The spice for joint inflammation: anti-inflammatory role of curcumin in treating osteoarthritis

Figures & data

Figure 1 Chemical structure of curcumin, demethoxycurcumin, and bisdemethoxycurcumin.

Table 1 Clinical studies on the antiosteoarthritic effects of curcumin

Reference (year)	Characteristic of the subjectsa	Treatment	WOMAC	Karnofsky	Walking test# (treadmill/time to walk)	Inflammation	Side effects	Management cost	Concurrent drug use	Other pain assessment	Oxidative stress	Other assessments
Appelboom et al^Citation45 (2014)	820 OA patients aged 64.2±12.4 years attended by 110 general physicians.	Curcuma extract: 739 took four capsules per day, and 81 took six capsules for at least 6 months.	NA	NA	NA	NA	Reduced	NA	Reduced	Reduced	NA	Improved flexibility
Badria et al^Citation32 (2002)	30 OA patients received the treatment, 15 received placebo, and 15 without OA.	500 mg of curcumin plus boswellia preparation per day for 3 months.	NA	NA	Reduced	Reduced	NA	NA	NA	Reduced	Reduced	Improved clinical signs
Belcaro et al^Citation42 (2010)	Patients with bilateral OA diagnosed with X-ray, suffering from mild-to-moderate pain. Mean age ± SD of treatment group =44.4±7.2 years; control group =45.3±8.6 years).	Treatment group (n=50) received 1,000 mg Meriva tablets equivalent to 200 mg curcuminoids per day plus best available treatment deemed suitable by the physicians. Control group (n=50) received the best available treatment only. Period: 3 months.	Improved	NA	Improved	Reduced	Reduced	Reduced	Reduced	NA	NA	NA
Belcaro et al^Citation41 (2010)	Patients with bilateral OA diagnosed with X-ray, suffering from mild-to-moderate pain. Mean age ± SD of treatment group =43.6±5.5 years; control group =44.2±6 years).	Treatment group (n=50) received 1,000 mg Meriva tablets equivalent to 200 mg curcuminoids per day plus best available treatment deemed suitable by the physicians. Control group (n=50) received the best available treatment only. Period: 8 months.	Improved	Improved	Improved	Reduced	Reduced	Reduced	Reduced	NA	NA	NA
Belcaro et al^Citation43 (2014)	Grade 1–2 OA patients (according to criteria of American College of Rheumatology) aged 56.4±5.2 years.	Meriva 500 mg (curcumin in lecithin) + glucosamine 500 mg daily (n=63) or chondroitin 400 mg + glucosamine 415 mg (n=61) daily. Period: 4 months.	Improved	Improved	Improved	NA	Reduced	Reduced	Reduced	NA	NA	NA
Henrotin et al^Citation46 (2014)	22 OA patients (M, 7; F, 15) aged 64.3±8.4 years. They could not use NSAIDS and analgesics during the study.	3 caps of bioptimized curcumin (Flexofytol) in the morning and 3 caps in the evening. Each cap contains 42 mg curcumin mixed with polysorbate for 3 months. No placebo group. Period: 84 days.	NA	NA	NA	Reduced	NA	NA	NA	NA	NA	Improved global disease assessment
Kertia et al^Citation40 (2012)	Mild-to-moderate OA patients aged 64.05±8.83 years diagnosed using American College of Rheumatology criteria.	30 mg of curcuminoid extracted from Curcuma domestica (n=34) or 25 mg of diclofenac sodium three times daily (n=39). Period: 4 weeks (n=39).	NA	NA	NA	Reduced	NA	NA	NA	NA	NA	NA
Kizhakkedath^Citation39 (2013)	OA patients (mean age for treatment group =49.70±8.20 years, mean age for control group =47.20±9.70 years).	Treatment (n=14): 350 mg Curcuma longa extract containing 70% curcumin, 17% demethoxycurcumin, 3.5% bis- demethoxycurcumin and 7.5% turmeric essential oils and 150 mg Boswellia serrata extract containing 75% boswellic acids and 10% AKBA per capsule. Two capsules a day. Control (n=14): celecoxib 100 mg twice daily. Period: 12 weeks.	NA	NA	Improved	NA	NA	NA	NA	Reduced	NA	Improved clinical signs
