there was no significant improvement if each group was compared with placebo. This is partially attributed to the placebo effect, which was observed in Womac index values ​​between Baseline and week 4 (the placebo group showed significantly improved values ​​in week 4, but an insignificant improvement in week 12).

All clinical performance measurements from Oarsi improved with the combination supplement intervention. The curcumin group showed an improvement in every measurement with the exception of the TUG test. The effect size of the improvement compared to placebo for each measure was as follows:

• 30S-CST: only curcumin, 0.50; Curcumin/Boswellia, 0.63
• 40 m FPWT: only curcumin, 0.38; Curcumin/Boswellia, 0.32
• Tug: only curcumin, 0.53; Curcumin/Boswellia, 0.38 (not statistically significant)
• sct: only curcumin, 0.38; Curcumin/Boswellia, 0.45

A total of 13 units were reported in the course of the study, none of them were serious. Unwanted events were distributed to the 3 groups (placebo, 4 events; Curcumin, 7 events; Curcumin/Boswellia, 2 events); However, nausea was only reported in the treatment groups.

Blood markers for chronic inflammation did not differ significantly between treatment and control group. All groups had a significant increase in ESR and CRP in the course of the study, but the values ​​remained within the normal limits (ESR, 2-15 mm/h; Crp <5 mg/l).

practice implications

This study showed modest but statistically significant advantages of curcuminoids alone and in combination with boswelliasic acid for knee-oa pain and associated functional restrictions. These advantages exceeded the placebo effect after 12-week supplementation, and UES occurred occasionally and slightly.

The combination of curcumin/boswellia was more effective in the primary result measurements, and this higher performance can be attributed to the synergistic effects of the individual components to the pathophysiology of the disease. In-vitro and animal studies have shown that curcuminoids modulate inflammation, reduce chondrocyte catabolism and apoptosis and increase the apoptosis of adherent synovial cells. ^{1-3 Boswelliasic acid reduces leukocyte infiltration into the knee joint (which is reduced) Collagen breakdown and inhibits inflammatory mediators. 4-6}

In the development of a treatment plan, practitioners often use multiple modalities to achieve synergistic advantages. Nutraceutical therapies can be weaker than their pharmaceutical counterparts, and they often require more frequent dosage over longer periods to achieve the full therapeutic effect. As a rule, this also means that natural products have less serious side effects. So if a person wants an alternative to non-steroidal anti-inflammatory drugs for their OA symptoms, it is unlikely that an integrative medical doctor of this medication will exchanged this drug without additional recommendations.

exercise is an effective non-pharmacological intervention for knee-OA. There is strong indications that it improves the pain, function and quality of life of people with this disease. ⁷ In a similar way, weight optimization is essential for reducing the stress on the joints and reducing the inflammatory cytokines produced by the adipose tissue.

A practitioner for integrative medicine can also consider additional natural therapies that aim at other aspects of knee-OA pathogenesis, with the aim of achieving synergistic advantages. For example, it has been shown that oral glucosamine insulfate and chondroitine sulfate slow down the progression of the disease. ^{9 and acupuncture can help to relieve pain due to arthrosis of the peripheral joints. 10}

In the present study, neither curcumin was neither a miracle supplement for knee-oa, but both were modest for pain and function. You would be helpful additions to a comprehensive treatment plan for integrative medicine.

The restrictions of the study include the sample size (n = 201) and the short duration (12 weeks).