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Meta-Analysis
. 2014 May 22;2014(5):CD002947.
doi: 10.1002/14651858.CD002947.pub2.

Oral herbal therapies for treating osteoarthritis

Melainie Cameron  1 , Sigrun Chrubasik
Affiliations
Meta-Analysis

Oral herbal therapies for treating osteoarthritis

Melainie Cameron et al. Cochrane Database Syst Rev. .

Abstract

Background: Medicinal plant products are used orally for treating osteoarthritis. Although their mechanisms of action have not yet been elucidated in full detail, interactions with common inflammatory mediators provide a rationale for using them to treat osteoarthritic complaints.

Objectives: To update a previous Cochrane review to assess the benefits and harms of oral medicinal plant products in treating osteoarthritis.

Search methods: We searched electronic databases (CENTRAL, MEDLINE, EMBASE, AMED, CINAHL, ISI Web of Science, World Health Organization Clinical Trials Registry Platform) to 29 August 2013, unrestricted by language, and the reference lists from retrieved trials.

Selection criteria: Randomised controlled trials of orally consumed herbal interventions compared with placebo or active controls in people with osteoarthritis were included. Herbal interventions included any plant preparation but excluded homeopathy or aromatherapy products, or any preparation of synthetic origin.

Data collection and analysis: Two authors used standard methods for trial selection and data extraction, and assessed the quality of the body of evidence using the GRADE approach for major outcomes (pain, function, radiographic joint changes, quality of life, withdrawals due to adverse events, total adverse events, and serious adverse events).

Main results: Forty-nine randomised controlled studies (33 interventions, 5980 participants) were included. Seventeen studies of confirmatory design (sample and effect sizes pre-specified) were mostly at moderate risk of bias. The remaining 32 studies of exploratory design were at higher risk of bias. Due to differing interventions, meta-analyses were restricted to Boswellia serrata (monoherbal) and avocado-soyabean unsaponifiables (ASU) (two herb combination) products.Five studies of three different extracts from Boswellia serrata were included. High-quality evidence from two studies (85 participants) indicated that 90 days treatment with 100 mg of enriched Boswellia serrata extract improved symptoms compared to placebo. Mean pain was 40 points on a 0 to 100 point VAS scale (0 is no pain) with placebo, enriched Boswellia serrata reduced pain by a mean of 17 points (95% confidence interval (CI) 8 to 26); number needed to treat for an additional beneficial outcome (NNTB) 2; the 95% CIs did not exclude a clinically significant reduction of 15 points in pain. Physical function was 33 points on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) 0 to 100 point subscale (0 is no loss of function) with placebo, enriched Boswellia serrata improved function by 8 points (95% CI 2 to 14); NNTB 4. Assuming a minimal clinically important difference of 10 points, we cannot exclude a clinically important benefit in some people. Moderate-quality evidence (one study, 96 participants) indicated that adverse events were probably reduced with enriched Boswellia serrata (18/48 events versus 30/48 events with placebo; relative risk (RR) 0.60, 95% CI 0.39 to 0.92). Possible benefits of other Boswellia serrata extracts over placebo were confirmed in moderate-quality evidence from two studies (97 participants) of Boswellia serrata (enriched) 100 mg plus non-volatile oil, and low-quality evidence from small single studies of a 999 mg daily dose of Boswellia serrata extract and 250 mg daily dose of enrichedBoswellia serrata. It was uncertain if a 99 mg daily dose of Boswellia serrata offered benefits over valdecoxib due to the very low-quality evidence from a small single study. It was uncertain if there was an increased risk of adverse events or withdrawals with Boswellia serrata extract due to variable reporting of results across studies. The studies reported no serious adverse events. Quality of life and radiographic joint changes were not measured.Six studies examined the ASU product Piasclidine®. Moderate-quality evidence from four studies (651 participants) indicated that ASU 300 mg produced a small and clinically questionable improvement in symptoms, and probably no increased adverse events compared to placebo after three to 12 months treatment. Mean pain with placebo was 40.5 points on a VAS 0 to 100 scale (0 is no pain), ASU 300 mg reduced pain by a mean of 8.5 points (95% CI 1 to 16 points); NNTB 8. ASU 300 mg improved function (standardised mean difference (SMD) -0.42, 95% CI -0.73 to -0.11). Function was estimated as 47 mm (0 to 100 mm scale, where 0 is no loss of function) with placebo, ASU 300 mg improved function by a mean of 7 mm (95% CI 2 to 12 mm); NNTB 5 (3 to 19). There were no differences in adverse events (5 studies, 1050 participants) between ASU (53%) and placebo (51%) (RR 1.04, 95% CI 0.97 to 1.12); withdrawals due to adverse events (1 study, 398 participants) between ASU (17%) and placebo (15%) (RR 1.14, 95% CI 0.73 to 1.80); or serious adverse events (1 study, 398 participants) between ASU (40%) and placebo (33%) (RR 1.22, 95% CI 0.94 to 1.59). Radiographic joint changes, measured as change in joint space width (JSW) in two studies (453 participants) did not differ between ASU 300 mg treatment (-0.53 mm) and placebo (-0.65 mm); mean difference of -0.12 (95% CI -0.43 to 0.19). Moderate-quality evidence from a single study (156 participants) confirmed possible benefits of ASU 600 mg over placebo, with no increased adverse events. Low-quality evidence (1 study, 357 participants) indicated there may be no differences in symptoms or adverse events between ASU 300 mg and chondroitin sulphate. Quality of life was not measured.All other herbal interventions were investigated in single studies, limiting conclusions. No serious side effects related to any plant product were reported.

Authors' conclusions: Evidence for the proprietary ASU product Piasclidine® in the treatment of osteoarthritis symptoms seems moderate to high for short term use, but studies over a longer term and against an apparently active control are less convincing. Several other medicinal plant products, including extracts of Boswellia serrata, show trends of benefits that warrant further investigation in light of the fact that the risk of adverse events appear low.There is no evidence that Piasclidine® significantly improves joint structure, and limited evidence that it prevents joint space narrowing. Structural changes were not tested for with any other herbal intervention.Further investigations are required to determine optimum daily doses producing clinical benefits without adverse events.

