Osteoarthritis

Add Content

• Definition
• Introduction
• Signs & Symptoms
• Research Summary

Presentation Slides

---

Executive Summary

---

Write an executive summary in the form of a blog article on the topic of "Research into Chinese medicine treatment for Osteoarthritis" summarising the research below and using language that can be easily understood by patients and avoiding medical jargon using a professional and caring tone of voice.

Write an executive summary in the form of a blog article on the topic of "Researched Chinese medicine treatments for Osteoarthritis" summarising the research below in an objective and easy to understand way, and using language that can be easily understood by patients. Group the article into Chinese medicine treatments first, followed by nutrition and other treatments. Avoid using medical jargon and use a professional and caring tone of voice.

Write me a concise but easy to understand executive summary on the topic of "Chinese medicine treatments for Osteoarthritis" based on the following research that I will give you. Your summary should be 2 paragraphs long in Australian English spelling and include references to the studies.

A Systematic Review published in 2022 in the journal Frontiers in Nutrition found that Antioxidant therapy significantly reduces disease-related symptoms for patients with knee osteoarthritis. Methodology: The approach for this systematic review and meta-analysis was based on thorough literature analysis with no time or language restrictions from prominent databases including PubMed, International Scientific Indexing, and Scopus. The search was focused on the connections between "osteoarthritis" and "antioxidants". This study considered pain as the primary outcome while also analyzing the symptoms, functions of knee osteoarthritis, and quality of life. All these variables were measured using the corresponding instrument from existing studies. Only randomized controlled trials with a placebo control or other medical therapeutic interventions were included. Publication bias was evaluated using Begg's funnel plot and Egger's regression test, and results were validated using the trim-and-fill test. Results: From the initial 7,698 papers, information was obtained from 31 selected documents. Results showed that antioxidant therapy significantly affected the symptoms of patients with knee osteoarthritis, as validated using the Visual Analog Scale. However, there was no notable difference observed in the combined score, difficulty score, pain score, and stiffness score as reported by the Western Ontario and McMaster Universities Osteoarthritis Index.

A Systematic Review published in 2022 in the journal Evidence-Based Complementary and Alternative Medicine found that Acupuncture and moxibustion therapies have greater therapeutic effectiveness for knee osteoarthritis than sham treatments and generic acupuncture/moxibustion treatments. The researchers queried PubMed, Embase, and CNKI databases to find qualifying trials conducted between 2017 and 2022. All trials that employed acupuncture or moxibustion for knee osteoarthritis patients were included. The process of choosing studies to be included and extracting relevant data from them was carried out by two researchers independently. The data were analyzed using R 4.1.1. The meta-analysis included seventeen trials. The results of the analysis identified a correlation between several common forms of acupuncture and moxibustion therapies, as observed via a network meta-analysis. The findings showed that treatments involving acupuncture or moxibustion were more effective than sham treatments. Furthermore, when compared with standard acupuncture or moxibustion procedures, specific acupuncture or moxibustion procedures proved to be more effective.

A Systematic Review published in 2022 in the journal BioMed Research International found that Acupuncture can reduce pain and improve functional activities in patients with knee osteoarthritis, proving particularly beneficial for chronic sufferers and enhancing their quality of life. This study amassed randomized controlled trials from various databases including PubMed, Embase, and others to assess the effectiveness of acupuncture in alleviating the symptoms of knee osteoarthritis. The researchers conducted a meta-analysis using the Cochrane systematic review method by integrating Review Manager 5.4 and TSA 0.9.5.10 beta software, in conjunction with the GRADE approach for quality assessment of the evidence. They also implemented a trial sequential analysis to manage random errors and calculate the required information size. The meta-analysis included eleven randomized controlled trials involving 2484 patients. The results indicate a positive effect of acupuncture on reducing pain and enhancing patient functionality. Conversely, stiffness symptoms were not significantly alleviated by acupuncture. Moreover, the analysis demonstrated no substantial difference between the effectiveness of acupuncture and sham procedures in improving the psychological aspects of patients' quality of life. Furthermore, physical health improvement, as measured by SF-36 or SF-12, was not significantly different between groups receiving real or sham acupuncture. The trial sequential analysis graphs showed cumulative Z-curves crossing the traditional statistical level favoring acupuncture, highlighting its potential usefulness. Therefore, acupuncture shows promise as an alternative therapy for patients with knee osteoarthritis.

A Systematic Review published in 2022 in the journal Frontiers in Physiology found that Moxibustion, a form of traditional Chinese medicine, appears to be an effective and safe treatment for knee osteoarthritis. The researchers used a series of databases including Embase, PubMed, Web of Science, Cochrane Library, and others to carry out a comprehensive evaluation of previous systematic reviews on the treatment of knee osteoarthritis with moxibustion. They employed the Measurement Tool to Assess Systematic Reviews 2 to assess the methodological quality, Preferred Reporting Item for Systematic Reviews and Meta-analyses for reporting quality, and ROBIS Tool to evaluate the risk of bias in the systematic reviews. They also assessed the strength of evidence with the Grading of Recommendations Assessment, Development and Evaluation tool and carried out a meta-analysis of the total effectiveness rate. From this process, 10 systematic reviews were selected that had met their criteria. These reviews included the results of 57 randomized controlled trials involving a total of 5,149 participants. However, these reviews were found to have several critical deficiencies, scoring low on the quality scale used. Despite this, moxibustion, and its combination treatment, were shown to improve the total effectiveness rate in knee osteoarthritis. Eight of the reviews had reported adverse events but none were classified as serious in either the moxibustion group or control group.

