0 Supplements for Joint Pain
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Dynamic Chiropractic – July 1, 2019, Vol. 37, Issue 07

Supplements for Joint Pain

By Adrian Isaza, PhD, DC, DABCI, DACBN, CCAP

The Arthritis, Rheumatism, and Aging Medical Information System estimates that adverse effects due to NSAIDs are associated with more than 100,000 hospitalizations and more than 16,000 deaths in the U.S. each year. Both nonselective and selective COX-2 inhibitors have now been shown to be associated with an increased risk for cardiovascular events.

These studies, together with the recent U.S. Food and Drug Administration (FDA) decision to require "black box" warnings regarding potential cardiovascular risks associated with NSAIDs, suggest that the use of COX-2 inhibitors as the sole strategy for gastroprotection in patients with arthritis and other pain syndromes must be reconsidered, particularly among those at risk for cardiovascular events.1

Dietary Supplements for Knee, Hip and Spine Osteoarthritis

Ginger

In 2015, Bartels, et al., carried out a meta-analysis of five randomized, controlled trials involving more than 500 patients, comparing oral ginger treatment with placebo in adult osteoarthritis patients. This study concluded ginger was modestly efficacious and reasonably safe for treatment of knee and hip osteoarthritis.2

joint pain - Copyright – Stock Photo / Register Mark Effect on Inflammation: In 2016, Mazidi, et al., performed a systematic review and meta-analysis of  nine studies which suggests ginger supplementation significantly reduces serum C-reactive protein (CRP).3

Ginger vs. NSAIDs: In 2001, Altman, et al., conducted a randomized, double-blind, placebo-controlled, multicenter, parallel-group study of 247 patients with osteoarthritis of the knee and moderate-to-severe pain. In this study, ginger extract had a statistically significant effect on reducing symptoms of osteoarthritis of the knee. Moreover, the reduction in intake of acetaminophen was greater in the ginger extract group.4

In 2012, Drozdov, et al., designed a randomized, controlled trial of 43 patients with knee or hip osteoarthritis who were given ginger or diclofenac. This study showed that ginger is as effective as diclofenac, but safer in treating osteoarthritis. Moreover, ginger has an increased mucosa-protective potential.5

In 2013, Paramdeep performed a randomized, placebo-controlled, open-label study of 60 patients with osteoarthritis of the knee who were divided into diclofenac, ginger and placebo groups. The percentage improvement in pain score from baseline in the diclofenac group  was 60.31 percent vs. 59.11 percent in the ginger group.6

Curcumin / Turmeric

In 2016, Daily, et al., published a systematic review and meta-analysis of randomized, controlled trials that provided scientific evidence supporting the efficacy of turmeric extract in the treatment of knee and hip osteoarthritis.7

Effect on Inflammation: In 2014, Sahebkar published a meta-analysis of six clinical trials involving over 300 subjects. This study showed that compared with placebo, supplementation with curcumin was associated with a significant reduction in circulating CRP levels.8

In 2019, Tabrizi, et al., performed a systematic review and meta-analysis of 15 randomized, controlled trials. This study suggests taking curcumin-containing supplements may exert anti-inflammatory effects by reducing  interleukin-6 (IL-6), high sensitivity C-reactive protein (hs-CRP) and malondialdehyde (MDA) levels.9

Curcumin vs. NSAIDs: In 2009, Kuptniratsaikul, et al., designed a single-blind, randomized, controlled trial to evaluate the efficacy of 2,000 mg/day of Curcuma domestica extracts compared with 800 mg/day of ibuprofen in 107 knee osteoarthritis patients. This study found that after six weeks, curcumin extracts were similarly efficacious as ibuprofen.

Moreover, adverse events for curcumin were 33.3 percent compared to 44.2 percent for ibuprofen.10

In 2012, Kertia, et al.,conducted a prospective, randomized, open-end blinded study of 80 patients with knee osteoarthritis. Curcuma domestica extract was not significantly different compared to diclofenac sodium in suppressing the secretion of cycloxygenase-2 enzyme.11

In 2014, Kuptniratsaiku, et al., carried out a follow-up with better methodology than the first study. This study was a double-blind, randomized, controlled trial of 367 knee osteoarthritis patients which indicated that Curcuma domestica extracts are as effective as ibuprofen for the treatment of knee osteoarthritis.