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Conflict of interest statement

None known

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Boswellia serrata 999 mg versus placebo, Outcome 1 Pain (0 to 3).
1.2
1.2. Analysis
Comparison 1 Boswellia serrata 999 mg versus placebo, Outcome 2 Function: loss of function (0 to 3).
1.3
1.3. Analysis
Comparison 1 Boswellia serrata 999 mg versus placebo, Outcome 3 Participants (n) reported adverse effects.
2.1
2.1. Analysis
Comparison 2 Boswellia serrata (enriched) 100 mg versus placebo, Outcome 1 Pain VAS 0‐100 at 90 days.
2.2
2.2. Analysis
Comparison 2 Boswellia serrata (enriched) 100 mg versus placebo, Outcome 2 WOMAC‐VAS (Function).
2.3
2.3. Analysis
Comparison 2 Boswellia serrata (enriched) 100 mg versus placebo, Outcome 3 Adverse event episodes (n) reported.
3.1
3.1. Analysis
Comparison 3 Boswellia serrata (enriched) 250 mg versus placebo, Outcome 1 Pain VAS 0‐100 at 90 days.
3.2
3.2. Analysis
Comparison 3 Boswellia serrata (enriched) 250 mg versus placebo, Outcome 2 WOMAC‐VAS (Function).
3.3
3.3. Analysis
Comparison 3 Boswellia serrata (enriched) 250 mg versus placebo, Outcome 3 Adverse event episodes (n) reported.
4.1
4.1. Analysis
Comparison 4 Boswellia serrata (enriched) 100 mg plus non‐volatile oil versus placebo, Outcome 1 Pain VAS 0‐100.
4.2
4.2. Analysis
Comparison 4 Boswellia serrata (enriched) 100 mg plus non‐volatile oil versus placebo, Outcome 2 WOMAC‐VAS (Function).
4.3
4.3. Analysis
Comparison 4 Boswellia serrata (enriched) 100 mg plus non‐volatile oil versus placebo, Outcome 3 Participants (n) reported adverse events.
5.1
5.1. Analysis
Comparison 5 Boswellia serrata 999 mg versus valdecoxib, Outcome 1 WOMAC‐VAS (Pain).
5.2
5.2. Analysis
Comparison 5 Boswellia serrata 999 mg versus valdecoxib, Outcome 2 WOMAC‐VAS (Function).
5.3
5.3. Analysis
Comparison 5 Boswellia serrata 999 mg versus valdecoxib, Outcome 3 Participants (n) reported adverse events.
5.4
5.4. Analysis
Comparison 5 Boswellia serrata 999 mg versus valdecoxib, Outcome 4 Participants (n) withdrew due to adverse events.
6.1
6.1. Analysis
Comparison 6 Curcuma domestica versus ibuprofen, Outcome 1 Pain on walking NRS 0‐10.
6.2
6.2. Analysis
Comparison 6 Curcuma domestica versus ibuprofen, Outcome 2 Function: 100m walk time (seconds).
6.3
6.3. Analysis
Comparison 6 Curcuma domestica versus ibuprofen, Outcome 3 Participants (n) reported adverse events.
7.1
7.1. Analysis
Comparison 7 Derris scandens versus naproxen, Outcome 1 WOMAC‐VAS (Pain) change from baseline.
7.2
7.2. Analysis
Comparison 7 Derris scandens versus naproxen, Outcome 2 WOMAC‐VAS (Function) change from baseline.
7.3
7.3. Analysis
Comparison 7 Derris scandens versus naproxen, Outcome 3 Participants (n) reported adverse events..
8.1
8.1. Analysis
Comparison 8 Harpagophytum procumbens versus diacerhein, Outcome 1 Pain VAS 0‐100 change from baseline at 120 days.
8.2
8.2. Analysis
Comparison 8 Harpagophytum procumbens versus diacerhein, Outcome 2 Participants (n) reported adverse events.
9.1
9.1. Analysis
Comparison 9 Petiveria alliacea versus placebo, Outcome 1 Pain (scale unknown) with mvt change from baseline.
9.2
9.2. Analysis
Comparison 9 Petiveria alliacea versus placebo, Outcome 2 Participants (n) reported adverse events.
10.1
10.1. Analysis
Comparison 10 Pinus pinaster (Pycnogenol® 150 mg) versus placebo, Outcome 1 WOMAC‐VAS (Pain).
10.2
10.2. Analysis
Comparison 10 Pinus pinaster (Pycnogenol® 150 mg) versus placebo, Outcome 2 WOMAC‐VAS (Function).
10.3
10.3. Analysis
Comparison 10 Pinus pinaster (Pycnogenol® 150 mg) versus placebo, Outcome 3 Participants (n) reported adverse events.
11.1
11.1. Analysis
Comparison 11 Pinus pinaster (Pycnogenol® 100 mg) versus placebo, Outcome 1 WOMAC 0‐4 (Pain).
11.2
11.2. Analysis
Comparison 11 Pinus pinaster (Pycnogenol® 100 mg) versus placebo, Outcome 2 WOMAC 0‐4 (Function).
12.1
12.1. Analysis
Comparison 12 Ricinus officinale versus placebo, Outcome 1 Participants (n) reported adverse events.
13.1
13.1. Analysis
Comparison 13 Rosa canina versus placebo, Outcome 1 Relief of pain (0 to 4) at 3 months.
13.2
13.2. Analysis
Comparison 13 Rosa canina versus placebo, Outcome 2 WOMAC‐VAS (Pain).
13.3
13.3. Analysis
Comparison 13 Rosa canina versus placebo, Outcome 3 WOMAC‐VAS (Function).
13.4
13.4. Analysis
Comparison 13 Rosa canina versus placebo, Outcome 4 Participants (n) reported adverse events.
14.1
14.1. Analysis
Comparison 14 Salix purpurea x daphnoides versus placebo, Outcome 1 Pain VAS 0‐100 at 14 days.
14.2
14.2. Analysis
Comparison 14 Salix purpurea x daphnoides versus placebo, Outcome 2 Function VAS 0‐100 at 14 days.
14.3
14.3. Analysis
Comparison 14 Salix purpurea x daphnoides versus placebo, Outcome 3 Participants (n) reported adverse events.
15.1
15.1. Analysis
Comparison 15 Salix purpurea x daphnoides versus diclofenac, Outcome 1 WOMAC‐VAS (Pain).
15.2
15.2. Analysis
Comparison 15 Salix purpurea x daphnoides versus diclofenac, Outcome 2 WOMAC‐VAS (Function).
15.3
15.3. Analysis
Comparison 15 Salix purpurea x daphnoides versus diclofenac, Outcome 3 Participants (n) reported adverse events.
16.1
16.1. Analysis
Comparison 16 Uncaria guianensis versus placebo, Outcome 1 Pain VAS 0‐100 (night).
16.2
16.2. Analysis
Comparison 16 Uncaria guianensis versus placebo, Outcome 2 Participants (n) reported adverse events.
17.1
17.1. Analysis
Comparison 17 Zingiber officinale (Zintona EC) versus placebo, Outcome 1 Pain VAS 0‐100 (movement).
17.2
17.2. Analysis
Comparison 17 Zingiber officinale (Zintona EC) versus placebo, Outcome 2 Function (handicap) VAS 0‐100.
17.3
17.3. Analysis
Comparison 17 Zingiber officinale (Zintona EC) versus placebo, Outcome 3 Participants (n) reported adverse events.
18.1
18.1. Analysis
Comparison 18 Boswellia carteri + Curcuma longa versus placebo, Outcome 1 Function: pain free walking time (minutes).
19.1
19.1. Analysis
Comparison 19 Persea gratissma + Glycine max (ASU 300 mg) versus placebo, Outcome 1 Pain VAS 0‐100.
19.2
19.2. Analysis
Comparison 19 Persea gratissma + Glycine max (ASU 300 mg) versus placebo, Outcome 2 Pain VAS 0‐100 change from baseline at 36 months.
19.3
19.3. Analysis
Comparison 19 Persea gratissma + Glycine max (ASU 300 mg) versus placebo, Outcome 3 Pain VAS 0‐100 grouped by joint.
19.4
19.4. Analysis
Comparison 19 Persea gratissma + Glycine max (ASU 300 mg) versus placebo, Outcome 4 Function: disability VAS 0‐100.
19.5
19.5. Analysis
Comparison 19 Persea gratissma + Glycine max (ASU 300 mg) versus placebo, Outcome 5 WOMAC‐VAS (Function) change from baseline at 36 months.
19.6
19.6. Analysis
Comparison 19 Persea gratissma + Glycine max (ASU 300 mg) versus placebo, Outcome 6 Lequesne algofunctional index.
19.7
19.7. Analysis
Comparison 19 Persea gratissma + Glycine max (ASU 300 mg) versus placebo, Outcome 7 Function (various tools).
19.8
19.8. Analysis
Comparison 19 Persea gratissma + Glycine max (ASU 300 mg) versus placebo, Outcome 8 Participants (n) reported adverse events.
