| Complementary and alternative medicines: use in osteoarthritis |
For information on use of glucosamine and chondroitin,.
Some CAMs for which there is at least limited evidence of benefit for symptom relief in osteoarthritis include:
topical capsaicin—small but significant reduction in pain compared to placebo
ginger, Zingiber officinale—small short-term benefit in pain relief compared to placebo in one study
devil’s claw, Hapargophytum procumbens—showed a reduction in pain in patients with osteoarthritis of the hip and knee
avocado/soybean unsaponifiables—may decrease pain, decrease the need for NSAIDs, and improve function and overall wellbeing
willow bark extract, Salix purpureax daphnoides—may reduce pain in osteoarthritis, but contains salicin which can increase the risk of bleeding and peptic ulceration
topical stinging nettle, Urtica dioica—showed decreased pain in carpometacarpophalangeal joint osteoarthritis compared with placebo
Boswellia, Boswellia serrata—inhibits leukotriene via the 5-lipoxygenase pathway and may reduce pain and swelling and improve mobility in knee osteoarthritis
SAM-e, S-adenosylmethionin (ademetionine)—some analgesic benefit may be evident
New-Zealand green-lipped mussels, Perna canaliculus, a 5-lipoxygenase inhibitor—showed significant improvements in pain and stiffness and quality of life in a short-term study among patients with knee and hip osteoarthritis.
Diacerein was shown in one well-conducted 3-year study to reduce progression of hip joint space narrowing compared to placebo. No benefit was seen for symptom relief in these patients with osteoarthritis of the hip. A smaller study among patients with osteoarthritis of the knee failed to show any symptomatic or structural benefit.
A Cochrane review of herbal therapy for treating osteoarthritis was only able to evaluate randomised controlled trials. Two studies of avocado/soybean unsaponifiables were consistent in their findings of long-term symptomatic relief that was particularly evident in patients with chronic, stable hip osteoarthritis. Avocado/soybean unsaponifiables were also found to potentially reduce NSAID use. Other studies were thought to be promising, but due to the small number of studies and variability in their quality, there was insufficient evidence for reliable assessment of efficacy to be made.