Kuptniratsaikul et al^Citation38 (2009)	Subjects (treatment group aged 61.4±8.7 years; ibuprofen group aged 60.0±8.4 years) with knee pain (pain score >5–10) and radiographic OA.	Treatment (n=45): C. domestica extract 2,000 mg/day. Standard treatment (n=46): Ibuprofen 800 mg/day. Period: 6 weeks.	NA	NA	Improved	NA	NS	NA	NA	NA	NA	Patients’ satisfaction was similar with standard
Kuptniratsaikul et al^Citation37 (2014)	185 patients (aged 60.3±6.8 years) were placed in the treatment group and 182 (aged 60.9±6.9 years) in the ibuprofen group. Recruitment performed in eight hospitals in Thailand.	Treatment (n=171): C. domestica extract 1,500 mg/day (containing 750 mg curcuminoids). Standard treatment (n=160): Ibuprofen 1,200 mg/day. Period: 4 weeks.	Improved	NA	NA	NA	NS	NA	NA	NA	NA	Patients’ global rating and satisfaction were similar between two groups
Madhu et al^Citation44 (2013)	Clinically or radiographically diagnosed OA patients with KL grade 2–3 or OA grade 2–3.	Treatment (n=29): C. longa extract 1,000 mg/day Standard treatment (n=28): glucosamine 1,500 mg/day. Combination group (n=24): C. longa extract and glucosamine. Placebo (n=29): cellulose 800 mg/day. Period: 42 days.	Improved	NA	NA	NA	Reduced	NA	Reduced	Reduced	NA	Improved clinical signs
Nakagawa et al^Citation33 (2014)	Patients aged 68.7±7.0 years with OA of KL grade 2 or 3.	Placebo (n=20) or Theracurmin (n=15) containing 180 mg curcurmin daily. Period: 8 weeks.	NA	NA	NA	NA	NA	NA	Reduced	Reduced	NA	Improved Japanese knee osteoarthritis measure score
Panahi et al^Citation35 (2014)	Subjects with degenerative primary OA, mild-moderate severity, mild-moderate pain with active movement. Mean age for treatment group was 57.32±8.78 years; placebo group 57.57±9.05 years. Subjects could use naproxen if necessary.	Treatment (n=19): curcuminoid capsules 1,500 mg/day containing 15 mg/day piperine to improve bioavailability. Placebo (n=21): inert starch. Period: 6 weeks.	Improved	NA	NA	Reduced	NA	NA	Reduced	Reduced (Lequesne’s scale)	NA	NA
Panahi et al^Citation34 (2016)	Subjects with degenerative primary OA, mild-moderate severity, mild- moderate pain with active movement. Mean age for treatment group was 57.32±8.78 years; placebo group 57.57±9.05 years.	Treatment (n=19): curcuminoid capsules 1,500 mg/day containing 15 mg/day piperine to improve bioavailability. Placebo (n=21): inert starch. Period: 6 weeks.	NA	NA	NA	NA	NA	NA	NA	NA	Reduced	NA
Rahimnia et al^Citation36 (2015)	Subjects with degenerative primary OA, mild-moderate severity, mild–moderate pain with active movement. Mean age for treatment group was 57.32±8.78 years; placebo group 57.57±9.05 years.	Treatment (n=19): curcuminoid capsules 1,500 mg/day containing 15 mg/day piperine to improve bioavailability. Placebo (n=21): inert starch. Period: 6 weeks.	NA	NA	NA	Reduced	NA	NA	NA	NA	NA	NA

Notes:

a Age data shown as mean ± SD.

# Treadmill test/Time needed to walk certain distance.

Abbreviations: AKBA, 3-O-acetyl-11-keto-boswellic acid; F, female; KL, Kellgren–Lawrence grading; M, male; NA, data not available; NSAIDS, nonsteroidal anti-inflammatory agents; OA, osteoarthritis; SD, standard deviation; WOMAC, The Western Ontario and McMaster Universities Arthritis Index; C. longa, Curcuma longa.

Figure 2 The action of curcumin on NF-κB pathway.

Abbreviations: IKK, IκB kinase; IL-1α, interleukin 1 alpha; NF-κB, nuclear factor kappa-light-chain-enhancer of activated B cells; TNFα, tumor necrosis factor alpha.

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