A Experimental Study published in 2022 in the journal Frontiers in Pharmacology found that PIASCLEDINE-ExpASU®, a type of avocado/soybean unsaponifiable product, displays superior pharmacological activity due to its unique composition, including a high inhibitory effect on pro-inflammatory factors. The study began with the characterisation of the lipid content of seven different avocado/soybean unsaponifiable (ASU) products through gas chromatography analysis performed on a VARIAN 3400 chromatograph. In parallel, the effects of these products were tested on human osteoarthritis chondrocytes (cartilage cells) cultured in alginate beads. The researchers focused on the effects of these ASU products on aggrecan, key interleukins, and matrix metalloproteases. In terms of results, PIASCLEDINE-ExpASU® stood out due to a specific profile involving unique chromatographic peaks and the presence of specific compounds like alkyl furan fraction, alkyl triols, and squalene. Remarkably, this product showed heightened efficacy in inhibiting production of nitric oxide, interleukins, and catabolic factors. Meanwhile, excepting two products, the remaining ASUs showed varied capacity in increasing aggrecan production, a positive factor in the context of osteoarthritis treatment.

A Systematic Review published in 2021 in the journal Health Promotion Perspectives found that Pomegranate has been confirmed to improve clinical features and reduce inflammatory, oxidative stress, and apoptosis markers in osteoarthritis. In the methodology, a systematic review was conducted using established databases like Scopus, PubMed, Embase, WOS, ProQuest, and Google Scholar up until February 2021. Both MESH and non-MESH keyword searches were performed in the title, abstract, and keywords. The review considered full-text clinical, animal, and in vitro studies in all languages and specifically excluded review articles, book chapters, conference abstracts, and research related to pomegranate in health problems other than osteoarthritis. A manual search was performed to examine the references or citations of eligible papers as well as grey literature to discover potential researches. The results of the systematic review included twenty-three articles which all showed the beneficial impact of pomegranate across human, animal, and in vitro studies. These showed improvements in clinical presentations and reductions in inflammatory, oxidative stress, and apoptosis markers in osteoarthritis. This demonstrated the therapeutic potential of pomegranate for easing the effects of osteoarthritis.

A Systematic Review published in 2021 in the journal Complementary Therapies in Medicine found that Turmeric curcuminoids are associated with better pain relief than NSAIDs in knee osteoarthritis. The meta-analysis results showed that curcuminoids were significantly more effective than comparators regarding visual analogue scale (VAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain scores. However, no significant difference in pain relief or AEs between the high-dose (daily dose ≥1000 mg or total dose ≥42 gm) and low-dose (daily dose <1000 mg or total dose <42 gm) curcuminoid treatments was observed. When comparing curcumininoids versus NSAIDs, a significant difference in VAS pain was found. For AE analysis, three of our included studies used NSAIDs as comparators, with all reporting higher AE rates in the NSAID group, though significance was reached in only one study.

A Randomised Controlled Trial published in 2021 in the journal Advances in Integrative Medicine found that Pomegranate peel extract supplementation can decrease total cholesterol and triglyceride levels while boosting antioxidant status in obese women with knee osteoarthritis. The research was a randomized, double-blind placebo-controlled trial involving 66 obese women aged 38 to 60 years old with knee osteoarthritis. These participants were split into two groups, the intervention group and control group, each containing 33 members. The intervention group received pomegranate peel extract capsules (500 mg) twice daily for 8 weeks including standard drug therapy while the control group was given a placebo during the same period. All participants' fasting blood samples, anthropometric measurements, dietary intake data, and physical activity levels were collected both before the start and at the end of the trial. Results analysis showed that pomegranate peel extract supplementation brought down levels of serum total cholesterol, triglyceride and an oxidative stress marker while enhancing levels of some antioxidant enzymes and the overall antioxidant capacity when compared to the control group. However, there were no noticeable alterations between the two groups in terms of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and body mass index by the end of the experiment.

A Randomised Controlled Trial published in 2021 in the journal Journal of Complementary and Integrative Medicine found that Avocado/soy unsaponifiables effectively treat osteoarthritis by controlling the balance between oxidant and antioxidant molecular markers. The methodology used in this study was a double-blind, randomized, placebo-controlled, cross-over trial. Forty osteoarthritis patients were classified into two groups: one received avocado/soy unsaponifiables (ASU) for three months followed by three months of placebo, and the other group received a placebo first for three months followed by three months of ASU. The patients' oxidant status was evaluated by measuring their serum malonldialdehyde (MDA). Other measures such as total antioxidant capacity, reduced glutathione, and antioxidant enzymes like superoxide dismutase and catalase were also assessed. After three months of treatment, all patients who were given avocado/soy unsaponifiables exhibited a significant decrease in their serum MDA levels, indicating lower oxidative stress. In comparison, these levels were higher at baseline and after placebo treatment. Furthermore, the treatment with avocado/soy unsaponifiables resulted in positive changes in the patients' antioxidant levels. Analysis also showed that the effect of avocado/soy unsaponifiables was consistent, regardless of the sequence in which the medication was received. These findings demonstrate that avocado/soy unsaponifiables can contribute effectively to the treatment of osteoarthritis by regulating the balance between oxidant and antioxidant molecular markers.

