Indian medicines ‘promising’ for osteoarthritis care

Ayurvedic medicine may offer osteoarthritis (OA) relief, say Indian researchers who found traditional formulations to be equal to conventional drugs for the improvement of pain and knee function.

The team reports the outcome of a 6-month randomized, double-blind, clinical trial comparing celecoxib (200 mg/day) or glucosamine sulfate (2 g/day) with one of two Ayurvedic 400 mg/day formulations containing extracts of Zingiber officinale, Tinospora cordifolia, and Phyllanthus emblica alone (SGC) or with Boswellia serrata (SGCG).

Assessment of the 440 patients in the trial showed significant improvement over 24 weeks, with around a 30% improvement for active body weight-bearing pain measured on a visual analog scale (VAS).

Similarly, there was significant improvement on the Western Ontario and McMaster Universities (WOMAC) pain and functional difficulty Likert scores for hip and knee pain, the patient and physician global assessments, and the Stanford Health Assessment Questionnaire.

"The mean percentage improvement in active pain (VAS and WOMAC) in the current study for each of the study interventions was much higher than the historical data for placebo," say Arvind Chopra (Center for Rheumatic Diseases, Pune) and co-authors.

However, there was no significant difference in improvements achieved between the treatment groups, either in intent-to-treat analysis or per protocol analysis, they report in Rheumatology.

Of concern, 26 patients in the study experienced an asymptomatic increase in glutamic pyruvic transaminase (SGPT) levels; 11 were using SGCG and nine were using SGC, compared with just two celecoxib- and four glucosamine-treated patients.

Indeed, 10 patients in the Ayurvedic therapy groups experienced a SGPT rise of between three and six fold, and seven withdrew from treatment. SGPT levels returned to normal within 8-12 weeks regardless of whether treatment was withdrawn.

There was a significantly smaller increase noted for other liver enzymes and no other signs of hepatic, biliary or pancreatic disorders.

While SGCG is "promising" for clinical use, Chopra et al write: "A longer study period would be required to endorse its long-term efficacy and safety, especially with reference to hepatic effects."

They conclude: "Ethnic medicines and medicinal plants must be explored to fulfill some of the unmet need for chondroprotective agents in the long-term management of OA."

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