19.9
19.9. Analysis
Comparison 19 Persea gratissma + Glycine max (ASU 300 mg) versus placebo, Outcome 9 Participants (n) withdrew due to adverse events.
19.10
19.10. Analysis
Comparison 19 Persea gratissma + Glycine max (ASU 300 mg) versus placebo, Outcome 10 Particpants (n) reported serious adverse events.
19.11
19.11. Analysis
Comparison 19 Persea gratissma + Glycine max (ASU 300 mg) versus placebo, Outcome 11 JSW change from baseline.
20.1
20.1. Analysis
Comparison 20 Persea gratissma + Glycine max (ASU 600 mg) versus placebo, Outcome 1 Pain VAS 0‐100.
20.2
20.2. Analysis
Comparison 20 Persea gratissma + Glycine max (ASU 600 mg) versus placebo, Outcome 2 Lequesne algofunctional index.
20.3
20.3. Analysis
Comparison 20 Persea gratissma + Glycine max (ASU 600 mg) versus placebo, Outcome 3 Participants (n) reported adverse events.
21.1
21.1. Analysis
Comparison 21 Persea gratissma + Glycine max (ASU 300 mg) versus chondroitin sulphate, Outcome 1 WOMAC‐VAS (Pain).
21.2
21.2. Analysis
Comparison 21 Persea gratissma + Glycine max (ASU 300 mg) versus chondroitin sulphate, Outcome 2 WOMAC‐VAS (Function).
21.3
21.3. Analysis
Comparison 21 Persea gratissma + Glycine max (ASU 300 mg) versus chondroitin sulphate, Outcome 3 Participants (n) reported adverse events.
21.4
21.4. Analysis
Comparison 21 Persea gratissma + Glycine max (ASU 300 mg) versus chondroitin sulphate, Outcome 4 Paricipants (n) reported serious adverse events.
22.1
22.1. Analysis
Comparison 22 Phellondendron amurense + Citrus sinensis (NP 06‐1) versus placebo, Outcome 1 Lequesne algofunctional index.
23.1
23.1. Analysis
Comparison 23 Uncaria guianensis + Lepidium meyenii versus glucosamine sulphate, Outcome 1 Participants (n) reported adverse events.
24.1
24.1. Analysis
Comparison 24 Zingiber officinale + Alpinia galanga (EV.EXT77) versus placebo, Outcome 1 Pain immediately after walking 50 feet VAS 0‐100.
24.2
24.2. Analysis
Comparison 24 Zingiber officinale + Alpinia galanga (EV.EXT77) versus placebo, Outcome 2 WOMAC‐VAS (Function).
24.3
24.3. Analysis
Comparison 24 Zingiber officinale + Alpinia galanga (EV.EXT77) versus placebo, Outcome 3 Participants (n) reported adverse events.
25.1
25.1. Analysis
Comparison 25 SKI306X versus placebo, Outcome 1 Pain VAS 0‐100 change from baseline.
25.2
25.2. Analysis
Comparison 25 SKI306X versus placebo, Outcome 2 Lequesne algofunctional index change from baseline.
25.3
25.3. Analysis
Comparison 25 SKI306X versus placebo, Outcome 3 Participants (n) reported adverse events.
26.1
26.1. Analysis
Comparison 26 SKI306X (600 mg) versus diclofenac, Outcome 1 Pain VAS 0‐100 change from baseline.
26.2
26.2. Analysis
Comparison 26 SKI306X (600 mg) versus diclofenac, Outcome 2 Lequesne algofunctional index change from baseline.
26.3
26.3. Analysis
Comparison 26 SKI306X (600 mg) versus diclofenac, Outcome 3 Participants (n) reported adverse events.
27.1
27.1. Analysis
Comparison 27 Phytodolor N versus placebo, Outcome 1 Enduring pain (0 to 3).
27.2
27.2. Analysis
Comparison 27 Phytodolor N versus placebo, Outcome 2 Function: mobility limitations (0 to 3).
27.3
27.3. Analysis
Comparison 27 Phytodolor N versus placebo, Outcome 3 Participants (n) reported adverse events.
28.1
28.1. Analysis
Comparison 28 Reumalex versus placebo, Outcome 1 AIMS2 arthritis pain score change from baseline.
28.2
28.2. Analysis
Comparison 28 Reumalex versus placebo, Outcome 2 Participants (n) reported adverse events.
29.1
29.1. Analysis
Comparison 29 Chinese DJW versus diclofenac, Outcome 1 Pain VAS 0‐100 (total).
29.2
29.2. Analysis
Comparison 29 Chinese DJW versus diclofenac, Outcome 2 Lequesne algofunctional index.
29.3
29.3. Analysis
Comparison 29 Chinese DJW versus diclofenac, Outcome 3 Participants (n) reported adverse events.
30.1
30.1. Analysis
Comparison 30 Chinese BNHS versus Chinese active control, Outcome 1 Pain VAS 0‐100 (walking).
30.2
30.2. Analysis
Comparison 30 Chinese BNHS versus Chinese active control, Outcome 2 WOMAC‐VAS (Function).
30.3
30.3. Analysis
Comparison 30 Chinese BNHS versus Chinese active control, Outcome 3 Participants (n) reported adverse events.
31.1
31.1. Analysis
Comparison 31 Chinese BNHS versus glucosamine sulphate, Outcome 1 Pain VAS 0‐100 (walking).
31.2
31.2. Analysis
Comparison 31 Chinese BNHS versus glucosamine sulphate, Outcome 2 WOMAC‐VAS (Function).
31.3
31.3. Analysis
Comparison 31 Chinese BNHS versus glucosamine sulphate, Outcome 3 Participants (n) reported adverse events.
32.1
32.1. Analysis
Comparison 32 Ayurvedic A to E versus placebo, Outcome 1 Adverse event episodes (n) reported.
33.1
33.1. Analysis
Comparison 33 Ayurvedic Antarth versus placebo, Outcome 1 Pain VAS 0‐100.
34.1
34.1. Analysis
Comparison 34 Ayurvedic RA‐II versus placebo, Outcome 1 Pain VAS 0‐100.
34.2
34.2. Analysis
Comparison 34 Ayurvedic RA‐II versus placebo, Outcome 2 WOMAC 0‐4 (Function).
34.3
34.3. Analysis
Comparison 34 Ayurvedic RA‐II versus placebo, Outcome 3 Participants (n) reported adverse events.
35.1
35.1. Analysis
Comparison 35 Ayurvedic SGC versus glucosamine sulphate, Outcome 1 Pain VAS 0‐100 change from baseline.
35.2
35.2. Analysis
Comparison 35 Ayurvedic SGC versus glucosamine sulphate, Outcome 2 WOMAC 0‐4 (Function) change from baseline.
35.3
35.3. Analysis
Comparison 35 Ayurvedic SGC versus glucosamine sulphate, Outcome 3 Participants (n) reported adverse events.
36.1
36.1. Analysis
Comparison 36 Ayurvedic SGC versus celecoxib, Outcome 1 Pain VAS 0‐100 change from baseline.
36.2
36.2. Analysis
Comparison 36 Ayurvedic SGC versus celecoxib, Outcome 2 WOMAC 0‐4 (Function) change from baseline.
36.3
36.3. Analysis
Comparison 36 Ayurvedic SGC versus celecoxib, Outcome 3 Participants (n) reported adverse events.
37.1
37.1. Analysis
Comparison 37 Ayurvedic SGCG versus glucosamine sulphate, Outcome 1 Pain VAS 0‐100 change from baseline.
37.2
37.2. Analysis
Comparison 37 Ayurvedic SGCG versus glucosamine sulphate, Outcome 2 WOMAC 0‐4 (Function) change from baseline.
37.3
37.3. Analysis
Comparison 37 Ayurvedic SGCG versus glucosamine sulphate, Outcome 3 Participants (n) reported adverse events.
38.1
38.1. Analysis
Comparison 38 Ayurvedic SGCG versus celecoxib, Outcome 1 Pain VAS 0‐100 change from baseline.
38.2
38.2. Analysis
Comparison 38 Ayurvedic SGCG versus celecoxib, Outcome 2 WOMAC 0‐4 (Function) change from baseline.
38.3
38.3. Analysis
Comparison 38 Ayurvedic SGCG versus celecoxib, Outcome 3 Participants (n) reported adverse events.
39.1
39.1. Analysis
Comparison 39 Japanese Boiogito + loxoprofen versus loxoprofen, Outcome 1 Pain: Knee Society Rating System 0‐100 (knee).
39.2
39.2. Analysis
Comparison 39 Japanese Boiogito + loxoprofen versus loxoprofen, Outcome 2 Function: Knee Society Rating System 0‐50 (stairs).
39.3
39.3. Analysis
Comparison 39 Japanese Boiogito + loxoprofen versus loxoprofen, Outcome 3 Participants (n) reported adverse events.
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Update of