A Randomised Controlled Trial published in 2021 in the journal Arthritis & Rheumatology found that Intensive electroacupuncture appears to reduce pain and improve function in knee osteoarthritis patients more effectively than sham acupuncture. In this multicenter research, individuals suffering from knee osteoarthritis were randomly selected to receive one of three treatments thrice weekly, over an eight-week period: electroacupuncture, manual acupuncture, or sham acupuncture. A double-blind model was enforced where participants, outcome assessors, and statisticians remained unaware of the specific treatment group allocations. The primary benchmark of success was the response rate, which gauged the ratio of participants who noted a minimum clinically important improvement in both pain and function by the eighth week. In the study involving 480 participants, 442 were evaluated for the effectiveness of treatment. The response rates varied among the groups at week 8: with electroacupuncture and manual acupuncture groups reporting higher rates of improvement compared to the sham acupuncture group. On continued assessment at weeks 16 and 26, these higher response rates were sustained in both the electroacupuncture and manual acupuncture groups. Among the patients, those who received intensive electroacupuncture reported less pain and better function at week 8 compared to those who received sham acupuncture, and these effects persisted through week 26. Whereas, intensive manual acupuncture did not show any significant benefits at week 8 but showed improvement in the follow-up period.

A Systematic Review published in 2020 in the journal Pain Research and Management found that The use of various treatments of traditional Chinese medicine can significantly improve the level of the total effective rate and reduce the occurrence of recurrence rate in the later stage of osteoarthritis treatment. These effects are mediated by a combination of several mechanisms. This method of treatment with TCM can reduce pain, improve their ability to move, and improve their living standards by reducing the level of VAS, WOMAC, SSTCM, SS, and Lequesne and increasing the level of Lysholm. TCM therapy can reduce inflammation and exert anti-inflammatory effects by reducing the levels of IL-1, IL-6, TNF-α, MMP-3, ESR, and CRP and increasing TGF-β. TCM therapy can increase BGP, FGF-2, IGF-1, and OPG and reduce BMP-7 and RANKL levels to improve bone metabolism in order to achieve the balance of bone metabolism. The TCM therapy can also reduce the levels of VEGF and Ang I, reduce cartilage injury, and restore vascular endothelial function. The effect of TCM therapy can also increase the level of SOD and reduce the existence of reactive oxygen species. The net analysis of ACU and index showed that ACU at local acupoints such as Yinlingxue, Xuehai, and Yanglingquan can reduce inflammatory indexes, reduce cartilage damage, balance bone metabolism, reduce WOMAC, and improve TER. The network analysis chart of TCMs and index showed that TCMs can effectively reduce WOMAC through the inhibition of IL-1 and MMP-3 and improve the effect of TER and so on. However, our findings must be handled with care because of the small size and low quality of the clinical trial samples cited. Other rigorous and large-scale RCTs are needed to confirm these results.

A Review Article published in 2020 in the journal Antioxidants found that Green tea catechins potentially contribute to maintaining joint and skeletal muscle health, mitigating symptoms of osteoarthritis and sarcopenia. The research begins by providing an understanding of osteoarthritis, a degenerative inflammatory disorder of articular cartilage, and sarcopenia, a condition characterized by loss of muscle mass and strength. It explores their prevalence, causes such as excessive inflammation and oxidative stress, mitochondrial dysfunction, and diminished autophagy. It then delves into the role of green tea catechins in joint health, including their influence on inflammatory signaling agents, anabolic mediators, and miRNAs expression. This leads to a decrease in chondrocyte death and collagen degradation, thereby offering cartilage protection. The investigation also examines the effects of green tea catechins on skeletal muscle health. It highlights their role in maintaining an equilibrium between protein synthesis and degradation, and enhancing the synthesis of mitochondrial energy metabolism. The review thus suggests a positive impact of green tea catechins on joint and muscle health, helping to maintain favorable muscle homeostasis and reduce muscle atrophy associated with aging. It ends by pointing out the limitations of the current study and proposing future research directions.

A Systematic Review published in 2020 in the journal Current Rheumatology Reports found that The majority of studies concluded the superiority of short-term analgesic effects over various controls and suggested that acupuncture may be efficacious for chronic musculoskeletal pain. We examined 16 review articles and 11 randomized controlled trials published in the last 5 years on the clinical efficacy of acupuncture in adults with CMP conditions. The available evidence suggests that acupuncture does have short-term pain relief benefits for patients with symptomatic knee osteoarthritis and chronic low back pain and is a safe and reasonable referral option. Acupuncture may also have a beneficial role for fibromyalgia. However, the available evidence does not support the use of acupuncture for treating hip osteoarthritis and rheumatoid arthritis.

