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Efficacy and Safety of Turmeric Extracts for the Treatment of Knee Osteoarthritis: a Systematic Review and Meta-analysis of Randomised Controlled Trials

  • Complementary and Alternative Medicine (S Kolasinski, Section Editor)
  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Purpose of the Review

Finding appropriate pharmacological options to treat osteoarthritis (OA) remain challenging. We aimed to determine the efficacy and safety of all types of turmeric extracts for the management of knee OA.

Recent Findings

Sixteen RCTs of up to 16 weeks duration including 1810 adults with knee OA were included. Eleven RCTs compared the efficacy of turmeric extracts with placebo and five with active comparators (NSAIDs). The overall risk bias of included RCTs was moderate. Turmeric extracts significantly reduced knee pain (SMD − 0.82, 95% CI − 1.17 to − 0.47, I2 = 86.23%) and improved physical function (SMD − 0.75, 95% CI − 1.18 to − 0.33, I2 = 90.05%) compared to placebo but had similar effects compared to NSAIDs. BMI was the major contributor to heterogeneity in the placebo-controlled studies (explained 37.68% and 67.24%, respectively, in the models) and modified the effects of the turmeric on pain and physical function with less improvement with higher BMI (SMD 0.26 95% CI 0.04 to 0.48; SMD 0.48 95% CI 0.21 to 0.74). No significant between-group differences were reported for either biochemical markers or imaging outcomes. Turmeric extracts had 12% fewer adverse events than NSAIDs and similar rates to placebo.

Summary

Turmeric extract is a safe and effective option for the symptomatic management of knee OA, compared to placebo or NSAIDs. However, current evidence from short-term studies is heterogeneous and has moderate risk of bias leading to some uncertainty about the true effect.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019;393(10182):1745–59.

    Article  CAS  PubMed  Google Scholar 

  2. Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M, et al. The global burden of hip and knee osteoarthritis: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(7):1323–30.

    Article  PubMed  Google Scholar 

  3. Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthr Cartil. 2019;27:1578–89.

    Article  CAS  Google Scholar 

  4. Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, et al. OARSI recommendations for the management of hip and knee osteoarthritis, part I: critical appraisal of existing treatment guidelines and systematic review of current research evidence. Osteoarthr Cartil. 2007;15(9):981–1000.

    Article  CAS  Google Scholar 

  5. Singh S. From exotic spice to modern drug? Cell. 2007;130(5):765–8.

    Article  CAS  PubMed  Google Scholar 

  6. Asher GN, Spelman K. Clinical utility of curcumin extract. Altern Ther Health Med. 2013;19(2):20–2.

    PubMed  Google Scholar 

  7. Ayati Z, Ramezani M, Amiri MS, Moghadam AT, Rahimi H, Abdollahzade A, et al. Ethnobotany, phytochemistry and traditional uses of Curcuma spp. and pharmacological profile of two important species (C. longa and C. zedoaria): a review. Curr Pharm Des. 2019;25(8):871–935.

    Article  CAS  PubMed  Google Scholar 

  8. Goel A, Jhurani S, Aggarwal BB. Multi-targeted therapy by curcumin: how spicy is it? Mol Nutr Food Res. 2008;52(9):1010–30.

    Article  CAS  PubMed  Google Scholar 

  9. Yue GG, Chan BC, Hon PM, et al. Immunostimulatory activities of polysaccharide extract isolated from Curcuma longa. Int J Biol Macromol. 2010;47(3):342–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Sahebkar A. Are curcuminoids effective C-reactive protein-lowering agents in clinical practice? Evidence from a meta-analysis. Phytother Res. 2014;28(5):633–42.

    Article  CAS  PubMed  Google Scholar 

  11. Chandrasekaran CV, Kannan Sundarajan JRE, Gururaja GM, et al. Immune-stimulatory and anti-inflammatory activities of Curcuma longa extract and its polysaccharide fraction. Pharm Res. 2013;5(2):71.

    Google Scholar 

  12. Gupta SC, Sung B, Kim JH, Prasad S, Li S, Aggarwal BB. Multitargeting by turmeric, the golden spice: from kitchen to clinic. Mol Nutr Food Res. 2013;57(9):1510–28.

    Article  CAS  PubMed  Google Scholar 

  13. Prasad S, Gupta SC, Tyagi AK, Aggarwal BB. Curcumin, a component of golden spice: from bedside to bench and back. Biotechnol Adv. 2014;32(6):1053–64.

    Article  CAS  PubMed  Google Scholar 

  14. Peddada KV, Peddada KV, Shukla SK, Mishra A, Verma V. Role of curcumin in common musculoskeletal disorders: a review of current laboratory, translational, and clinical data. Orthop Surg. 2015;7(3):222–31.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Bannuru RR, Osani MC, Al-Eid F, et al. Efficacy of curcumin and Boswellia for knee osteoarthritis: systematic review and meta-analysis. Semin Arthritis Rheum. 2018;48(3):416-429. This review discussess the evidence of curcuminoid relieving symptoms of knee osteoarthritis.

