Zeitschrift für Phytotherapie, Table of Contents

Zeitschrift für Phytotherapie 2016; 37(06): 242-247
DOI: 10.1055/s-0042-121567

Forschung

© Haug Verlag in MVS Medizinverlage Stuttgart GmbH & Co. KG

Phytotherapy for osteoarthritis

Evidence derived from two Cochrane reviews

Milena Trifunovic-König

¹Centre of Integrative Gastroenterology, Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany

²Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany

,

Petra Klose

²Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany

,

Holger Cramer

²Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany

³Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia

,

Anna K. Koch

¹Centre of Integrative Gastroenterology, Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany

²Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany

,

Gustav Dobos

²Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany

,

Jost Langhorst

¹Centre of Integrative Gastroenterology, Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany

²Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany

› Author Affiliations

Summary

Background: In order to present recent findings on the effectiveness and safety of phytotherapy for treatment of osteoarthritis (OA) we summarized the two latest Cochrane reviews (Cameron & Chrubasik, 2013; Cameron & Chrubasik, 2014). One of them included oral and the other topical herbal treatment options as a treatment for OA.

Methods: We conducted a thorough evaluation of the Cochrane reviews. We assessed methodological quality of the reviews and extracted evidence.

Results: Meta-analyses found evidence for effects of the oral herbal products Boswellia serrata and only partially for avocado-soybean unsaponifiable (ASU). However, they included only a small number of primary studies. The systematic review on topical herbal treatments included fewer trials and did not include a meta-analysis.

Discussion: Based on the qualitative synthesis Boswellia serrata can be applied in the treatment of OA. It is not clear if ASU can be recommended. No valid recommendation can be given for or against other herbal therapies due to a lack of randomized clinical trials in the field.

Zusammenfassung

Phytotherapie bei Arthrose: Evidenz zweier Cochrane-Reviews

Hintergrund: Um aktuelle Erkenntnisse über Wirksamkeit und Sicherheit von phytotherapeutischen Präparaten bei der Behandlung von Osteoarthritis (OA) zu erlangen, wurden die beiden neuesten Cochrane-Reviews (Cameron & Chrubasik, 2013; Cameron & Chrubasik, 2014) zusammengefasst. Ein Review befasste sich mit oralen und der andere mit topisch-pflanzlichen Behandlungsmöglichkeiten bei OA.

Methodik: Es wurde eine gründliche Bewertung der beiden Cochrane-Reviews durchgeführt. Wir beurteilten die methodische Qualität der Bewertungen und leiteten daraus Aussagen zur Evidenz ab.

Ergebnisse: Die Metaanalysen offenbarten Nachweise für die Wirkung der oralen Boswellia-serrata-Produkte sowie der teilweisen Wirksamkeit der Avocado-Soja (ASU)-Präparate. Die Primärstudien enthielten jedoch nur eine kleine Anzahl von Stichproben. Die systematische Überprüfung der topisch-pyhtotherapeutischen Produkte enthielt nur wenige klinische Studien und beinhaltete keine Metaanalyse.

Schlussfolgerung: Basierend auf der qualitativen Synthese kann eine Behandlung von OA mit Boswellia-serrata-Präparaten empfohlen werden. Zur Anwendung von ASU liegt nur unzureichende Evidenz hinsichtlich der Wirksamkeit vor. Aufgrund mangelnder randomisierter klinischer Studien kann keine gültige Empfehlung für oder gegen andere pflanzliche Präparate gegeben werden.