A Systematic Review published in 2020 in the journal Clinical Rehabilitation found that Tai Chi exercise was beneficial for ameliorating physical and mental health of patients with knee osteoarthritis and should be available as an alternative non-pharmacological therapy in rehabilitation programmes. A total of 16 RCTs involving 986 patients with knee osteoarthritis met the established inclusion criteria. The strength of evidence for the main outcomes was low or moderate. The systematic review illustrated the efficacy of Tai Chi exercise in treating and managing knee osteoarthritis. Patients’ outcomes practising Tai Chi exercise were improved significantly, including pain, stiffness, physical function, dynamic balance, physiological and psychological health. No adverse events associated with Tai Chi exercise were reported.

A Review Article published in 2020 in the journal Longhua Chinese Medicine found that Green tea and its compounds, especially catechins, may potentially prevent and treat osteoarthritis due to their potent antioxidant and anti-inflammatory properties. The researchers performed an extensive review exploring the potential impact of green tea and its bioactive compounds, chiefly catechins, on osteoarthritis management. Their focus was on the anti-inflammatory and antioxidant abilities of these compounds. Based on the review, such compounds can quell inflammation by blocking various signaling pathways interconnected with inflammatory processes. Specifically, they have the potential to suppress the expression of several cytokines and enzymes related to inflammation. In addition, green tea was noted for its property to neutralize free radicals, thus averting the formation of harmful reactive oxygen species and countering oxidative stress. While many conventional, non-surgical osteoarthritis therapies can lead to numerous adverse effects, the current review suggests that green tea could serve as a safer alternative. It may be a promising direction in the prevention and management of this chronic, painful, and inflammatory condition, which touches a significant number of people globally.

A Systematic Review published in 2020 in the journal Journal of Acupuncture and Tuina Science found that In the treatment of knee osteoarthritis, the acupuncture group had significant advantages over sham acupuncture or no-acupuncture groups in relieving pain and improving physical function. Eight databases were extensively searched up to March 2018. Randomized controlled trials (RCTs) comparing the efficacy of acupuncture with sham acupuncture or no acupuncture for knee osteoarthritis were included. The Cochrane Collaboration’s tool was used for assessing the risk of bias. A total of 18 RCTs were included, involving a total of 3 522 participants. The results showed that acupuncture was superior to sham acupuncture in relieving pain and improving physical function. In comparison to the no-acupuncture group, the acupuncture group also showed significant advantages in relieving pain and improving physical function. Sensitivity analyses suggested that the results were robust, and Egger’s test found no potential publication bias.

A Review Article published in 2020 in the journal Phytotherapy Research found that Ginger, through various methods, exhibits promising pain reduction effects for conditions such as dysmenorrhea, muscle soreness, osteoarthritis, low back pain, and migraines. The review incorporates a vast range of randomized controlled trials conducted over the past decade, where ginger was mainly used for pain relief in distinct conditions. The conditions included dysmenorrhea, delayed onset muscle soreness, osteoarthritis, chronic low back pain, and migraines. The variety of methods used included oral administration, topical application, and aromatic oil massages. In the analysed trials, for dysmenorrhea and muscle soreness, the considered studies suggested a promising effect after both oral and topical administration of ginger. As for osteoarthritis, most trials demonstrated pain reduction following topical and oral use of ginger, one focused on the beneficial effects of ginger in relieving migraine pain. Last but not least, a trial involving massages with aromatic ginger oil highlighted its potential in reducing chronic low back pain.

A Randomised Controlled Trial published in 2020 in the journal Acupuncture in Medicine found that Electroacupuncture might provide stronger impact on knee osteoarthritis than manual acupuncture, though both methods are safe and feasible treatments. The study consisted of a multicenter randomized controlled clinical trial conducted in Beijing, during which 60 participants suffering from knee osteoarthritis were split into two groups: Electroacupuncture and Manual Acupuncture. Participants in both groups were treated at the same local traditional acupuncture points, with the Electroacupuncture group using an electrical apparatus. The Manual Acupuncture group experienced a sham procedure, utilizing a working power indicator but no actual current, to keep the participants blind to the experimental conditions. Over 8 weeks, both groups received 24 treatment sessions. The successfulness of the treatments was determined by response rates, pain, stiffness, functionality, and quality of life. In the results, 53 out of 60 participants completed the study. Within these participants, the response rates were 43% for the Electroacupuncture group and 30% for the Manual Acupuncture group. Differences between group outcomes were noted but not deemed statistically significant. There were low rates of adverse effects in correspondence with the two methods, which were also evenly distributed across the two groups.

A Review Article published in 2020 in the journal Biomolecules found that Avocado and soybean unsaponifiables may effectively reduce inflammation and symptoms related to osteoarthritis, autoimmune diseases, and menopause. The research involves summarizing various studies on the biological effects of the avocado-soybean unsaponifiables (ASU), highlighting its potent anti-inflammatory properties. The extracted ASU are a combination of elements derived from the fruits and seeds of avocados and soybeans. To understand its impact, the researchers categorized the applications of ASU in treating different conditions such as osteoarthritic pain, hip and knee osteoarthritis, autoimmune diseases, and menopause-related symptoms amongst postmenopausal women. The discussion revealed significant links between avocado and soybean unsaponifiables and symptom improvement in areas of osteoarthritic pain, autoimmune conditions, and postmenopause. Particularly notable is the ASU mixture's potential role as an adjunct treatment, meaning it’s meant to supplement primary treatments for such conditions. Its benefits were not only limited to physical reduction of inflammation and associated pain, but also improved mood and quality of life for postmenopausal women by significantly reducing menopause-related symptoms. The study also delves into the safety, toxicological considerations, and regulatory practices related to the use of ASU.