  16. Onakpoya IJ, Spencer EA, Perera R, Heneghan CJ. Effectiveness of curcuminoids in the treatment of knee osteoarthritis: a systematic review and meta-analysis of randomized clinical trials. Int J Rheum Dis. 2017;20:420–33.

    Article  CAS  PubMed  Google Scholar 

  17. Wang Z, Singh A, Antony B. Efficacy and safety of turmeric extracts in knee osteoarthritis: protocol for a systematic review and meta-analysis of randomised controlled trials. medRxiv. 2020.

  18. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Pinsornsak P, Niempoog S. The efficacy of Curcuma longa L. extract as an adjuvant therapy in primary knee osteoarthritis: a randomized control trial. J Med Assoc Thail. 2012;95:S51–8.

    Google Scholar 

  20. Rongwei Fu, Benjamin W. Vandermeer, et al. Handling continuous outcomes in quantitative synthesis. Rockville,.

  21. Higgins JPT. Cochrane handbook for systematic reviews of interventions. Wiley-Blackwell; 2020.

  22. Madhu K, Chanda K, Saji MJ. Safety and efficacy of Curcuma longa extract in the treatment of painful knee osteoarthritis: a randomized placebo-controlled trial. Inflammopharmacology. 2013;21(2):129–36.

    Article  CAS  PubMed  Google Scholar 

  23. Shep D, Khanwelkar C, Gade P, Karad S. Safety and efficacy of curcumin versus diclofenac in knee osteoarthritis: a randomized open-label parallel-arm study. Trials. 2019;20(1):214–25.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Shep D, Khanwelkar C, Gade P, Karad S, et al. Int J Curr Pharm Res. 2019;11(6):111–4.

    Article  CAS  Google Scholar 

  25. Shep D, Khanwelkar C, Gade P, Karad S. Efficacy and safety of combination of curcuminoid complex and diclofenac versus diclofenac in knee osteoarthritis: a randomized trial. Medicine (Baltimore). 2020;99(16):e19723.

    Article  Google Scholar 

  26. Henrotin Y, Malaise M, Wittoek R, et al. Bio-optimized Curcuma longa extract is efficient on knee osteoarthritis pain: a double-blind multicenter randomized placebo controlled three-arm study. Arthritis Res Ther. 2019;21(1):179. This randomized trial is a recent randomized trial about tumeric for osteoarthritis that are of high quality.

  27. Gupte PA, Giramkar SA, Harke SM, Kulkarni SK, Deshmukh AP, Hingorani LL, et al. Evaluation of the efficacy and safety of capsule Longvida((R)) optimized curcumin (solid lipid curcumin particles) in knee osteoarthritis: a pilot clinical study. J Inflamm Res. 2019;12:145–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Furukawa TA, Barbui C, Cipriani A, Brambilla P, Watanabe N. Imputing missing standard deviations in meta-analyses can provide accurate results. J Clin Epidemiol. 2006;59(1):7–10.

    Article  PubMed  Google Scholar 

  29. Higgins JP, Savović J, Page MJ, Elbers RG, Sterne JA. Assessing risk of bias in a randomized trial. Cochrane handbook for systematic reviews of interventions 2019:205–228.

  30. Higgins JPT, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343(oct18 2):d5928-d5928.

  31. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Stuck AE, Rubenstein LZ, Wieland D. Bias in meta-analysis detected by a simple, graphical test. Asymmetry detected in funnel plot was probably due to true heterogeneity. BMJ. 1998;316(7129):469.

  33. Duval S, Tweedie R. A nonparametric “trim and fill” method of accounting for publication bias in meta-analysis. J Am Stat Assoc. 2000;95(449):89–98.

    Google Scholar 

  34. Thompson SG, Higgins JPT. Can meta-analysis help target interventions at individuals most likely to benefit? Lancet. 2005;365(9456):341–6.

    Article  PubMed  Google Scholar 

  35. Higgins JP, Thompson SG, Spiegelhalter DJ. A re-evaluation of random-effects meta-analysis. J R Stat Soc A Stat. 2009;172(1):137–59.

    Article  Google Scholar 

  36. Nakagawa Y, Mukai S, Yamada S, Matsuoka M, Tarumi E, Hashimoto T, et al. Short-term effects of highly-bioavailable curcumin for treating knee osteoarthritis: a randomized, double-blind, placebo-controlled prospective study. J Orthop Sci. 2014;19(6):933–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Panahi Y, Rahimnia A-R, Sharafi M, Alishiri G, Saburi A, Sahebkar A. Curcuminoid treatment for knee osteoarthritis: a randomized double-blind placebo-controlled trial. Phytother Res. 2014;28(11):1625–31.

    Article  CAS  PubMed  Google Scholar 

  38. Srivastava S, Saksena AK, Khattri S, Kumar S, Dagur RS. Curcuma longa extract reduces inflammatory and oxidative stress biomarkers in osteoarthritis of knee: a four-month, double-blind, randomized, placebo-controlled trial. Inflammopharmacology. 2016;24:377–88.