References

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    1. Ferraz MB, Pereira RB, Iwata NM, Atra E. Tipi. A popular analgesic tea: A double‐blind cross‐over trial in osteoarthritis (letter). Clinical and Experimental Rheumatology 1991;9:205‐12. - PubMed
Frerick 2001 {published data only}
    1. Frerick H, Biller A, Schmidt U. A treatment schedule for coxarthrosis: A double‐blind study with Devil's claw [Stufenschema bei coxarthrose: Doppelblindstudie mit Teufelskralle]. Der Kassenarzt 2001;5:34‐41.
Gupta 2011 {published data only}
    1. Gupta AK, Acharya K, Sancheti PS, Joshi RS. A double‐blind, randomized, multicentric, placebo‐controlled clinical trial of Antarth, a phytomedicine, in the treatment of osteoarthritis. Indian Journal of Pharmacology 2011;43:69‐72. [DOI: 10.4103/0253-7613.75674] - DOI - PMC - PubMed
Huber 1991 {published data only (unpublished sought but not used)}
    1. Huber B. Therapy of degenerative rheumatic diseases: Use of analgesic medication with Phytodolor N [Therapie degenerativer rheumatischer erkrankungen: Bedarf an zusatzlicher analgetischer medikation unter Phytodolor N]. Fortschritte der Medizin 1991;109:248‐50. - PubMed
Jung 2001 {published data only}
    1. Jung YB, Roh KJ, Jung JA, Jung K, Yoo H, Cho YB, et al. Effect of SKI306X, a new herbal anti‐arthritic agent, in patients with osteoarthritis if the knee: A double‐blind placebo controlled study. American Journal of Chinese Medicine 2001;29(3‐4):485‐91. - PubMed
Jung 2004 {published data only}
    1. Jung YB, Seong SC, Lee MC, Shin YU, Kim DH, Kim JM, et al. A four‐week randomized, double‐blind trial of the efficacy and safety of SKI306X: A herbal anti‐arthritic agent versus diclofenac in osteoarthritis of the knee. American Journal of Chinese Medicine 2004;32(2):291‐301. - PubMed
Kimmatkar 2003 {published data only}
    1. Kimmatkar N, Thawani V, Hingorani L, Khiyani R. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee ‐ A randomized double blind placebo controlled trial. Phytomedicine 2003;10:3‐7. - PubMed
Kuptniratsaikul 2009 {published data only}
    1. Kuptniratsaikul V, Thanakhumtorn S, et al. Efficacy and safety of Curcumica domestica extracts in patients with knee osteoarthritis. Journal of Alternative and Complementary Medicine 2009;15:891‐7. [DOI: 10.1089/acm.2008.0186] - DOI - PubMed
Kuptniratsaikul 2011 {published data only}
    1. Kuptniratsaikul V, Pinthong T, Bunjob M, Thanakhumtorn S, Chinswangwatanakul P, Thamlikitkul V. Efficacy and safety of Derris scandens benth extracts in patients with knee osteoarthritis. Journal of Alternative and Complementary Medicine 2011;17:147‐53. [DOI: 10.1089/acm.2010.0213] - DOI - PubMed
Leblan 2000 {published data only}
    1. Leblan D, Chantre P, Fournié B. Harpogophytum procumbens in the treatment of knee and hip osteoarthritis: Four‐month results of a prospective, multicenter, double‐blind trial versus diacerhein [L'harpagophyton dans le traitement de la gonarthrose et de la coxarthrose. Résultats à quatre mois d'une étude prospective multicentrique, contrôlée en double aveugle, versus diacerhéine]. Revue du Rhumatisme [Éd Fr Joint Bone Spine] 2000;67(5):462‐7. - PubMed
Lequesne 2002 {published data only}
    1. Lequesne M, Maheu E, Cadet C, Dreiser RL. Structural effect of avocado/soyabean unsaponifiables on joint space loss in osteoarthritis of the hip. Arthritis Care & Research 2002;47:50‐8. - PubMed
Maheu 1998 {published data only}
    1. Maheu E, Mazieres B, Valat J‐P, Loyau G, Loet X, Bourgeois P, et al. Symptomatic efficacy of avocado/soybean unsaponifiables in the treatment of osteoarthritis of the knee and hip. Arthritis & Rheumatism 1998;41(1):81‐91. - PubMed
Maheu 2013 {published data only}
    1. Maheu E, Cadet C, Marty M, Moyse D, Kerloch I, Coste P, Dougados M, Mazières B, Spector TD, Halhol H, Grouin JM, Lequesne M. Randomised, controlled trial of avocado‐soybean unsaponifiable (Piascledine) effect on structure modification in hip osteoarthritis: the ERADIAS study. Annals of the Rheumatic Diseases 2013;Jan 23:[Epub ahead of print]. [DOI: 10.1136/annrheumdis-2012-202485] - DOI - PMC - PubMed
Majima 2012 {published data only}
    1. Majima T, Inoue M, Kasahara Y, Onodera T, Takahashi D, Minami A. Effect of the Japanese herbal medicine, Boiogito,on the osteoarthritis of the knee with jointeffusion. Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2012;4:3. [DOI: 10.1186/1758-2555-4-3] - DOI - PMC - PubMed
Medhi 2009 {published data only}
    1. Medhi B, Kishore K, Singh U, Seth SD. Comparative clinical trial of castor oil and diclofenac sodium in patients with osteoarthritis. Phytotherapy Research 2009;23:1469‐73. [DOI: 10.1002/ptr.2804] - DOI - PubMed
Mehta 2007 {published data only}
    1. Mehta K, Gala J, Bhasale S, Naik S, Modak M, Thakur H, et al. Comparison of glucosamine sulfate and a polyherbal supplement for the relief of osteoarthritis of the knee: a randomized controlled trial [ISRCTN25438351]. BMC Complementary and Alternative Medicine 2007;7:34. [DOI: 10.1186/1472-6882-7-34] - DOI - PMC - PubMed