A Systematic Review published in 2019 in the journal International Journal of Rheumatic Diseases found that Avocado-soybean unsaponifiables treatment is effective in reducing knee osteoarthritis symptoms without increasing adverse events, contrary to those with hip osteoarthritis. To assess avocado-soybean unsaponifiables (ASU) effectiveness and safety, a systematic review and meta-analysis of randomized controlled trials involving patients with hip or knee osteoarthritis was conducted. Various scientific databases, including Medline, SCOPUS, Web of Science, and Google Scholar, were thoroughly searched for suitable trials. Selection criteria consisted of randomized placebo-controlled trials wherein the effect of orally administered ASU on knee or hip osteoarthritis symptoms were evaluated, primarily using the Lequesne index, visual analog scale, and joint space width. The meta-analysis revealed a significant reduction in pain as assessed by the visual analog scale for those under Avocado-soybean unsaponifiables therapy, particularly for patients with knee osteoarthritis, indicated by a decrease in both the visual analogue scale and Lequesne index. However, no such significant effect was found for patients with hip osteoarthritis. In terms of safety, there were no significant differences in adverse events between patients receiving ASU and those given a placebo, confirming ASU's relative safety as a treatment option.

A Systematic Review published in 2019 in the journal Medicine found that According to high-quality outcomes, acupuncture had more total effective rate, short-term effective rate, and less adverse reactions than western medicine in treating knee osteoarthritis. Firstly, this overview provides the latest evidence on acupuncture for knee osteoarthritis based on the findings of systematic reviews, which indicated that acupuncture may have more total effective rate, short-term effective rate, and less adverse reactions in treating knee osteoarthritis than western medicine. Secondly, this overview is predesigned, which helps restrict the likelihood of biased decisions in reviewing. Thirdly, comprehensive search strategies were conducted for a wide range of data. Fourthly, independent reviewers were engaged in searching, screening, and assessing the potential studies and there was a high consistency among the reviewers.

A Randomised Controlled Trial published in 2019 in the journal International Journal of Basic & Clinical Pharmacology found that Avocado oil supplement combined with exercise improves joint function in osteoarthritis over traditional treatments like NSAIDS and multivitamins with exercise. In this study, 90 osteoarthritis patients were randomly sorted into three groups for different treatments: one group took multivitamins associated with exercise, the second group took NSAIDS, and the third, avocado oil combined with strengthening exercises. The pain and knee functionality of each participant were measured using the Visual Analogue Scale and Oxford Knee score respectively. Throughout the three-month treatment course, the group that used avocado oil alongside exercises outperformed the others. They had the highest Oxford Knee scores, indicating better knee functionality, and also had higher average Pain Threshold scores from the Visual Analogue Scale. Hence, this study postulates that avocado oil, coupled with muscle exercises, offers a more effective solution for managing osteoarthritis over NSAIDS and multivitamins.

A Randomised Controlled Trial published in 2019 in the journal Arthritis Research & Therapy found that Strong electroacupuncture for at least two weeks improves chronic pain management in knee osteoarthritis patients better than weak or sham electroacupuncture. In this investigation, a multicenter, three-arm parallel, single-blind randomized controlled trial was conducted in which 301 patients suffering from knee osteoarthritis were randomly divided into three groups based on the electroacupuncture current intensity: strong, weak, and sham. Treatments were carried out in five sessions per week over a two-week period. The impact of these treatments was primarily measured by assessing the Visual Analog Scale, conditioned pain modulation function, and the Western Ontario and McMaster Universities Osteoarthritis Index. After a week of electroacupuncture, a clinically significant improvement was observed in Visual Analog Scale scores and Western Ontario and McMaster Universities Osteoarthritis Index scores, but not in conditioned pain modulation function. However, after two weeks of treatment, improvements were seen in all three primary outcomes when compared to baseline. In terms of enhancing conditioned pain modulation function specifically, both weak and strong electroacupuncture outperformed the sham option, with strong electroacupuncture showing superiority to weak, and resulted in better pain management.

A Randomised Controlled Trial published in 2018 in the journal Clinical Interventions in Aging found that The extract from cucumber, Q-Actin, is effective in reducing moderate knee osteoarthritis related pain and potentially in managing knee pain, stiffness, and physical functions. In this double-blind, parallel-group clinical trial conducted in three different centres, 122 patients aged between 40 and 75 years with diagnosed moderate knee Osteoarthritis were randomly divided into two groups. Over a 180-day period, one group received the cosmetically prescribed dose of 1,350 mg of glucosamine-chondroitin orally twice daily, and the other group took an orally administered 10 mg of Q-Actin (aqueous extract of cucumber) twice per day. The results showed a significant decrease in Osteoarthritis Index scores in the group that received the cucumber extract, indicating reduced pain and improved physical function. This trend was observed throughout the trial, and by the 180th day, the extract's effectiveness was substantially higher than that of the traditionally prescribed glucosamine-chondroitin. Notably, no adverse effects from the cucumber extract were reported during the trial period.

