Turmeric for osteoarthritis pain

Integrative Medicine

An estimated 27 million Americans have osteoarthritis, including one-third of adults aged 65 years and older.1 Osteoarthritis is now the cause of 70% of arthritis-related hospitalizations in the United States.1 Pain, the most frequent symptom, is treated with NSAIDs, which may cause gastric ulceration, hemorrhage, and perforation. Because of these and other risks, many patients choose dietary supplements, including glucosamine, chondroitin, and S-adenosylmethionine (known as SAMe), and medicinal herbs such as turmeric.

Turmeric is an Indian spice with medicinal uses, as well as a yellow coloring agent in curry powder. A recent report indicated that turmeric and curcumin, its primary active constituent, are among the top-selling supplements in the United States, with sales increasing more than 25% in 2013.2 In vitro studies have shown that curcumin has inhibitory effects on lipoxygenase, cyclooxygenase, and phospholipase. Pro-inflammatory cytokines, including tumor necrosis factor alpha (TNFα), interleukin-1, and interleukin-8, are also reduced.3 NSAIDs work similarly, suggesting a potential role for turmeric in osteoarthritis.

Clinical trial

A multicenter study in Thailand evaluated turmeric on pain reduction and functional improvement in 367 patients with knee osteoarthritis. Patients’ pain score was 5 or more on a 10-point scale using American College of Rheumatology criteria. Most participants were women, with a mean age of 60 years and body mass index of 26 kg/m3. Participants were randomized to receive either 1,200 mg per day of ibuprofen or 1,500 mg per day of turmeric extract in divided doses for 4 weeks.

Outcome measures were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, with pain, stiffness, and function subscales ranging from 0 to 10. Outcomes were evaluated at weeks 2 and 4 by a blinded assessor. Adverse effects, adherence, and satisfaction with the treatment were also assessed.

Outcomes in each group significantly improved compared with their baseline values. At week 4, the WOMAC scores in the turmeric extract group were similar to those of the ibuprofen group. The mean difference of the WOMAC total, pain, and function scores were within 0.5 points (−0.07, −0.09, and 0.06, respectively), indicating the results from the turmeric extract group were noninferior to the ibuprofen group.

The WOMAC stiffness score improved to a greater degree with ibuprofen. Dyspepsia, nausea, and loose stool were similar between groups. The rate of abdominal pain was significantly lower in the turmeric group compared with that of the ibuprofen group (20 and 33 patients, respectively). Patients in both groups were adherent and satisfied with their treatment.

Although turmeric had similar efficacy as ibuprofen, a lower dose of ibuprofen was used because Thai people have a lower average body weight compared with Caucasians. Because this study was done in Thailand, the results may not be generalizable to older Americans, especially if they are overweight.

Turmeric or curcumin supplements should be standardized for 95% curcuminoids. Products commonly contain piperine, a constituent of black pepper, which inhibits intestinal and hepatic glucuronidation and increases the bioavailability of turmeric and curcumin.4

What to tell patients

Osteoarthritis is a chronic disease. Its treatment focuses on relieving pain and stiffness, improving joint mobility, and maintaining quality of life. Regular exercise and maintaining an appropriate weight are essential. Acetaminophen should be used initially for pain relief. Turmeric use for osteoarthritis pain reduction has shown similar safety and efficacy results as low-dose ibuprofen. The product may potentially increase the risk of bleeding, especially for people taking anticoagulants or NSAIDs.

References

  1. www.cdc.gov/arthritis/basics/osteoarthritis.htm
  2. HerbalGram. 2014;103:52–56
  3. Clinical Interventions in Aging. 2014; 9:451–8
  4. Planta Med. 1998;64(4):353–6