Mills 1996 {published data only}
    1. Mills SY, Jacoby RK, Chacksfield M, Willoughby M. Effect of a proprietary herbal medicine on the relief of chronic arthritic pain: A double‐blind study. British Journal of Rheumatology 1996;35:874‐8. - PubMed
Oben 2009 {published data only}
    1. Oben J, Enonchong E, Kothari S, Chambliss W, Garrison R, Dolnick D. Phellodendron and citrus extracts benefit joint health in osteoarthritis patients: a pilot, double‐blind, placebo‐controlled study. Nutrition Journal 2009;8:38. [DOI: 10.1186/1475-2891-8-38] - DOI - PMC - PubMed
Pavelka 2010 {published data only}
    1. Pavelka K, Coste P, Géher P, Krejci G. Efficacy and safety of piascledine 300 versus chondroitin sulfate in a 6 months treatment plus 2 months observation in patients with osteoarthritis of the knee. Clinical Rheumatology 2010;29:659‐70. [DOI: 10.1007/s10067-010-1384-8] - DOI - PubMed
Piscoya 2001 {published data only}
    1. Piscoya J, Rodriguez Z, Bustamante SA, Okuhama NN, Miller MJS, Sandoval M. Efficacy and safety of freeze‐dried cat's claw in osteoarthritis of the knee: Mechanism of action of the species Uncaria guianensis. Inflammation Research 2001;50:442‐8. - PubMed
Rein 2004a {published data only}
    1. Rein E, Kharazami A, Winther K. A herbal remedy, Hyben Vital (stand. powder of a subspecies of Rosa canina fruits), reduces pain and improves general wellbeing in patients with osteoarthritis ‐ a double‐blind, placebo‐controlled, randomised trial. Phytomedicine 2004;11:383‐91. - PubMed
Schadler 1988 {published data only (unpublished sought but not used)}
    1. Schadler W. Phytodolor for the treatment of activated arthrosis. Rheuma 1988;8:288‐90.
Schmelz 1997 {published data only}
    1. Schmelz H, Hammerle HD, Springorum HW. Analgesic effect of a Devil's claw extract in various chronic degenerative joint diseases [Analgetische Wirkung eines Teufelskrallenwurzel‐Extraktes bei verschiedenen chronisch‐degenerativen Gelenkerkrankungen]. In: Chrubasik S, Wink M editor(s). Rheumatherapie mit Phytopharmaka. Stuttgart: Hippokrates Verlag, 1997:86‐9.
Schmid 2000 {published data only}
    1. Schmid B, Ludtke R, Selbmann HK, Kotter I, Tschirdewahn B, Schaffner W, et al. Efficacy and tolerability of a standardized willow bark extract in patients with osteoarthritis: Randomized placebo‐controlled double blind clinical trial [Wirksamkeit und vertraglichkeit eines standardisierten weidenrindenextraktes bei arthose‐patienten: Randomisierte, placebo‐kontrollierte doppelblindstudie]. Zeitschrift für Rheumatologie 2000;59:1‐7. - PubMed
Sengupta 2008 {published data only}
    1. Sengupta K, Alluri KV, Satish AR, Mishra S, Golakoti T, Sarma KVS, et al. A double blind, randomized, placebo controlled study of the efficacy and safety of 5‐Loxin® for treatment of osteoarthritis of the knee. Arthritis Research & Therapy 2008;10:R85. [DOI: 10.1186/ar2461] - DOI - PMC - PubMed
Sengupta 2010 {published data only}
    1. Sengupta K, Krishnaraju AV, Vishal AA, Mishra A, Trimurtulu G, Sarma KVS, et al. Comparative efficacy and tolerability of 5‐Loxin® and Aflapin® against osteoarthritis of the knee: A double blind, randomized, placebo controlled clinical study. International Journal of Medical Sciences 2010;7(6):366‐77. - PMC - PubMed
Sontakke 2007 {published data only}
    1. Sontakke S, Thawani V, Pimpalkhute S, Kambra P, Babhulkar S, Hingorani L. Open, randomized, controlled trial of Boswellia serrata extract as compared to valdecoxib in osteoarthritis of knee. Indian Journal of Pharmacology 2007;39:27‐9.
Teekachunhatean 2004 {published data only}
    1. Teekachunhatean S, Kunanusom P, Rojanasthien N, Sananpanich K, Pojchamarnwitputh S, Lheiochaiphunt S, Pruksakorn S. Chinese herbal recipe versus diclofenac in symptomatic treatment of osteoarthritis of the knee: A randomized controlled trial. BMC Comlementary and Alternative Medicine 2004;4:19. [DOI: 10.1186/1472‐6882‐4‐19] - PMC - PubMed
Vishal 2011 {published data only}
    1. Vishal AA, Mishra A, Raychaudhuri SP. A double blind, randomized, placebo controlled clinical study evaluates the early efficacy of Aflapin® in subjects with osteoarthritis of the knee. International Journal of Medical Sciences 2011;8(7):615‐22. - PMC - PubMed
Warholm 2003 {published data only}
    1. Warholm O, Skaar S, Hedman E, Molmen HM, Eik L. The effects of a standardized herbal remedy made from a subtype of Rosa canina in patients with osteoarthritis: A double‐blind, randomized, placebo‐controlled clinical trial. Current Therapeutic Research 2003;64(1):21‐31. - PMC - PubMed
Wigler 2003 {published data only}
    1. Wigler I, Grotto I, Caspi D, Yaron M. The effects of Zintona EC (a ginger extract) on symptomatic gonarthritis. Osteoarthritis and Cartilage 2003;11:783‐9. - PubMed
Winther 2005 {published data only}
    1. Winther K, Apel K, Thamsborg G. A powder made from seeds and shells of a rose‐hip subspecies (Rosa canina) reduces symptoms of knee and hip osteoarthritis: A randomized, double‐blind, placebo‐controlled clinical trial. Scandinavian Journal of Rheumatology 2005;34:302‐8. - PubMed