    Article  PubMed  Google Scholar 

  39. Haroyan A, Mukuchyan V, Mkrtchyan N, et al. Efficacy and safety of curcumin and its combination with boswellic acid in osteoarthritis: a comparative, randomized, double-blind, placebo-controlled study. BMC Complement Altern Med. 2018;18(1).

  40. Panda SK, Nirvanashetty S, Parachur VA, et al. A randomized, double blind, placebo controlled, parallel-group study to evaluate the safety and efficacy of Curene® versus placebo in reducing symptoms of knee OA. Biomed Res Int. 2018;2018:1–8.

    Article  CAS  Google Scholar 

  41. Hashemzadeh K, Davoudian N, Jaafari MR, Mirfeizi Z. The effect of nanocurcumin on the improvement symptoms of knee osteoarthritis: a randomized clinical trial. Curr Rheumatol Rev. 2020;16:158–64.

    Article  CAS  PubMed  Google Scholar 

  42. Zhiqiang W, Graeme J, Tania W, et al. Effectiveness of Curcuma longa extract for the treatment of symptoms and effusion-synovitis of knee osteoarthritis: a randomized trial. Ann Intern Med. 2020. This study provides a high-quality evidence on efficacy and safety of Curcuma longa extract for the treatment of knee OA.

  43. Kuptniratsaikul V, Thanakhumtorn S, Chinswangwatanakul P, Wattanamongkonsil L, Thamlikitkul V. Efficacy and safety of Curcuma domestica extracts in patients with knee osteoarthritis. J Altern Complement Med. 2009;15(8):891–7.

    Article  PubMed  Google Scholar 

  44. Kertia N. Ability of curcuminoid compared to diclofenac sodium in reducing the secretion of cycloxygenase-2 enzyme by synovial fluid’s monocytes of patients with osteoarthritis. Acta Med Indones. 2012.

  45. Kuptniratsaikul V, Dajpratham P, Taechaarpornkul W, et al. Efficacy and safety of Curcuma domestica extracts compared with ibuprofen in patients with knee osteoarthritis: a multicenter study. Clin Interv Aging. 2014;451.

  46. Kertia N. Anti-inflammatory activities and the safety of curcuminoid from curcuma domestica val. Rhyzome extract compared to diclofenac sodium for the treatment of osteoarthritis. International Conference and Exhibition on Pharmacognosy, Phytochemistry & Natureal Products; 2013; Hyderabad, India.

  47. Rahimnia AR, Panahi Y, Alishiri G, Sharafi M, Sahebkar A. Impact of supplementation with curcuminoids on systemic inflammation in patients with knee osteoarthritis: findings from a randomized double-blind placebo-controlled trial. Drug Res (Stuttg). 2015;65(10):521–5.

    CAS  Google Scholar 

  48. Panahi Y, Alishiri GH, Parvin S, et al. Mitigation of systemic oxidative stress by curcuminoids in osteoarthritis: results of a randomized controlled trial. J Diet Suppl. 2015;13(2):209–20.

    Article  PubMed  CAS  Google Scholar 

  49. Wu J, Lv M, Zhou Y. Efficacy and side effect of curcumin for the treatment of osteoarthritis: a meta-analysis of randomized controlled trials. Pak J Pharm Sci. 2019;32(1):43–51.

    CAS  PubMed  Google Scholar 

  50. White CM, Pasupuleti V, Roman YM, Li Y, Hernandez AV. Oral turmeric/curcumin effects on inflammatory markers in chronic inflammatory diseases: a systematic review and meta-analysis of randomized controlled trials. Pharmacol Res. 2019;146:104280.

    Article  PubMed  CAS  Google Scholar 

  51. McAlindon TE, Bannuru RR, Sullivan MC, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cartil. 2014;22(3):363–88.

    Article  CAS  Google Scholar 

  52. Gregori D, Giacovelli G, Minto C, Barbetta B, Gualtieri F, Azzolina D, et al. Association of pharmacological treatments with long-term pain control in patients with knee osteoarthritis. JAMA. 2018;320(24):2564–79.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Roberts E, Delgado Nunes V, Buckner S, Latchem S, Constanti M, Miller P, et al. Paracetamol: not as safe as we thought? A systematic literature review of observational studies. Ann Rheum Dis. 2016;75(3):552–9.

    Article  CAS  PubMed  Google Scholar 

  54. Fine M. Quantifying the impact of NSAID-associated adverse events. Am J Manag Care. 2013;19(14):s267–72.

    PubMed  Google Scholar 

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Contributions

B.A. conceived and designed the study. Acquisition and assessment of data were performed by Z.W. and A.S. Data extraction and analysis were conducted by Z.W., B.A and A.S. Z.W., A.S. and B.A. drafted the manuscript, and all authors contributed with a thorough and critical revision for important intellectual content. All authors have approved the final version of this manuscript.

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Correspondence to Benny Antony.

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Wang, Z., Singh, A., Jones, G. et al. Efficacy and Safety of Turmeric Extracts for the Treatment of Knee Osteoarthritis: a Systematic Review and Meta-analysis of Randomised Controlled Trials. Curr Rheumatol Rep 23, 11 (2021). https://doi.org/10.1007/s11926-020-00975-8

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