Curcuma Longa Effective for Knee Osteoarthritic Pain

Post on October 1, 2020 by André Broussard, D.C.

October 01, 2020

Annals of Internal Medicine

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This randomized controlled trial examined the use curcumin over 12 weeks for treatment of osteoarthritis. Use of curcumin improved pain for patients, but did not improve effusion volumes or relaxation time of the lateral femoral cartilage when compared with placebo.
Curcumin is presented as a potential therapeutic option for osteoarthritis symptoms. Evidence from this article shows symptomatic improvement for patients without an increased risk of side effects.
– Andrea Dotson, MD, MSPH

Written by David Rakel MD, FAAFP

Curcumin for Osteoarthritis of the Knee

A number of years ago when the Cox-2 inhibitor, rofecoxib (Vioxx) was taken off the market due to its CV risk, I had my patients switch to Turmeric 1 gm twice daily and it worked quite well. It is also quite tasty in curry dishes.

This study builds on a prior systematic review showing that curcumin (an ingredient within the turmeric root of the plant, Curcuma longa) reduced knee pain and improved quality of life in those with osteoarthritis of the knee. What makes this rather small study (n-70) unique is that they did baseline and follow-up MRI of the knee to see if it had disease modifying abilities with reduced synovial swelling.

Turmeric-Curcumin

The study used a two 500 mg tablets (1 gm daily) of Turmeric with 20% curcuminoids for 12 weeks compared to placebo. Like the prior systematic review, it again showed a moderate 10% reduction in pain with improvement in function and stiffness compared to placebo. The authors point out that the symptom reduction of turmeric is greater than that of acetaminophen. Unfortunately, it did not result in a reduction in synovial swelling on MRI.

Turmeric with curcuminoids is likely another symptom modifying agent that can be used with confidence for this common condition. Although maybe it needed more than 12 weeks to show an effect, it does not appear at this time to have disease modifying capabilities.

How to Prescribe Turmeric or Curcumin

  • Recommend a turmeric product that contains a specific percentage of curcuminoids. This study used one with 20%. Giving the root (turmeric) with a specific amount of what we think is the active ingredient (curcumin) honors the synergy of the many other chemicals in the root that likely help curcumin work better. Giving just one active ingredient (curcumin) in isolation may limit this effect and increase side effects.
  • This study used just 1 gm of turmeric which may have been on the low side. You can go up to 2-3 gms a day.
  • Like NSAIDS, turmeric has COX inhibitory properties and although there were no significant side effects in this study, theoretically high doses could cause GI distress, gastritis and high blood pressure.
  • Turmeric and curcumin are poorly absorbed. Adding piperine, the active ingredient in black pepper enhances absorption greatly. Make sure the product includes this on the ingredient label. Taking turmeric with a fatty meal also enhances absorption.

Abstract

This abstract is available on the publisher’s site.

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BACKGROUND

Current pharmacologic therapies for patients with osteoarthritis are suboptimal.

OBJECTIVE

To determine the efficacy of Curcuma longa extract (CL) for reducing knee symptoms and effusion-synovitis in patients with symptomatic knee osteoarthritis and knee effusion-synovitis.

DESIGN

Randomized, double-blind, placebo-controlled trial. (Australian New Zealand Clinical Trials Registry: ACTRN12618000080224).

SETTING

Single-center study with patients from southern Tasmania, Australia.

PARTICIPANTS

70 participants with symptomatic knee osteoarthritis and ultrasonography-defined effusion-synovitis.

INTERVENTION

2 capsules of CL (n = 36) or matched placebo (n = 34) per day for 12 weeks.

MEASUREMENTS

The 2 primary outcomes were changes in knee pain on a visual analogue scale (VAS) and effusion-synovitis volume on magnetic resonance imaging (MRI). The key secondary outcomes were change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and cartilage composition values. Outcomes were assessed over 12 weeks.

RESULTS

CL improved VAS pain compared with placebo by -9.1 mm (95% CI, -17.8 to -0.4 mm [P = 0.039]) but did not change effusion-synovitis volume (3.2 mL [CI, -0.3 to 6.8 mL]). CL also improved WOMAC knee pain (-47.2 mm [CI, -81.2 to -13.2 mm]; P = 0.006) but not lateral femoral cartilage T2 relaxation time (-0.4 ms [CI, -1.1 to 0.3 ms]). The incidence of adverse events was similar in the CL (n = 14 [39%]) and placebo (n = 18 [53%]) groups (P = 0.16); 2 events in the CL group and 5 in the placebo group may have been treatment related.

LIMITATION

Modest sample size and short duration.

CONCLUSION

CL was more effective than placebo for knee pain but did not affect knee effusion-synovitis or cartilage composition. Multicenter trials with larger sample sizes are needed to assess the clinical significance of these findings.

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