References to studies excluded from this review

Anonymous 1993 {published data only}
    1. Anonymous. The garlic treatment: detoxifying with garlic. [Die knoblauchkur: entschlackung durch knoblauch]. Natur & Heilen 1993;70(10):520‐1.
Belcaro 2010 {published data only}
    1. Belcaro G, Cesarone MR, Dugall M, Pellegrini L, Ledda A, Grossi MG, et al. Efficacy and safety of Meriva®, a curcumin‐phosphatidylcholine complex, during extended administration in osteoarthritis patients. Alternative Medicine Review 2010;15(4):337‐44. - PubMed
Biswas 1997 {published data only}
    1. Biswas NR, Biswas A, Pandey RM. EASE ‐ a herbal preparation for rheumatoid arthritis, non specific arthritis and osteoarthritis. FACT: Focus on Alternative and Complementary Therapies. Proceedings of 4th Annual Symposium on Complementary Health Care. Exeter (UK), 1997; Vol. 2, issue 4:186‐7.
Biswas 1998 {published data only}
    1. Biswas NR, Biswas K, Pandey M, Pandy RM. Treatment of osteoarthritis, rheumatoid arthritis and non‐specific arthritis with a herbal drug: a double‐blind, active drug controlled parallel study. JK Practitioner 1998;5(2):129‐32.
Brien 2006 {published data only}
    1. Brien S, Lewith GT, McGregor G. Devil's Claw (Harpagophytum procumbens) as a treatment for osteoarthritis: A review of safety and efficacy. The Journal of Alternative and Complementary Medicine 2006;12:981‐93. - PubMed
Chantre 2000 {published data only}
    1. Chantre P, Cappelaere A, Leblan D, Guedon D, Vandermander J, Fournie B. Efficacy and tolerance of Harpagophytum procumbens versus diacerhein in treatment of osteoarthritis. Phytomedicine 2000;7(3):177‐83. - PubMed
Chrubasik 1998 {published data only}
    1. Chrubasik S, Wink M. Traditional herbal therapy for the treatment of rheumatic pain: Preparations from Devil's claw and stinging nettle. Pain Digest 1998;8:94‐101.
Dharmananda 1985 {published data only}
    1. Dharmananda S. Chinese herbal therapies for chronic joint pain. The American Chiropractor 1985;January:38‐42.
Du 2006 {published data only}
    1. Du T‐X, Han X‐F, Gao S‐T. Effect of hanshibi granule on rheumatism due to blockage of cold and damp. Chinese Journal of Clinical Rehabilitation 2006;10:148‐50.
Falch 1997 {published data only}
    1. Falch VB. Ginger ‐ not only a spice. Review of its effect and efficacy profile [Ingwer ‐ nicht nur ein Gewurz. Untersuchungen zu Wirkungen und Wirksamkeit]. Deutsche Apotheker Zeitung 1997;137:47‐52, 55‐60.
Fang 2008 {published data only}
    1. Fang R, Meng Q‐C, Deng Y‐J, Song G, Bai Y‐P. Effects of Bu Shen Tong Luo decoction on matrix metalloproteinase‐1, matrix metalloproteinase‐3, tissue inhibitor of matrix metalloprotease‐1 and interleukin‐1beta content in the synovial fluid and serum of patients with knee osteoarthritis. Journal of Clinical Rehabilitative Tissue Engineering Research 2008;12:5581‐5.
Gendo 1997 {published data only}
    1. Gendo U. Chronische Polyarthritis in view of traditional Chinese medicine (TCM) [Die chronische Polyarthritis aus der Sicht der traditionellen Chinesischen Medizin (TCM)]. Naturamed 1997;12(10):37‐40.
Grahame 1981 {published data only}
    1. Grahame R, Robinson BV. Devil's claw (Harpagophytum procumbens): Pharmacological and clinical studies. Annals of the Rheumatic Diseases 1981;40:632. - PMC - PubMed
Guyader 1984 {published data only}
    1. Guyader M. Herbal anti‐rheumatic therapies: A longitudinal, pharmacological and clinical study of the treatment of 50 osteoarthritic patients with Harpagophytum procumbens (Devil's Claw) following hospital intervention [Les plantes anti‐rhumatismales. Etude historique et pharmacologique, et etude clinique du nebulisat d'harpagophytum procumbens D.C. chez 50 patients arthrosiques suivis en service hospitalier]. Thesis for the award of the degree Doctor of Medicine. 1984.
Hamblin 2008 {published data only}
    1. Hamblin L, Laird A, Parkes E, Walker AF. Improved arthritic knee health in a pilot RCT of phytotherapy. The Journal of the Royal Society for the Promotion of Health 2008;128(5):255‐62. [CENTRAL: 00651201] - PubMed
Jacquet 2009 {published data only}
    1. Jacquet A, Girodet P, Pariente A, Forest K, Mallet, Moore N. Phytalgic, a food supplement, vs placebo in patients with osteoarthritis of the knee or hip: a randomised double‐blind placebo‐controlled clinical trial. Arthritis Research & Therapy 2009;11:R192. [DOI: 10.1186/ar2891] - DOI - PMC - PubMed
Kagore 2011 {published data only}
    1. Kogure T, Tatsumi T, Shigeta T, Fujinaga H, Sato T, Niizawa A. Effect of Kampo medicine on pain and range of motion of osteoarthritis of the hip accompanied by acetabular dysplasia: Case report and literature review. Integrative Medicine Highlights 2011;6:13‐7. [DOI: 10.4137/IMI.S7884] - DOI - PMC - PubMed
Kielczynski 1997 {published data only}
    1. Kielczynski W. Osteoarthritis ‐ clinical outcomes after uniform, long‐term herbal treatment. The European Journal of Herbal Medicine 1997;3(2):29‐35.
Kulkarni 1991 {published data only}
    1. Kulkarni RR, Patki PS, Jog VP, Gandage SG, Patwardhan B. Treatment of osteoarthritis with a herbomineral formulation: A double‐blind, placebo‐controlled, cross‐over study. Journal of Ethnopharmacology 1991;33:91‐5. - PubMed
Lechner 2011 {published data only}
    1. Lechner M, Steirer I, Brinkhaus B, Chen Y, Krist‐Dungl C, Koschier A, et al. Efficacy of individualized Chinese herbal medication in osteoarthrosis of hip and knee: a double‐blind, randomized‐controlled clinical study. Journal of Alternative and Complementary Medicine 2011;17(6):539‐47. - PubMed
Levy 2009 {published data only}
    1. Levy RM, Saikovsky R, Shmidt E, Khokhlov A, Burnett BP. Flavocoxid is as effective as naproxen for managing the signs and symptoms of osteoarthritis of the knee in humans: a short‐term randomized, double‐blind pilot study. Nutrition Research 2009;29:298‐304. - PubMed
Linsheng 1997 {published data only}