A Systematic Review published in 2018 in the journal MOJ Food Processing & Technology found that Chili pepper has preventive and therapeutic properties for many ailments such as different types of cancer, rheumatism, stiff joints, bronchitis and chest colds with cough and headache, arthritis, heart arrhythmias and used as stomachic. A vanilloid receptor known as VR1 which was later found to be member of the family TRP and was called TRPV1 (transient receptor potential vanilloid subtype 1) is the receptor for capsaicin and is universally distributed in the brain, sensory nerves, dorsal root ganglia, bladder, gut, and blood vessels. Capsaicin is activate and then desensitize or block VR1 and was found to be powerful drug in animal models of human disease. Capsaicin plays a potential role in cardiometabolic protection through the activation of TRPV1 in different target organs or tissues, which suggests that TRPV1 may be a promising target for the management of cardiometabolic diseases such as obesity, hypertension, dyslipidemia, diabetes and atherosclerosis. However, association between the dosage of dietary capsaicin and the effect on cardiometabolic protection need to be clarified for determining the daily usage or intake of capsaicin or its derivatives. The activation of VR1 by capsaicin make it possible to be involved in various human disease states ranging from genetic pain insensitivity to chronic pain syndromes. In addition to that VR1 has much broader clinical benefits than mere pain case. Chili pepper has preventive and therapeutic properties for many ailments such as different types of cancer, rheumatism, stiff joints, bronchitis and chest colds with cough and headache, arthritis, heart arrhythmias and used as stomachic. Chili preparations for treating ailments can be standard capsaicin, pharmaceutically prepared gels, creams and plasters, essential oils distilled from pods, powder prepared by crashing pods and extracts by soaking pods in water or ethanol.

A Systematic Review published in 2018 in the journal Cochrane Database of Systematic Reviews found that In people with hip osteoarthritis, at close to 8 weeks, acupuncture plus routine primary physician care may improve pain and function compared to routine primary physician care alone. Because acupuncture has previously been documented to have a low risk of adverse effects, and because arthritis patients seem to be accepting of acupuncture (Rao 1999), there seem to be few drawbacks to hip OA patients electing to receive acupuncture, other than the additional costs incurred. While some private health insurance plans cover much of the costs of acupuncture, it is not typically covered by governmental health plans, with some exceptions (NICE 2009). Thus, the out‐of‐pocket costs of the acupuncture will vary depending on an individual's health plan. Given the potential disability caused by OA of the hip and the few available treatments, acupuncture may be considered one treatment option, particularly among patients who are not yet ready for a joint replacement or who are unable to tolerate oral NSAIDs. However, patients should be informed that acupuncture probably has little or no effect in reducing pain or improving function relative to sham acupuncture. . Because there are currently no registered ongoing RCTs, this evidence base is unlikely to substantially change in the near future.

A published in 2018 in the journal Pain Medicine found that Acupuncture therapy offered in the group setting was effective in reducing pain severity, pain interference, and depression in patients with chronic neck, back, or shoulder pain or osteoarthritis. Subjects received eight weekly acupuncture therapy sessions in a group setting. Acupuncture therapy included a combination of palpation, acupuncture needling, Tui na, Gua sha, and auricular treatment. Baseline pain levels were established in a two- to four-week run-in; assessment of the intervention impact on pain intensity, mood, and functional status were made at the end of the treatment period (eight weeks) and 16 weeks after completion of intervention (24 weeks). Of the total 113 participants recruited for the trial, 96 completed the 24-week protocol. We found a statistically and clinically significant decrease in pain severity, pain interference, and depression in our study population. There were no serious adverse events. Acupuncture therapy offered in the group setting was effective in reducing pain severity, pain interference, and depression in patients with chronic neck, back, or shoulder pain or osteoarthritis. Benefit persisted through the 24-week measure despite no additional treatment. This finding has potentially important implications for improving access to effective acupuncture treatment for patients with limited financial resources.

A Randomised Controlled Trial published in 2018 in the journal Clinical Nutrition found that Green tea extract can potentially control pain and improve knee joint physical function in adults suffering from osteoarthritis. The study employed a randomized open-label active-controlled clinical trial in which fifty adults with knee osteoarthritis were randomly divided into two groups. One group received the green tea extract in tablet form along with diclofenac tablet, referred to as the "intervention group," while the other, the "control group," received only the diclofenac tablet. This trial period lasted four weeks. The researchers evaluated the patients at the start of the trial and then four weeks later, measuring the pain score through a visual analogue scale and a specific osteoarthritis questionnaire's score, in addition to its three sub-scores. The participants were also asked to report any side effects experienced during the trial period. The outcomes of the experiment showed that when compared to the control group, the green tea group showed a significant decrease in their pain score and the score measuring knee joint function. However, no differences were observed between the two groups in terms of the specific osteoarthritis questionnaire's pain and stiffness scores. An adverse event of gastric upset was reported in only one patient from the control group.

