Oral herbal medicines marketed in Brazil for the treatment of osteoarthritis: A systematic review and meta-analysis.

2017-09-05
Phytotherapy research : PTR 31(11)
- Mariana Del Grossi Moura
- Luciane Cruz Lopes
- Maique Weber Biavatti
- Sean Alexander Kennedy
- Maria Carolina de Oliveira E Silva
- Marcus Tolentino Silva
- Cristiane de Cássia Bergamaschi

PubMed: 28872719
DOI: 10.1002/ptr.5910

Study Design

Type: Meta-Analysis
Sample size: n = 741
Population: adults with osteoarthritis (OA)
Methods: systematic review of randomized clinical trials involving adults with OA treated by a herbal medicine or a control group

Herbal medications are commonly used to manage symptoms associated with osteoarthritis (OA). This systematic review evaluated the effectiveness and safety of oral medications used in Brazil for the treatment of OA. Randomized clinical trials involving adults with OA treated by a herbal medicine or a control group were eligible. The primary outcomes measured were pain, physical function, swelling, stiffness and quality of life; and the secondary outcomes were adverse events, activity limitations and treatment satisfaction. Sixteen studies were included (n = 1,741 patients) in the systematic review and nine studies in the meta-analysis, representing 6 of the 13 herbal medicines studied: Boswellia serrata (n = 2), Curcuma longa (n = 3), Harpagophytum procumbens (n = 1), Salix daphnoides (n = 3), Uncaria guianensis (n = 2) and Zingiber officinale (n = 5). B. serrata was more effective than both placebo and valdecoxib for improvement of pain and physical function. No difference was observed for H. procumbens, C. longa and U. guianensis compared with control. Z. officinale showed improvement of pain over placebo. The evidence was insufficient to support the effective and safe use of these herbal medicines, because the quality of evidence of studies was low. This study guides managers of the Brazilian public health system and prescribers in decision-making regarding the use of these herbal medicines for OA. Copyright © 2017 John Wiley & Sons, Ltd.

Research Insights

Boswellia→Improved Physical Function
B. serrata was more effective than both placebo and valdecoxib for improvement of pain and physical function.
Effect
Beneficial
Effect size
Moderate
Boswellia→Reduced Pain
The evidence was insufficient to support the effective and safe use of these herbal medicines, because the quality of evidence of studies was low.
Effect
Neutral
Effect size
Small
Cat's Claw→Reduced Pain
The evidence was insufficient to support the effective and safe use of these herbal medicines, because the quality of evidence of studies was low.
Effect
Neutral
Effect size
Small
Devil's Claw→Reduced Pain
The evidence was insufficient to support the effective and safe use of these herbal medicines, because the quality of evidence of studies was low.
Effect
Neutral
Effect size
Small
Ginger→Reduced Pain
The evidence was insufficient to support the effective and safe use of these herbal medicines, because the quality of evidence of studies was low.
Effect
Neutral
Effect size
Small
Turmeric→Reduced Pain
The evidence was insufficient to support the effective and safe use of these herbal medicines, because the quality of evidence of studies was low.
Effect
Neutral
Effect size
Small
Willow→Reduced Pain
The evidence was insufficient to support the effective and safe use of these herbal medicines, because the quality of evidence of studies was low.
Effect
Neutral
Effect size
Small

Adverse Events Reported

Ginger→adverse events
The evidence was insufficient to support the effective and safe use of these herbal medicines, because the quality of evidence of studies was low.
Finding
Reported
Turmeric→adverse events
The evidence was insufficient to support the effective and safe use of these herbal medicines, because the quality of evidence of studies was low.
Finding
Reported
Boswellia→adverse events
The evidence was insufficient to support the effective and safe use of these herbal medicines, because the quality of evidence of studies was low.
Finding
Reported
Devil's Claw→adverse events
The evidence was insufficient to support the effective and safe use of these herbal medicines, because the quality of evidence of studies was low.
Finding
Reported
Cat's Claw→adverse events
The evidence was insufficient to support the effective and safe use of these herbal medicines, because the quality of evidence of studies was low.
Finding
Reported
Willow→adverse events
The evidence was insufficient to support the effective and safe use of these herbal medicines, because the quality of evidence of studies was low.
Finding
Reported