Turmeric with essential turmeric oil in the case of knee osteoarthritis

reference

Shep D, Khanwelkar C, Gade P, Karad S. Security and Effectiveness of Curcumin compared to Diclofenac in the case of knee arthrosis: a randomized open label study with parallel arms. (Link away). 2019; 20 (1): 214.

Study goal

evaluation of the security and effectiveness of curcumin compared to diclofenac for pain relief for knee osteoarthritis (oa).

draft

prospective, randomized, open, parallel clinical study with active control

participant

The study comprised 139 patients aged 38 to 65 from the City Care Accident Hospital in Parli Vaijnath, Maharashtra, India. The participants have suffered from osteoarthritis in the knee joint (confirmed by X -rays) with moderate pain for at least 3 months. There were 70 (45 men, 25 women) patients in the curcumin group and 69 (48 men, 21 women) patients in the Diclofenac group.

Intervention

The patients received 500 mg curcumin with essential turmeric oil (BCM-95 curcumin) or 50 mg diclofenac (a non-steroidal anti-inflammatory drug) three times a day. [NSAID]) 2 times a day (BID) for 28 days.

study parameters evaluated

The study parameters were rated at the start of the course (day 0), week 2 (day 14) and week 4 (day 28). The parameters included the visual analogue scale (VAS) for pain, knee injury and osteoarthritis outcome score (KOOS), weight changes, anti -flatulence effect, general assessment of symptom relief by the patient, general assessment of treatment by the doctor and effect against ulcers.

Primary result measurements

The primary endpoint was the pain perception about the change in the VAS (0–10, where 10 is the worst).

important knowledge

Both treatment groups experienced a significant reduction ( p <0.05) in the level of pain.

• The average VAS values ​​at the start of the study were 7.84 ± 0.63 (curcumin) and 7.81 ± 0.73 (diclofenac).
• on day 14 the vas scores were 4.69 ± 0.79 (curcumin) and 4.58 ± 0.60 (diclofenac).
• on day 28 the vas scores were 2.20 ± 0.81 (curcumin) and 2.20 ± 0.61 (diclofenac).
• A vas reduction of> 50 % was achieved in 66/70 participants in the curcumin group and 67/69 participants in the Diclofenac group.

A frequent side effect of NSAIDS are gastrointestinal (GI) disorders. Nineteen participants (28 %) In the Diclofenac Group, a Histamin 2 receptor antagonist (H2-blocker) medication needed to treat stomach problems, while 0 % of the curcumin group did so. Patients in the curcumin group also experienced a significant reduction in flatulence and body weight.

practice implications

knee-OA is one of the main causes of disabilities in the United States and worldwide. The incidence of knee arthrosis has more than doubled since the middle of the 20th century. ¹ An estimated 30 million adults in the USA are currently affected by OA. to be influenced.

Conventional treatment strategies include pain and inflammation control using NSAIDS, opioids, antidepressants, intra-articular injections and topical therapies. ^{4 A recently published study in jama Function was not superior over 12 months. ”}

Non -steroidal anti -rheumatics are among the most frequently used medication and are available without a prescription or prescription. Diclofenac sodium is only available in the United States on a prescription, but some countries offer a lower dosage as an OTC medication. Although NSAIDs are widespread and easily accessible, they have some serious side effects, including ulcers, gastrointestinal bleeding, acute or chronic kidney failure and cardiovascular complications.

In view of the annual 16,500 deaths from NSAID use, other pain treatment strategies are clearly required.

diclofenac sodium is one of the most commonly used NSAIDs. ^{6 It is assumed that its primary mechanism of action is the inhibition of prostaglandin synthesis via the paths of cyclooxygenase-1 (Cox-1) and Cyclooxygenase-2 (COP> 7 Prostaglandins play an important role in acute inflammation and their cardinal signals (pain, redness, swelling and heat). However, prostaglandins also have an advantageous activity. They protect the mucous membrane, especially in the stomach by compensating for gastric acid secretion and pH. The inhibition of prostaglandin function can lead to the formation of ulcers and other serious GI-side effects.}

Consequently, the most common side effects of NSAIDS generally have to do with the GI system. Minor complaints such as dyspepsia, heartburn and nausea are most often reported. Serious GI complications can be a mucosal destruction that leads to ulcers and strictures. ^{6 simultaneous treatment with other drugs for the treatment of GI effects, such as H2 blockers and proton pump inhibitors, may be necessary if patients with NSAID are treated. It is also known that non -steroidal anti -inflammatory means increase fluid retention and contribute to cardiovascular side effects. Liquid retention is also an essential factor for weight gain when using this class of medication. In view of the considerable risk of side effects by NSAIDs, it is important to research safe, effective and natural alternatives to treat OA pain. Curcumin is particularly suitable for this application, since it has an exceptional amount of data that supports its use in numerous diseases, including arthritic diseases.}

A clinical study from 2012 showed the non-subdue of curcumin (BCM-95) compared to diclofenac sacrium in rheumatoid arthritis. 10 The 3-armed study included a curcumin monotherapy, a diclofenac monotherapy and a combination group. All groups experienced a reduction in Disease Activity Score and the criteria of the American College of Rheumatology. The biggest improvements were observed in the curcumin group, which was statistically significant. In addition, 14 % of the Diclofenac Natrium group dropped due to side effects.

There are many ways to improve the relatively poor absorption and bioavailability of curcumin. It has been shown that the use of essential turmeric oil helps to keep the curcumin level in the serum over 200 ng/g for over 8 hours. Essential turmeric oil also has scientifically confirmed health advantages. Researchers have identified a key connection in the essential turmeric oil called aromatic turmeron (AR-Turmeron) that has its own analgesic properties. ^{11 AR towering has shown in vitro (breast cancer and microglia cells) that it inhibits COX-2 and MATRIX metaloproteinase (MMP) -9 by Core factor (NF)-κB. 12,13 It was also shown that AR-Turmeron has positive effects on proliferation of new stem cells.}

In view of the 16,500 deaths documented annually by NSAID use, other pain treatment strategies are clearly required. ^{Fifteen curcumin with essential turmeric oil offers a safe and effective solution for OA. Curcumin offers gastric-protecting effects, including anti-ulcus properties. An animal model from 2016 showed that curcumin rats protected against naproxen-induced ulcers in terms of dose by increasing the radical catcher enzymes (superoxiddismmutase, catalase, glutathione peroxidase) and preventing lipid peroxide.}

restrictions

The restrictions in this study include the open label design, the lack of a placebo group and the short duration. A treatment duration of 28 days can be inadequate to draw long -term conclusions. A double -blind study with longer duration and more participants should be considered.

conclusions

Overall, curcumin with essential turmeric oil (BCM-95 curcumin) in a dose of 500 mg seems to have a similar effectiveness profile three times a day as Diclofenac-Natrium 50 mg twice a day to relieve knee pain due to OA. Due to the GI side effects of Diclofenac, 28 participants had to undergo the addition of an H2 block, compared to none of the participants in the curcumin group. The curcumin group experienced less and less serious side effects (13 % in the curcumin group compared to 38 % in the Diclofenac group), which shows its superior security profile. Turmeric with essential turmeric oil can offer a safe and effective alternative to the treatment of knee-OA, especially in patients who are particularly susceptible to the side effects of NSAIDS.

disclosure of conflicts of interest

Cheryl Myers is the head of scientific matters and education at Euromedica, a company for nutritional supplements and naturopathy that has the exclusive product families Curapro and Curaph with BCM-95 curcumin.