    1. Linsheng W. Treatment of bony arthritis with herbal medicine and by massotherapy ‐ analysis of 121 cases. Journal of Traditional Chinese Medicine 1997;17(1):32‐6. - PubMed
Loew 1996 {published data only}
    1. Loew D, Schuster O, Mollerfeld J. Stability and biopharmaceutical quality. A postulate for bioavailability and effectiveness of Harpagophytum procumbens [Stabilitat und biopharmazeutische Qualitat. Voraussetzung fur Bioverfugbarkeit und Wirksamkeit von Harpagophytum procumbens]. In: Loew D, Rietcrock N editor(s). Phytopharmaka II. Forschung und klinische Anwendung. Darmstadt: Steinkopf‐Verlag, 1996:83‐93.
Long 2001 {published data only}
    1. Long L, Soeken K, Ernst E. Herbal medicines for the treatment of osteoarthritis: A systematic review. Rheumatology 2001;40:779‐93. - PubMed
Lung 2004 {published data only}
    1. Lung YB, Seong SC, Lee MC, Shin YU, Kim DH, Kim JM, et al. A four‐week, randomized, double‐blind trial of the efficacy and safety of SKI306X: a herbal anti‐arthritic agent versus diclofenac in osteoarthritis of the knee. The American Journal of Chinese Medicine 2004;32:291‐301. - PubMed
Mishra and Singh 2003 {published data only}
    1. Mishra LC, Singh BB, Vinjamury SP. The effectiveness of Commiphora mukul for osteoarthritis of the knee: an outcomes study. Althernative Therapies in Health and Medicine 2003;9:74‐9. - PubMed
Myers 2010 {published data only}
    1. Myers S, O'Connor J, Fitton JH, Brooks L, Rolfe M, Connellan P, et al. A combined phase I and phase II open label study on the effects of a seaweed extract nutrient complex on osteoarthritis. Biologics: Targets & Therapy 2010;4:33‐44. - PMC - PubMed
Park 2009 {published data only}
    1. Park SH, Kim SK, et al. Effects of AIF on knee osteoarthritis patients: Double‐blind, randomized, placebo‐controlled study. Korean Journal of Physiology and Pharmacology 2009;13:33‐7. - PMC - PubMed
Rein 2004b {published data only}
    1. Rein E, Kharazmi A, Thamsborg G, Winther K. A herbal remedy, made from a subspecies of rose‐hip Rosa canina, reduces symptoms of knee and hip osteoarthritis. Osteoarthritis and Cartilage 2004;12 Suppl 2:S80.
Reuss 1981 {published data only}
    1. Ruess D. Echinacin in the treatment of primary chronic polyarthritis [Echinacin in der Therapie der primar‐chronischen Polyarthritis]. ZFA ‐ Stuttgart 1981;57(11):865. - PubMed
Rosen 2013 {published data only}
    1. Rosen PD, Liakeas GP, Sadigim E, Bied AM. A pilot study assessing the short term use of Tanacetum parthenium for treatment of osteoarthritis. Integrative Medicine 2013;12(3):31‐6.
Sagar 1988 {published data only}
    1. Sagar VMV. A clinical study of Amavata with special reference to some indigenous drugs. Rheumatism 1988‐89;24(3):3‐7.
Saley 1987 {published data only}
    1. Saley SR, Tilak MN, Deshmukh SS. Amavata ‐ a clinical study of 41 cases. Rheumatism 1987;22(2):46‐50.
Schaffner 1997 {published data only}
    1. Schaffner W. Willow bark ‐ an antirheumatic in modern phytotherapy? [Weidenrinde ‐ Ein Antirheumatikum der modernen Phytotherapie?]. In: Chrubasik S, Wink M editor(s). Rheumatherapie mit Phytopharmaka. Stuttgart: Hippokrates Verglag, 1997:125‐7.
Schmid 1998a {published data only}
    1. Schmid B, Tschirdewahn B, Kotter I, Gunaydin I, Ludtke R, Selbmann HK, et al. Analgesic effects of willow bark extract in osteoarthritis: results of a clinical double‐blind trial. FACT:Focus on Alternative and Complementary Therapies 1998;3(4):186.
Schmid 2001 {published data only}
    1. Schmid B, Lüdtke R, Selbmann H‐K, Kötter I, Tschirdewahn B, Schaffner W, Heide L. Efficacy and tolerability of a standardized willow bark extract in patients with osteoarthritis: Randomized placebo‐controlled double blind clinical trial. Phytotherapy Research 2001;15:344‐50. [DOI: 10.1002/ptr.981] - DOI - PubMed
Srivastava 1989 {published data only}
    1. Srivastava KC, Mustafa T. Ginger (Zingiber officinale) and rheumatic disorders. Medical Hypotheses 1989;29:25‐8. - PubMed
Wang 1985 {published data only}
    1. Wang ZM, Chang JY, et al. A report on 310 cases of articular rheumatism treated with Feng Shi Han Tong tablet. Chung Hsi I Chieh Ho Tsa Chih 1985;5(5):284‐5, 260. - PubMed
Wegener 2003 {published data only}
    1. Wegener T, Lupke NP. Treatment of patients with arthrosis of hip or knee with an aqueous extract of Devil's claw (Harpagophytum procumbens DC). Phytotherapy Research 2003;17(10):1165‐72. - PubMed
Winther 2004 {published data only}
    1. Winther K, Kharazmi A, Rein E. A powder made from a subspecies of rosehip (Rosa canina) reduces WOMAC symptoms scores as well as cholesterol levels in patients suffering from osteoarthritis. Osteoarthritis and Cartilage 2004;13 Suppl A:S93.
Xu 2005 {published data only}
    1. Xu J‐W, Ding J‐X. An analysis on the clinical therapeutic effect of the manipulation matched with Chinese medical herb washing for treatment of osteoarthritis of the knee. Journal of Beijing Teachers College of Physical Education 2005;1:9.
Yuelong 2011 {published data only}
    1. Yuelong C, Hongsheng Z, Jian P, Feiyue L, Shaojian X, Jinghua G, et al. Individually integrated traditional Chinese medicine approach in the management of knee osteoarthritis: study protocol for a randomized controlled trial. Trials 2011;12:160. [DOI: 10.1186/1745-6215-12-160] - DOI - PMC - PubMed
Zell 1993 {published data only}
    1. Zell J, Ecker R, Batz H, Vestweber AM. Mistletoe for hip and knee arthrosis: Segment ‐ or immunotherapy? [Misteltherapie bei Gon‐ und Coxarthrose: Segment ‐ oder Immuntherapie? Eine Pilotstudie]. Heilkunst 1993;106(9):23‐6.
Zeng 2008 {published data only}
    1. Zeng Y‐R, Fan Y‐G, Wu F, Li X‐P, Fan H‐J. Effects of compound herb of invigorating kidney and promoting blood flow on serum matrix metalloproteinases‐3, tumor necrosis factor alpha, interleukin‐1, hyaluronic acid, lipid peroxidation levels and superoxide dismutase activity in patients with knee osteoarthritis. Journal of Clinical Rehabilitative Tissue Engineering Research 2008;12:5436‐9.

