Clinical evaluation of Vatari guggulu, Maharasnadi kwatha and Narayan taila in the management of osteoarthritis knee

Efficacy of topical analgesia Zanthoxylum rhetsa in the treatment of primary knee osteoarthritis: A randomized, double-blind, positive-controlled clinical trial

BACKGROUND

The essential oil from the pericarp (EOP) of Zanthoxylum rhetsa (Roxb.) DC. inhibits prostaglandin E2, which is related to knee osteoarthritis (OA). However, there is no clinical report on its efficacy.

OBJECTIVES

To assess the efficacy of EOP in Z. rhetsa (ZR) spray as a novel spray compared to diclofenac (DF) spray in elderly individuals diagnosed with primary knee OA.

METHODS

60 patients with unilateral knee pain over three months were randomly assigned to either the ZR spray (experimental) or DF spray (control) group. Each group applied the spray topically 3 times daily (2 mL each time) for 14 consecutive days. Follow-ups occurred after day 7 and after day 14. Primary outcomes included pain score measurements, with secondary outcomes focusing on WOMAC index scores.

RESULTS

The ZR and DF spray groups did not significantly differ at baseline. ZR spray is the first to demonstrate non-inferior efficacy compared to DF spray, with no significant difference in the mean change of pain scores at rest after 10 min (effect size <0.2) and following a 20-m walk test (effect size <0.5), including walking time (effect size <0.2), as well as in WOMAC index scores (effect size <0.3) from baseline to the first and second visits. Additionally, patients treated with ZR spray required less oral medication from the first visit.

CONCLUSIONS

Analgesia and improved knee functionality provided by ZR spray are suitable for combined treatment in elderly patients with co-morbidities or limited oral NSAID medication due to increased risk.

Evaluation of Yograj Guggulu, Ashwagandha Churna and Narayana Taila in management of Osteoarthritis Knee: A study in tribal dominant community

BACKGROUND

Osteoarthritis (OA) is the most prevalent joint disease and a major cause of joint impairment and physical debility, common in elderly, women and laborious workers. The available non-steroidal anti-inflammatory drugs (NSAID) are being prescribed to manage the condition; however, newly discovered alternatives are looked upon by the practitioners. Thus, the study was aimed to provide an effective and safer alternative through Ayurveda for the management of OA.

OBJECTIVE

To document the role of the selected Ayurveda formulations in the management of OA and to assess the tolerability of the formulations.

MATERIAL AND METHODS

It was an open-label, multicentric, single-arm, prospective, study conducted at 14 peripheral institutes of the Central Council for Research in Ayurvedic Sciences, New Delhi. 483 participants of any gender between the age 40 to 65 years diagnosed with OA knee as per the ACR diagnostic criteria (2012) and willing to provide consent were enrolled in the study. Oral administration of Ayurvedic formulations Yograj Guggulu, Ashwagandha Churna and the local application of Narayana Taila was given for 12 weeks and assessment was done by means of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Modified-CRD, Pune version Score, Visual Analogue Scale score and disease-specific symptoms on 28th, 56th, 84th and 112th day.

RESULTS

Significant change (P<0.001) was observed in WOMAC score, VAS score and cardinal symptoms of OA knee. No adverse events reported in the study and the study drugs were well tolerated by the participants.

CONCLUSION

The study substantiates that administration of Yograj guggulu, Ashwagandha Churna and Narayana Taila, is well acceptable and tolerable. The interventions effectively alleviate the cardinal symptoms of OA knee.

Efficacy of massage therapy in improving outcomes in knee osteoarthritis: A systematic review and meta-analysis

BACKGROUND

and purpose: Massage therapy is being used for knee osteoarthritis. However, level-1 evidence is lacking. This systematic review and meta-analysis aimed to synthesize evidence on the effect of massage therapy on knee osteoarthritis.

METHODS

PubMed, Embase, Ovid, Springer, and Google Scholar databases were searched up to May 8, 2021 for randomized controlled trials comparing massage with controls for knee osteoarthritis. Review manager was used for a random-effect meta-analysis. Risk of bias was assessed using the Cochrane collaboration risk assessment tool and certainty of evidence using Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

RESULTS

Twelve studies with 737 participants were included. After 1-4 weeks of therapy, there was a significant reduction in pain and stiffness scores in the massage group and after 6-8 weeks of therapy, there was a significant reduction in stiffness and functionality scores. There was no significant difference in outcomes with long-term therapy. A statistically significant reduction in stiffness scores was seen with aromatherapy massage. Aromatherapy massage was not superior to standard massage. The overall quality of evidence according to GRADE was low to moderate for standard massage therapy and very low for aromatherapy.

CONCLUSION

Massage therapy may lead to some improvement in pain, stiffness, and functionality scores in the short term but not in long term. Aromatherapy massage was not found to be any better than standard massage therapy. Current evidence is limited by methodological heterogeneity amongst trials and small sample size of the studies.