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. 2022 Dec 19:9:1026450.
doi: 10.3389/fnut.2022.1026450. eCollection 2022.

The effects of antioxidants on knee osteoarthritis: A systematic review and meta-analysis

Mohammad Nejadhosseinian  1   2 , Shirin Djalalinia  3   4 , Hoda Haerian  2 , Majid Alikhani  2 , Asieh Mansour  5 , Amir-Hossein Mousavian  6   7 , Heydar Ali Mardani-Fard  8 , Amir Kasaeian  6   7   9 , Seyedeh Tahereh Faezi  2
Affiliations

The effects of antioxidants on knee osteoarthritis: A systematic review and meta-analysis

Mohammad Nejadhosseinian et al. Front Nutr. .

Abstract

Objective: Knee osteoarthritis (KOA) is one of the growing health problems with a considerable burden. With recent research on the possible effectiveness of antioxidants in the remission of KOA symptoms, a systematic review and meta-analysis was required to confirm this hypothesis.

Design: Literature studies were searched on the most comprehensive databases such as PubMed, International Scientific Indexing, and Scopus, with no language and time restrictions. On 17 July 2021, a search strategy was developed based on the roots of "osteoarthritis (OA)" and "antioxidants," with no time or language limitations. As the primary outcome, pain was evaluated based on all indicators for evaluating pain [e.g., Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores, the visual analog scale (VAS), and the numerical rating scale (NRS)]. The symptoms and functions of KOA and quality of life (QOL) were also considered as secondary outcomes, each of which was measured and reported by the corresponding instrument in the studies. To measure the changes in pain, symptoms, and functions of participants, we included randomized controlled trials with a placebo control or other medical therapeutic interventions. Publication bias was assessed using Begg's funnel plot and Egger's regression test, which was deemed to be statistically significant at 0.1, and the results were checked by the trim-and-fill test.

Results: After refinement, data were extracted from 31 documents from 7,698 primary searched papers. Using the VAS as a reliable psychometric measuring instrument, the present study revealed that a significant difference in the characteristics of disease-related symptoms of patients with KOA was reached after antioxidant therapy (standardized mean difference (SMD): 0.467, 95% confidence interval (CI): 0.303-0.632, p < 0.0001). The results reported by WOMAC confirmed no significant difference in the combined score, difficulty score, pain score, and stiffness score.

Conclusion: As the first comprehensive systematic review of the association between antioxidant supplementation and KOA, this study showed that antioxidants can decrease disease-related symptoms in patients with KOA. The results can be useful for health policy decisions and future related studies.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022351060, identifier: CRD42022351060.

Keywords: antioxidant; cartilage damage; knee osteoarthritis (KOA); meta-analysis; osteoarthritis; systematic reviews.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The review flowchart for the selection of the primary studies.
Figure 2
Figure 2
(UP) A forest plot for the association between antioxidants and the outcomes of interest in osteoarthritis (OA) based on the visual analog scale (VAS). (DOWN) Forest plot of sensitivity analysis for the association between antioxidants and the outcomes of interest in OA based on the VAS.
Figure 3
Figure 3
(UP) A forest plot for the association between antioxidants and the outcomes of interest in OA based on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) combined pain score. (DOWN) Forest plot of sensitivity analysis for the association between antioxidants and the outcomes of interest in OA based on the WOMAC combined pain score.
Figure 4
Figure 4
(UP) A forest plot for the association between antioxidants and the outcomes of interest in OA based on the WOMAC difficulty pain score. (DOWN) Forest plot of sensitivity analysis for the association between antioxidants and the outcomes of interest in OA based on the WOMAC difficulty pain score.
Figure 5
Figure 5
(UP) A forest plot for the association between antioxidants and the outcomes of interest in OA based on the WOMAC pain score. (DOWN) Forest plot of sensitivity analysis for the association between antioxidants and the outcomes of interest of OA based on the WOMAC pain score.
Figure 6
Figure 6
(UP) A forest plot for the association between antioxidants and the outcomes of interest in OA based on the WOMAC stiffness score. (DOWN) Forest plot of sensitivity analysis for the association between antioxidants and the outcomes of interest in OA based on the WOMAC stiffness score.
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