Introduction

Osteoarthritis (OA) is a persistent cause of physical disability and compromised quality of life, especially among the elderly, affecting 7% of the global population [1]. It is characterized by gradual wearing of the joint cartilage, inflammation of the fluid spaces within articulating (moving) joints, and increased oxidative stress damage to connective tissues and muscles. Traditional herbal extracts, typically as blends, have been dispensed for rheumatism, non-specific arthritis and joint pain for hundreds of years in Eastern and Western cultures with more than 30 known herbal species that have been evaluated in clinical trials [2, 3]. This article highlights the outcomes of a recent clinical intervention involving a combination herbal formula as a complementary strategy for elderly sufferers of mild knee OA.

Study design

This open-label trial was conducted in Poland during 2019 [4] involving 137 subjects with grade 0-2 OA (age range 40-88; male: 32%; female: 68%, with mostly right knee dominant OA, with 1-17 years in duration). The investigational material was a combination herbal formula combining Curcuma longa (turmeric) phospholipid complex, along with Boswellia serrata, Harpagophytum procumbens, Apium graveolens and Zingiber officinale. Subjects were given 2 tablets/day, supplementary to their standard-of-care pain medications, for 36 weeks, with a total of 107 subjects completing the course. Primary measures included quantitation of endurance responses to a 6-minute walking test challenge, pain, swelling, physical function and joint flexibility.

Study outcomes

Over weeks 12-36, a progressive increase in distance covered during the 6-minute walking test was observed, equating to an overall increase of 26.0 m by the end of treatment (p < 0.001 for each time point vs baseline) (Fig. 1). This improvement in endurance corresponded significant improvements in knee flexibility, including decreased in heel-to-thigh distances, measured when lying on their back (supine) by up to 4.6% (P=0.001) and front (prone) by up to 0.45% (P=0.002) (Fig 2).

According to the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index employed for all subjects at all timepoints, significant decreases in knee pain, stiffness and physical function were reported throughout the intervention, combining to a global improvement of 58% (P<0.001) by the end of the trial (Fig. 3). A decrease in the use of prescription medications at all three timepoints was also reported, representing a 50% reduction (Fig. 4). Furthermore, more than 90% of participants reported being satisfied with the herbal formula by the end of the supplementation period.

Implications of the study

The outcomes of this trial confirm the efficacy of a specific herbal formula for middle aged to elderly people with mild knee OA sufferers, as a complementary therapy, alongside conventional medication. The results also confirm that individual herbal extracts retain their efficacy when used in combination. For example, the present observations were consistent with findings of reduced pain and improved quality of life observations of previous clinical evaluations involving the same curcumin complex over a similar time frame (3 months) [5]. Similarly, the other herbal ingredients have each shown individual efficacy in pain management in other studies, especially Boswellia serrata and Harpagophytum procumbens. [2, 3]. While the present study was an uncontrolled, single-arm study, it remains relevant to current herbal medicine practices, whereby the efficacy of these types of natural remedies for mobility is largely based on individual patient responses before and after administration, over a controlled time frame.

Conclusion

This study highlights that defined extracts of phytomedicines have quantifiable efficacy and provide further support for herbal medicines as alternatives to conventional medications for age-related joint conditions.

References

1. Cross, 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): p. 1323-30. doi: 10.1136/annrheumdis-2013-204763. Epub 2014 Feb 19.
2. Choudhary, M., et al., Medicinal plants with potential anti-arthritic activity. J Intercult Ethnopharmacol., 2015. 4(2): p. 147-79. doi: 10.5455/jice.20150313021918. Epub 2015 Mar 14.
3. Cameron, M. and S. Chrubasik, Oral herbal therapies for treating osteoarthritis. Cochrane Database Syst Rev., 2014. 2014(5): p. CD002947. doi: 10.1002/14651858.CD002947.pub2.
4. Żęgota, Z., J. Goździk, and J. Głogowska-Szeląg, Prospective, Multicenter Evaluation of a Polyherbal Supplement alongside Standard-of-Care Treatment for Mild Knee Osteoarthritis. Adv Orthop., 2021. 2021:5589597.(doi): p. 10.1155/2021/5589597. eCollection 2021.
5. Belcaro, G., et al., Product-evaluation registry of Meriva®, a curcumin-phosphatidylcholine complex, for the complementary management of osteoarthritis. Panminerva Med., 2010. 52(2 Suppl 1): p. 55-62.

from an Expert Author

George Thouas

BSc, MRepSc, PhD – Biomedical Scientist

George has worked as a medical researcher for 17 years in the university sector, at both Monash University health institutes, and The University of Melbourne. He spent 12 of those years in reproductive health and fertility research, in roles such as Clinical Research Associate, Clinical Embryologist, Post-graduate Demonstrator, Lecturer, and later as a Senior Research Fellow and Lab Manager. His doctoral thesis investigated the effects of mitochondrial damage in the oocyte. He also worked on improving the nutrient and growth requirements for in vitro fertilization and embryo development.

George has authored and coauthored more than 50 publications, including 1 book, 5 book chapters, 30 peer-reviewed journal reports and reviews, 6 patents, international scientific conference proceedings and health practitioner journal articles.

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