A Review Article published in 2017 in the journal PLOS One found that Traditional Chinese Medicine offers potential benefits like pain relief and functional improvement for knee osteoarthritis with few adverse events. Five electronic databases were searched up until April 2016 to study the efficacy and safety of Traditional Chinese Medicine (TCM) for treating knee osteoarthritis. The methodological quality of the included studies was evaluated using the Assessment of Multiple Systematic Reviews (AMSTAR) and the Risk of Bias in Systematic reviews (ROBIS) tools. The quality of evidence was determined using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. The findings indicate that TCM potentially benefits patients with knee osteoarthritis through pain relief, functional improvement, and few adverse effects. However, deficiencies were found in the methodological quality of the reviews, such as the absence of an a-priori protocol or protocol registration, and an incomplete literature search. Furthermore, none of the studies offered a list of excluded studies. Overall, the quality of evidence in the systematic reviews was deemed poor, ranging from 'very low' to 'low'. This shortcoming was primarily due to a substantial risk of bias in the original trials, inconsistencies, and imprecision in the outcomes. Though TCM generally appears to be effective for knee osteoarthritis treatment, the evidence is not strong enough due to methodological flaws. Therefore, these findings should be approached cautiously in a clinical setting.

A Systematic Review published in 2017 in the journal The Journal of Pain found that Acupuncture has a clinically relevant effect on chronic pain that persists over time. Referral for acupuncture treatment is a reasonable option for chronic pain patients. We included randomized trials of acupuncture needling versus either sham acupuncture or no acupuncture control for nonspecific musculoskeletal pain, osteoarthritis, chronic headache, or shoulder pain. Trials were only included if allocation concealment was unambiguously determined to be adequate. Raw data were obtained from study authors and entered into an individual patient data meta-analysis. The main outcome measures were pain and function. An additional 13 trials were identified, with data received for a total of 20,827 patients from 39 trials. Acupuncture was superior to sham as well as no acupuncture control for each pain condition (all P < .001) with differences between groups close to .5 SDs compared with no acupuncture control and close to .2 SDs compared with sham. We also found clear evidence that the effects of acupuncture persist over time with only a small decrease, approximately 15%, in treatment effect at 1 year. Acupuncture is effective for the treatment of chronic musculoskeletal, headache, and osteoarthritis pain. Treatment effects of acupuncture persist over time and cannot be explained solely in terms of placebo effects. Referral for a course of acupuncture treatment is a reasonable option for a patient with chronic pain.

A Systematic Review published in 2017 in the journal Programme Grants for Applied Research found that The programme of research found that acupuncture was more effective than usual care and sham acupuncture for chronic pain, that it was one of the more clinically effective physical therapies for osteoarthritis and that it showed benefits in the treatment of depression. We have provided the most robust evidence from high-quality trials on acupuncture for chronic pain. The synthesis of high-quality IPD found that acupuncture was more effective than both usual care and sham acupuncture. Acupuncture is one of the more clinically effective physical therapies for osteoarthritis and is also cost-effective if only high-quality trials are analysed. When all trials are analysed, TENS is cost-effective. Promising clinical and economic evidence on acupuncture for depression needs to be extended to other contexts and settings. For the conditions we have investigated, the drawing together of evidence on acupuncture from this programme of research has substantially reduced levels of uncertainty. We have identified directions for further research. Our research also provides a valuable basis for considering the potential role of acupuncture as a referral option in health care and enabling providers and policy-makers to make decisions based on robust sources of evidence.

A Systematic Review published in 2016 in the journal Complementary Medicine Research found that Acupuncture therapy is more effective than NSAID in improving clinical efficacy rates and pain scores for treatment of chrondomalacia patellae. To our knowledge, this is the first meta-analysis of acupuncture therapy in the treatment of CMP. Seven RCT involving 707 patients with CMP were selected for this meta-analysis. Based on the findings of the present systematic review, acupuncture therapy can further improve the clinical effect and pain scores when compared with NSAID controls. However, the potential beneficial effect of acupuncture is possibly overstated owing to the low general methodological quality of the included RCT. Conclusions regarding the safety of acupuncture therapy cannot be drawn since the eligible trials provide no evidence on this aspect.

A Experimental Study published in 2014 in the journal Arthritis Research & Therapy found that Epigallocatechin 3-gallate (EGCG), found in green tea, can significantly slow down osteoarthritis progression and reduce associated pain in a post-traumatic osteoarthritis mouse model. C57BL/6 mice were operated to destabilize the medial meniscus mimicking post-traumatic osteoarthritis or were subjected to a sham surgery as a control. From the day of the surgery, the mice were given daily injections of EGCG or a vehicle control for either four or eight weeks. The severity of osteoarthritis was evaluated by staining and scoring techniques, detection of type II collagen and aggrecan, as well as through the measurement of enzyme expression involved in cartilage degradation. After the surgery, at both four and eight weeks, the cartilage in EGCG-treated mice showcased lesser cartilage erosion and staining loss than the control mice. Furthermore, it also revealed lower osteoarthritis scores and reduced levels of enzymes implicated in cartilage degradation. The EGCG-treated mice exhibited elevated expression of genes that regulate these enzymes. Additionally, EGCG positively affected the cartilage's gene expression level for both pro and anti-inflammatory cytokines. EGCG treatment also resulted in a reduction of osteoarthritis-associated pain, reflected in higher locomotor behavior and a decrease in the expression of inflammatory cytokines and a chemokine receptor in the dorsal root ganglion.