Moreover, the incidence of abdominal pain and discomfort was significantly higher in the ibuprofen group than in the C. domestica group.12

In 2018, Bannuru, et al., performed a systematic review and meta-analysis of 11 randomized, controlled trials involving more than 1,000 patients. This study suggested NSAIDs have no statistically significant differences in efficacy outcomes compared to curcuminoids.13

Harpagophytum Proumbens ("Devil's Claw")

In 2004, Gagnier, et al., carried out a systematic review of 12 trials which revealed there is moderate evidence of effectiveness for the use of a Harpagophytum powder (60 mg) in the treatment of osteoarthritis of the spine, hip and knee. Moreover, the study provided strong evidence for the use of an aqueous Harpagophytum extract at a daily dose of 50 mg in the treatment of acute exacerbations of chronic nonspecific low back pain.14

Effect on Inflammation: In 2010, Inaba, et al., tested rats with Harpagophytum ethanol extract, which suppressed inflammatory cytokines [interleukin-1beta (IL-1beta), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha)] in macrophage cells.15

Devil's claw vs. NSAIDs: The study by Gagnier, et al., also found that the use of an aqueous extract of Harpagophytum procumbens at 60 mg  had similar efficacy to 12.5 mg of rofecoxib per day for chronic, nonspecific LBP  in the short term.

In 2000, Chantre, et al., conducted a double-blind, randomized, multicenter clinical study of 122 patients in which 435 mg / day of powdered Harpagophytum procumbens was compared with diacerhein 100 mg/day (anthraquinone). This study showed no difference in the efficacy of the two treatments, and patients taking Harpagophytum used significantly less NSAIDs. Furthermore, the most frequent adverse event reported was diarrhea, occurring in 8.1 percent of harpagophytum patients and 26.7 percent of diacerhein patients.16

Although osteoarthritis is a wear-and-tear condition systemic inflammation may play a role. In 2015, Jin, et al., carried out a systematic review and meta-analysis of 32 studies and found serum high-sensitivity CRP levels in OA patients were statistically significantly higher than controls. Moreover, CRP levels were significantly associated with pain and decreased function.17

Based on the aforementioned evidence, it seems plausible that supplementation with ginger, curcumin and devil's claw can exert an anti-inflammatory effect and help relieve the pain associated with osteoarthritis.

Dietary Supplements for RA

Omega-3s

In 2007, Goldberg, et al., published a meta-analysis of 17 randomized, controlled trials measuring the pain-relieving effects of omega-3 fatty acids in patients with rheumatoid arthritis or joint pain secondary to inflammatory bowel disease and dysmenorrhea. Supplementation with omega-3s for 3-4 months reduced patient-reported joint pain intensity, minutes of morning stiffness, number of painful and/or tender sites and NSAID consumption.18

Effect on Inflammation: In 2018, Gioxari, et al., performed a systematic review and meta-analysis of 20 randomized, controlled trials involving over 1,200 patients, finding a significant reduction of leukotriene B4 following omega-3 supplementation.19

Omega-3s vs. NSAIDs: In 2006, Maroon, et al., designed a study of 250 patients who had been seen by a neurosurgeon and were found to have nonsurgical neck or back disc pain. This study demonstrated equivalent effect in reducing arthritic pain between omega-3s and ibuprofen. It also appeared to be a safer alternative to NSAIDs for treatment of nonsurgical neck and back pain.20

In 2012, Lee, et al., conducted a meta-analysis of 10 randomized, controlled trials involving more than 300 total RA patients, finding that use of omega-3 PUFAs at dosages >2.7 g/day for >3 months reduces NSAID consumption.21

Given the above evidence, omega-3s may help relieve the pain associated with rheumatoid arthritis as an alternative to NSAIDs.

