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Complementary therapies for osteoarthritis - what works and what doesn't

Professor of complementary medicine Edzard Ernst and colleagues assess the evidence to give you the bottom line on what works, what doesn’t and what might cause harm among complementary osteoarthritis therapies.

Professor of complementary medicine Edzard Ernst and colleagues assess the evidence to give you the bottom line on what works, what doesn't and what might cause harm among complementary osteoarthritis therapies.

OA is a degenerative disease of the joints and variously defined by clinical and/or radiological features. It most commonly affects knees, hips, hands, and spinal apophyseal joints.

It is characterised by focal areas of damage to the cartilage surfaces of synovial joints and is associated with remodelling of the underlying bone and mild synovitis. Clinical features include pain, bony tenderness and crepitus.

Knee OA is about twice as prevalent as hip OA in people over 60.

In general practice, 1% of people over 45 have a clinical diagnosis of knee OA. Risk factors are obesity, abnormalities in joint shape, injury and previous joint inflammation.

Acupuncture, massage, manipulation, and homeopathy are most commonly used.

Clinical bottom line

Beneficial

• Acupuncture: alleviates pain, particularly from knee OA.

• Phytodolor: a proprietary herbal mixture shown to be safe and effective for alleviating pain and restoring function.

Likely to be beneficial

• Avocado/soybean unsaponifiables: positive but data not fully convincing for symptom control.

• Chondroitin, glucosamine: data suggested effectiveness for pain and function but contradicted by more recent studies of sulphate and hydrochloride variants; may even prevent joint space narrowing.

• Devil's claw (Harpagophytum procumbens): moderate evidence suggests reduction of spine, hip and knee OA.

• SK1 306X: this mixture of three herbs may be effective for pain relief.

• Spa therapy: may alleviate pain and function but data not entirely convincing.

Unknown effectiveness

• Arnica (Arnica montana), herbal tincture: may be effective for improving pain and function in hand OA but not enough data available.

• Arthritis Relief Plus: a herbal ointment may improve pain and stiffness, but not enough data available.

• Capsaicin: might be effective in reducing pain but not enough data.

• Chiropractic: may alleviate back pain secondary to OA but not enough data.

• Comfrey (Symphytum officinale): may improve pain and function but not enough data available.

• Duhuo Jisheng Wan: this Chinese herbal mixture may improve pain and stiffness but not enough data available.

• Ginger (Zingiber officinalis): data not convincing for pain relief.

• Gitadyl: some positive evidence, but not enough data available.

• Green-lipped mussel (Perna canaliculus): little consistent and compelling evidence.

• Herbomineral formulation: some positive evidence but not enough data available.

• Homeopathy: not enough data for symptom improvement available.

• Hyben vital: some positive evidence yet not enough data available.

• Imagery: may improve quality of life but not enough data available.

• Indian frankincense (Boswellia serrata): may reduce pain and increase walking distance, but data is scarce with methodological limitations.

• Magnets, static: no compelling evidence for pain relief.

• Massage: may improve pain, stiffness, function, range of motion, but not enough data available.

• Music therapy: not enough data available.

• Reumalex: herbal mixture that may have analgesic effects.

• Rose hip (Rosa canina): may reduce pain but more data required.

• Sierrasil: this herbomineral formulation may reduce pain but not enough data.

• Soy: may alleviate symptoms but not enough data available.

• Stinging nettle (Urtica dioica): may reduce pain in OA of the fingers but not enough data available.

• Tai chi: improvement of pain and function, no exacerbation of symptoms but not enough data available.

• Therapeutic touch: not enough data available.

• Willow bark (Salix spp): not enough data.

• Yoga: not enough data available for pain and function.

Unlikely to be beneficial

• EazMov: this Ayurvedic herbal preparation seems ineffective.

Likely to be ineffective or harmful

• Bromelain: likely to be ineffective in moderate to severe OA.

• Magnets, electromagnetic: ineffective for pain reduction in patients with knee OA.

• Tipi: a herbal combination, likely to be ineffective.

• Vitamin E: seems ineffective for preventing loss of cartilage in knee OA.

Conclusions

• Best evidence supports the use of acupuncture and Phytodolor. A number of other interventions are likely to be beneficial for improving pain and function.

• Allergic reactions and herb–drug interactions should be considered with Phytodolor. Serious adverse events in acupuncture are rare.

• The risk-benefit balance for acupuncture and Phytodolor is positive for improving pain and function in OA. It is likely to be positive for other interventions mentioned.

Osteoarthritis of the knees and hands Phytodolor

What is Phytodolor?
Proprietary medicine containing extracts of aspen (Populus tremula), ash (Fraxinus excelsior), and European goldenrod (Solidago virgaurea)
How does it work?
Analgesic, anti-inflammatory
How is it used?
Orally, three to four times daily, 20 to 30 drops
Are there any risks?
Allergic reactions, gastrointestinal complaints

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