References to studies awaiting assessment

Gao 2012 {published data only}
    1. Gao G, Wu H, Tian J, Du J, Xie X, Gao J. Clinical efficacy of bushen huoxue qubi decoction on treatment of knee‐osteoarthritis and its effect on hemarheology, anti‐inflammation and antioxidation. Zhongguo Zhong Yao Za Zhi 2012;37(3):390‐6. - PubMed
Hochberg 2012 {published data only}
    1. Hochberg MC, Lao LX, Langenberg P, Fong HHS, Lee DYW, Berman B. Efficacy and Safety of the Chinese Herbal Compound Hou‐Lou‐Xiao‐Ling Dan in Patients with Osteoarthritis of the Knee: Results of a Phase II International Study [Abstract]. Arthritis and Rheumatism 2012;64(10):S112. [DOI: 10.1002/art.37993] - DOI
Kang 2011 {published data only}
    1. Kang XZ, Wu QF, Jie HY. Clinical study on the treatment of knee osteoarthritis by wangbi tablet. Zhongguo Zhong Xi Yi Jie He Za Zhi [Chinese Journal of integrated Traditional and Western Medicine] 2011;31(9):1205‐8. - PubMed
Liu 2006 {published data only}
    1. Liu H‐B, Zhang J‐F, Zhong L‐W, Yang H. Manipulation plus pyrola compound traditional Chinese medicine in treatment of senile osteoarthritis of knee. Chinese Journal of Clinical Rehabilitation 2006;10(23):30‐2. [CENTRAL: 00613036]
Pinsornsak 2012 {published data only}
    1. Pinsornsak P, Niempoog S. The efficacy of Curcuma longa L. extract as an adjuvant therapy in primary knee osteoarthritis: A randomized controlled trial. Journal of the Medical Association of Thailand 2012;95 Suppl 1:S51‐8. - PubMed
Tao 2009 {published data only}
    1. Tao QW, Xu Y, Jin DE, Yan XP. Clinical efficacy and safety of Gubitong Recipe () in treating osteoarthritis of knee joint. Chinese Journal of Integrative Medicine 2009;15(6):458‐61. - PubMed
Zhong 2006 {published data only}
    1. Zhong Q‐S, Ye G‐H, Wang H‐Z, Lin S‐H. Treatment of knee osteoarthritis by invigorating the kidney, dispelling the cold and activating the collaterals: A randomized controlled study. Chinese Journal of Clinical Rehabilitation 2006;10:177‐9.

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