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Review on clinical trials assessing the efficacy of Curcuma in osteoarthritis.

Perkins K, Sahy W, Beckett RD. 2016. Efficacy of curcuma for treatment of osteoarthritis.,/ Evid Based Complementary Altern Med In Print: doi:10.1177/2156587216636747.

Curcumin, an active constituent of turmeric (Curcuma longa) has demonstrated anti-inflammatory activities in a number of studies, but the mechanism of action is not fully understood. Proposed mechanisms include inhibition of pro-inflammatory signals such as prostaglandins, leukotrienes and cyclo-oxygenases. Whilst observational studies have demonstrated statistically significant differences in pain scores in patients with osteoarthritis after curcumin intervention, clinical trials are more appropriate in determining cause and effect. Accordingly, the current review aimed to identify and evaluate clinical trials assessing the efficacy of Curcuma in the treatment of osteoarthritis.

A literature review was conducted using PubMed, Academic Search Premier, and Google Scholar for human interventional studies assessing the efficacy of Curcuma in the treatment of osteoarthritis. Articles were to be published in peer-reviewed scientific journals, with no limits to date of publication. The studies identified were then included in a narrative review with study results not pooled in a meta-analysis due to highly anticipated heterogeneity among studies.

Of the 35 articles identified, 8 articles were included for inclusion in the review with reasons for exclusion of articles including not assessing efficacy, not published in a peer-reviewed paper, animal studies, review articles, and observational or pilot studies. A variety of study designs were reported with comparisons of curcumin intervention to placebo or to an active NSAID anti-inflammatory control, and a number of trials using a Curcuma intervention in combination therapy. Authors reported that when compared to a placebo control, curcumin-containing products generally demonstrated a statistically significant improvement in osteoarthritis-related endpoints, with the exception of one study. When compared to an active control, curcumin-containing products were similar to NSAIDs and possibly glucosamine. However, it was noted the clinical significance of these findings remains uncertain due to the consistent presence of study limitations within the trials. Limitations identified included sample size, poor study design, issues with baseline characteristics, and the use of subjective scales rather than validated pain scores in some studies. Differences in dosing regimes, active constituent and duration of intervention were noted between studies.

Whilst the study concluded that clinical trials assessing the effectiveness of Curcuma in treatment of osteoarthritis found similar efficacy compared with NSAIDS, and potentially glucosamine; the authors highlighted the limitations of these studies which could limit the validity of these results and called for further high quality studies to be undertaken before the recommendation of Curcuma as an effective alternative therapy to currently recommended non-pharmacological and pharmacological therapies for knee osteoarthritis.

This review highlights that whilst there have been increasing clinical trials in herbal medicine, and in this instance curcumin in osteoarthritis; more high-quality, well-designed and rigorous studies are required.

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Article Details
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Author:Tester, Jodie
Publication:Australian Journal of Herbal Medicine
Article Type:Report
Geographic Code:8AUST
Date:Sep 1, 2016
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