English

Abstract

Introduction Homoeopathy seems scientifically implausible and is the most controversial form of complementary and alternative medicine therapies. This review aims to summarise the treatment effects of homoeopathy in osteoarthritis. Materials and methods Relevant studies from 1980 to 2013 were identified by a comprehensive literature search in electronic databases, reference list of relevant papers and contacts with experts. Clinical trials comparing homoeopathic treatment strategy with controls (placebo or conventional therapies) were eligible. Information on patients, interventions and comparators, outcomes, study designs and results was extracted in a standardised manner, and quality was assessed using the Jadad scoring and Cochrane bias minimisation criteria. Trials providing sufficient data were summarised and tabulated systematically. Results A total of eight controlled clinical trials involving 1444 patients were included in the analysis. None of the studies used individualised homoeopathy, rather tried ‘complex homoeopathy’ and ‘combination formulae’. Methodological quality of the trials was variable. Conclusion Overall results of our review show that homoeopathic complexes have a clear advantage in the treatment of osteoarthritis. However, the evidence is not convincing to arrive at a definite conclusion because of methodological inconsistencies and insufficient trial reporting. Further replications are warranted, provided the trials are rigorous, systematic and, above all, individualised. Introduction Osteoarthritis (OA) is a heterogeneous group of degenerative joint disease of multi-factorial origin, characterised by defective integrity and progressive loss of articular cartilage, subchondral bone remodelling, joint space narrowing and bone spur formation, as well as synovial inflammation1. Pain and functional impairment are the key domains of the burden of suffering experienced by people with OA that is of primary concern, and that burden can be significant, and taken together they often exert a significant reduction in quality of life2,3. Since the last decade, recommendations for managing OA have focused persistently on relieving pain and stiffness and improving physical function as important goals of therapy4,5. However, conventional drug therapy for OA successfully relieves pain only, alongside producing adverse gastrointestinal and cardiovascular effects, especially with long-term use6. Rheumatologic problems are among the most common disease conditions encountered by CAM practitioners7,8. Many patients use CAM therapies including homoeopathy to prevent, control and manage the pain of rheumatologic conditions9,10. However, scientific research has so far not provided evidences solid enough to support the effectiveness of CAM as treatment options for rheumatologic conditions including OA and has remained ambiguous11. Reviews have remained contradictory in conclusions12–18. Few low-potency homoeopathic complexes in the randomised controlled trials seemed to posses significant effects in OA19, but the potential of individualised homoeopathy remained untested. Hence, based on small-to-moderate effect sizes for the wide range of symptomatic treatments, conventional medicine in individualised approach still remains the mainstay of treatment20,21. The aim of this systemic review was to identify, evaluate and summarise the findings of all relevant individual studies, thereby making the available evidence more accessible to decision makers. Materials and Methods Protocol and registration A specific protocol (03/2013-14/ CRU(H)/Slg/MTA/SS; version 1.1, 1 June 2013) was developed for conducting this systematic review. The protocol was registered vide CRD42013004970, 1 July 2013 with the PROSPERO International prospective register of systematic reviews, Centre for Reviews and Dissemination, the University of York, National Institute of Health Research, York, UK. PRISMA guidelines22 were followed in structuring this review. Eligibility criteria Trials were eligible for this review if they compared homoeopathy applied for treatment of OA with placebo or H om eo pa th y * Corresponding author Email: dr.mkoley@gmail.com 1 Clinical Research Unit (Homoeopathy), Siliguri, India (under Central Council for Research in Homoeopathy, Government of India) 2 Naturopathic Private Practitioner, Adelaide Hills, South Australia (registered with Australian traditional Medicine Society)