Nutraceuticals for Knee Osteoarthritis Pain Relief. Results from a Preliminary Randomised Clinical Trial

Evdokia Valsamidou,Theodoros D Mariolis-Sapsakos,Panagiotis Zoumpoulakis,Charalampia Amerikanou,Chara Tzavara,George Skarpas,Andriana C Kaliora

doi:10.3390/dietetics1010002

Abstract

Osteoarthritis is the most common inflammation-based joint disease. Polyphenols are plant secondary metabolites with established antioxidant and anti-inflammatory properties. Recognizing the need for holistic approaches in the management of knee osteoarthritis, we designed a two-arm, randomised clinical trial to evaluate the efficacy of a supplement rich in phenolic compounds in OA. Primary outcomes included changes in Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) pain subscale. Secondary outcome measures were the changes in WOMAC stiffness and functionality subscales. Patients were randomised (1:1) to receive a mixture of phenolic compounds and ascorbic acid (PhAA,) or ascorbic acid (AA). Μedical history, biochemical profile and anthropometric measurements were obtained. Eighty-six patients were screened and 25 were randomly allocated in a pilot study to receive a mixture of phenolic compounds and ascorbic acid (PhAA,) or ascorbic acid (AA) adjunct to stable medical treatment. The nutraceutical supplements were well tolerated and no adverse events were reported. VAS decreased in the PhAA group (p < 0.001). Additionally, WOMAC composite score decreased significantly only in the PhAA group (p < 0.05). The WOMAC subscale of pain decreased in both treatment groups (p = 0.001 for the PhAA group, p < 0.05 for the AA group). The decrease in the subscales of stiffness and physical function was not significant for either group. A possible improvement in the quality of life of these patients using nutraceutical supplements is apparent. Although preliminary, our positive results support the hypothesis that treatment with nutraceuticals may be effective for pain relief in osteoarthritis. ClinicalTrials.gov Identifier: NCT04783792.

Highlights

Osteoarthritis (OA) is the most common joint malady and one of the major debilitating diseases, with an increasing social burden for most countries owing to the aging of the population
Our trial provided new evidence for the efficacy of a phenols and ascorbic acid (PhAA) supplement on pain, the main debilitating symptom of OA
The changes in WOMAC dimensions and total score showed no difference; the pain Visual Analog Scale (VAS) that was applied as a subjective measure of pain intensity was significantly decreased in PhAA but remained unchanged in ascorbic acid (AA)

Summary

Introduction

Osteoarthritis (OA) is the most common joint malady and one of the major debilitating diseases, with an increasing social burden for most countries owing to the aging of the population. OA affects the whole joint and is strongly mediated by age-related cellular senescence [2], genetics, and injury/malalignment [3], and is possibly exacerbated and/or induced by obesity and metabolic syndrome [4,5]. A stress stimulus can trigger innate immunity [6] and is partly due to the unique physiology of the articular cartilage inflammation that is sustained [7] in a catabolic, oxidative environment [8]. The activation of detrimental molecular cascades creates feedback loops that further contribute to the degradation and ossification of the cartilage, the inflammation of the synovium, and the formation of osteophytes

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