References

  1. Abramson SB, Weaver AL. Current state of therapy for pain and inflammation. Arthritis Res Ther, 2005;7 Suppl 4:S1-6.
  2. Bartels EM, Folmer VN, Bliddal H, et al. Efficacy and safety of ginger in osteoarthritis patients: a meta-analysis of randomized placebo-controlled trials. Osteoarthr Cartil, 2015;23(1):13-21.
  3. Mazidi M, Gao HK, Rezaie P, Ferns GA. The effect of ginger supplementation on serum C-reactive protein, lipid profile and glycaemia: a systematic review and meta-analysis. Food Nutr Res, 2016;60:32613.
  4. Altman RD, Marcussen KC. Effects of a ginger extract on knee pain in patients with osteoarthritis. Arthritis Rheum, 2001;44(11):2531-8.
  5. Drozdov VN, Kim VA, Tkachenko EV, Varvanina GG. Influence of a specific ginger combination on gastropathy conditions in patients with osteoarthritis of the knee or hip. J Altern Complement Med, 2012;18(6):583-8.
  6. Paramdeep G. Efficacy and tolerability of ginger (Zingiber officinale) in patients of osteoarthritis of knee. Indian J Physiol Pharmacol, 2013;57(2):177-83.
  7. Daily JW, Yang M, Park S. Efficacy of turmeric extracts and curcumin for alleviating the symptoms of joint arthritis: a systematic review and meta-analysis of randomized clinical trials. J Med Food, 2016;19(8):717-29.
  8. 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.
  9. Tabrizi R, Vakili S, Akbari M, et al. The effects of curcumin-containing supplements on biomarkers of inflammation and oxidative stress: a systematic review and meta-analysis of randomized controlled trials. Phytother Res, 2019;33(2):253-262.
  10. Kuptniratsaikul V, Thanakhumtorn S, Chinswangwatanakul P, et al. Efficacy and safety of Curcuma domestica extracts in patients with knee osteoarthritis. J Altern Complement Med, 2009;15(8):891-7.
  11. Kertia N, Asdie AH, Rochmah W, Marsetyawan . 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;44(2):105-13.
  12. 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;9:451-8.
  13. Bannuru RR, Osani MC, Al-eid F, Wang C. Efficacy of curcumin and Boswellia for knee osteoarthritis: systematic review and meta-analysis. Semin Arthritis Rheum, 2018 Dec;48(3):416-429.
  14. Gagnier JJ, Chrubasik S, Manheimer E. Harpgophytum procumbens for osteoarthritis and low back pain: a systematic review. BMC Complement Altern Med, 2004;4:13.
  15. Inaba K, Murata K, Naruto S, Matsuda H. Inhibitory effects of devil's claw (secondary root of Harpagophytum procumbens) extract and harpagoside on cytokine production in mouse macrophages. J Nat Med, 2010;64(2):219-22.
  16. Chantre P, Cappelaere A, Leblan D, et al. Efficacy and tolerance of Harpagophytum procumbens versus diacerhein in treatment of osteoarthritis. Phytomedicine, 2000;7(3):177-83.
  17. Jin X, Beguerie JR, Zhang W, et al. Circulating C reactive protein in osteoarthritis: a systematic review and meta-analysis. Ann Rheum Dis, 2015;74(4):703-10.
  18. Goldberg RJ, Katz J. A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain. Pain, 2007;129(1-2):210-23.
  19. Gioxari A, Kaliora AC, Marantidou F, Panagiotakos DP. Intake of w-3 polyunsaturated fatty acids in patients with rheumatoid arthritis: a systematic review and meta-analysis. Nutrition, 2018;45:114-124.e4.
  20. Maroon JC, Bost JW. Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain. Surg Neurol, 2006;65(4):326-31.
  21. Lee YH, Bae SC, Song GG.  Omega-3 polyunsaturated fatty acids and the treatment of rheumatoid arthritis: a meta-analysis. Arch Med Research, 2012; 43(5):356-362.

Dr. Adrian Isaza is both a physician and an academic. As an academic, he authored a chapter of the book, The Role of Functional Food Security in Global Health, has authored more than 30 papers advocating the use of alternative medicine, and teaches graduate students at Everglades University for the alternative medicine degree program. As a clinician, he holds a diplomate in diagnosis (American Board of Chiropractic Internists) and a diplomate in nutrition (American Clinical Board of Nutrition).

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