Key words

Key words

osteoarthritis - herbs - herbal therapy - phytotherapy - review

References
1 Rabenberg M. Gesundheitsberichterstattung des Bundes, Heft 24. Robert Koch-Institut; 2013
2 Symmons D, Mathers C, Pfleger B. Global burden of osteoarthritis in the year 2000. Geneva: World Health Organization; 2003
3 Sharma L, Berenbaum F. Osteoarthritis: a companion to rheumatology. Philadelphia: Mosby/Elsevier Health Sciences; 2007
4 Bannuru RR, Schmid CH, Kent DM et al. Comperative effectiveness of pharmacological interventions for knee osteoarthritis: a systematic review and network meta-analysis. Ann Intern Med 2015; 162: 46-54
5 Laupattarakasern W, Laopaiboon M, Laupattarakasern P et al. Arthroscopic debridement for knee osteoarthritis. Cochrane Database Syst Rev 2008; (1): CD005118
6 Cameron M, Chrubasik S. Oral herbal therapies for treating osteoarthritis. Cochrane Database Syst Rev 2014; (5): CD002947
7 Cameron M, Chrubasik S. Topical herbal therapies for treating osteoarthritis. Cochrane Database Syst Rev 2013; (5): CD010538
8 Kimmatkar N, Thawani V, Hingorani L et al. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee – A randomized double blind placebo controlled trial. Phytomedicine 2003; 10: 3-7
9 Sengupta K, Alluri KV, Satish AR et al. A double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin^® for treatment of osteoarthritis of the knee. Arthritis Res Ther 2008; 10: R85
10 Sengupta K, Krishnaraju AV, Vishal AA et al. Comparative efficacy and tolerability of 5-Loxin^® and Aflapin^® against osteoarthritis of the knee: A double blind, randomized, placebo controlled clinical study. Int J Med Sci 2010; 7: 366-377
11 Vishal AA, Mishra A, Raychaudhuri SP. A double blind, randomized, placebo controlled clinical study evaluates the early efficacy of Aflapin^® in subjects with osteoarthritis of the knee. Int J Med Sci 2011; 8: 615-622
12 Sontakke S, Thawani V, Pimpalkhute S et al. Open, randomized, controlled trial of Boswellia serrata extract as compared to valdecoxib in osteoarthritis of knee. Indian J Pharmacol 2007; 39: 27-29
13 Appelboom T, Schuermans J, Verbruggen G et al. Symptoms modifying effect of avocado/soybean unsaponifiables (ASU) in knee osteoarthritis: A double blind, prospective, placebo-controlled study. Scand J Rheumatol 2001; 30: 242-247
14 Blotman F, Maheu E, Wulwik A et al. Efficacy and safety of avocado/soybean unsaponifiables in the treatment of symptomatic osteoarthritis of the knee and hip. A prospective, multicenter, three-month, randomized, double-blind, placebo-controlled trial. Rev Rhum Engl Ed 1997; 64: 825-834
15 Lequesne M, Maheu E, Cadet C et al. Structural effect of avocado/soybean unsaponifiables on joint space loss in osteoarthritis of the hip. Arthritis Care & Research 2002; 47: 50-58
16 Maheu E, Mazieres B, Valat JP et al. Symptomatic efficacy of avocado/soybean unsaponifiables in the treatment of osteoarthritis of the knee and hip: a prospective, randomized, double-blind, placebo-controlled, multicenter clinical trial with a six-month treatment period and a two-month followup demonstrating a persistent effect. Arthritis Rheum 1998; 41: 81-91
17 Maheu E, Cadet C, Marty M et al. Randomised, controlled trial of avocado-soybean unsaponifiable (Piascledine) effect on structure modification in hip osteoarthritis: the ERADIAS study. Ann Rheum Dis 2014; 73: 376-384
18 Pavelka K, Coste P, Géher P et al. Efficacy and safety of piascledine 300 versus chondroitin sulfate in a 6 months treatment plus 2 months observation in patients with osteoarthritis of the knee. Clin Rheumatol 2010; 29: 659-670
19 Widrig R, Suter A, Saller R et al. Choosing between NSAID and arnica for topical treatment of hand osteoarthritis in a randomised, double-blind study. Rheumatol Int 2007; 27: 585-591
20 Kosuwon W, Sirichatiwapee W, Wisanuyotin T et al. Efficacy of symptomatic control of knee osteoarthritis with 0.0125% of capsaicin versus placebo. J Med Assoc Thai 2010; 93: 1188-1195
21 Grube B, Grünwald J, Krug L et al. Efficacy of a comfrey root (Symphyti offic. radix) extract ointment in the treatment of patients with painful osteoarthritis of the knee: Results of a double-blind, randomised, bicenter, placebo-controlled trial. Phytomedicine 2007; 14: 2-10
22 Soltanian AR, Mehdibarzi D, Faghihzadeh S et al. Mixture of Arnebia euchroma and Matricaria chamomilla (Marhame-Mafasel) for pain relief of osteoarthritis of the knee – a two-treatment, two-period crossover trial. Arch Med Sci 2010; 6: 950-955
23 Randall C, Randall H, Dobbs F et al. Randomized controlled trial of nettle sting for treatment of base-of-thumb pain. J Royal Soc Med 2000; 93: 305-309
24 Randall C, Dickens A, White A et al. Nettle sting for chronic knee pain: A randomised controlled pilot study. Complement Ther Med 2008; 16: 66-72
25 Bliddal H, Rosetzsky A, Schlichting P et al. A randomized, placebo-controlled, cross-over study of ginger extracts and Ibuprofen in osteoarthritis. Osteoarthritis Cartilage 2000; 8: 9-12
26 Wigler I, Grotto I, Caspi D et al. The effects of Zintona EC (a ginger extract) on symptomatic gonarthritis. Osteoarthritis Cartilage 2003; 11: 783-789
27 Altman RD, Marcussen KC. Effects of a ginger extract on knee pain in patients with osteoarthritis. Arthritis Rheum 2001; 44: 2531-2538
28 Frost R, MacPherson H, O’Meara S. A critical scoping review of external uses of comfrey (Symphytum spp.). Complement Ther Med 2013; 21: 724-745