A Review Article published in 2014 in the journal CARTILAGE found that A dietary supplement Avocado/Soybean Unsaponifiables aids in treating Osteoarthritis by preventing cartilage degradation and promoting cartilage repair, thereby reducing pain and enhancing joint functionality. Avocado/Soybean Unsaponifiables was studied for its effects on Osteoarthritis. The methodology highlighted its functions, which include inhibiting the release and activity of molecules and pathways that are implicated in OA, as well as those that prevent cartilage degradation. These functions are principally through the prohibition of matrix metalloproteinases and the increase of tissue inhibitors of the catabolic enzymes in question. Additionally, ASU was found to inhibit fibrinolysis by stimulating the expression of plasminogen activator inhibitor. Moreover, its anabolic properties were credited with promoting cartilage repair by stimulating collagen and aggrecan synthesis while inhibiting inflammatory cytokines. ASU's chondroprotective effects were noted as well; these effects are brought about by correcting growth factor abnormalities, and by simultaneously increasing Transforming Growth Factor-Beta in synovial fluid while decreasing vascular endothelial growth factor. Additionally, it was observed to inhibit cholesterol absorption and biosynthesis, which further contribute to its beneficial role by moderating reactive oxygen species pathology in chondrocytes. Results indicated that the dietary supplement has significant therapeutic value for those suffering from Osteoarthritis. It reduces pain and stiffness while improving joint function, resulting in less dependency on painkillers. It was found that ASU's preventative measures towards cartilage degradation and its promotion of cartilage repair play essential roles in its efficiency as a treatment for OA.

A Systematic Review published in 2014 in the journal BMC Complementary Medicine and Therapies found that The use of acupuncture for osteoarthritis is associated with significant reductions in pain intensity, improvement in functional mobility and quality of life. In this systematic review, we found acupuncture administered to adults with osteoarthritis to be associated with a statistically significant reduction in pain intensity, improved functional mobility and improved health-related quality of life. Reductions in pain were greater in trials with longer intervention periods. Though under-reported and inconsistently described, major adverse events with acupuncture were not reported. Subgroup analyses suggest that acupuncture is most effective for reducing osteoarthritic pain when administered for more than four weeks. Outcome assessment for the majority of trials occurred immediately following the intervention period and thus the durability of treatment effects are unknown.

A Randomised Controlled Trial published in 2013 in the journal Osteoarthritis and Cartilage found that Tart cherry juice potentially helps alleviate symptoms of mild to moderate knee osteoarthritis and decreases the levels of high sensitivity C-reactive protein. The study involved 58 non-diabetic participants with grade 2-3 osteoarthritis as categorized by Kellgren. Participants were randomly assigned to consume two 8-ounce bottles of either tart cherry juice or a placebo daily for six weeks. There was a one-week washout period before participants switched to the alternate treatment in a crossover design. The research measured participants' Western Ontario McMaster Osteoarthritis Index scores and walking times before and after each treatment. Levels of plasma urate, creatinine, and high sensitivity C-reactive protein were also noted at baseline and after each treatment. Acetaminophen was permitted as a rescue drug with self-reporting after each treatment period. There was a noticeable reduction in Western Ontario McMaster Osteoarthritis Index scores following the cherry juice treatment, an effect not observed with the placebo. High sensitivity C-reactive protein also showed a decrease during the cherry juice treatment. The reduction in high sensitivity C-reactive protein was consistent with the improvement observed in osteoarthritis index scores. However, consumption of tart cherry juice didn't significantly affect walking time, usage of acetaminophen, or plasma urate and creatinine levels.

A Randomised Controlled Trial published in 2013 in the journal Osteoarthritis and Cartilage found that Tart cherry juice shows promise in easing knee osteoarthritis symptoms. This study included 58 patients with knee osteoarthritis (OA) who were given either cherry juice or a placebo. While both groups showed some improvement in WOMAC scores, the cherry juice group experienced a 15% improvement, compared to 6% in the placebo group. However, this difference wasn't statistically significant. The cherry juice group also saw a 23% reduction in hsCRP (an inflammation marker), whereas the placebo group had a 51% increase. This suggests an anti-inflammatory effect of cherry juice. The study notes some limitations, including small sample size and the need for further research. Overall, cherry juice may offer benefits for OA patients.

A Randomised Controlled Trial published in 2013 in the journal Annals of the Rheumatic Diseases found that The daily use of avocado-soybean unsaponifiable-expanscience (ASU-E) reduces the progression of joint space narrowing in patients with hip osteoarthritis. The conducted trial was a prospective, randomised, double-blind study with parallel groups under placebo control over three years. The participants included symptomatic hip osteoarthritis patients having experienced pain for a minimum of one year and featuring a joint space width (JSW) between 1 and 4 mm in the affected hip. Participants were assigned randomly to a daily intake of 300 mg ASU-E or a placebo. Annual pelvic radiographs in standing position were performed, with the primary focus on the change in JSW at the end of year three. Despite no significant difference in mean JSW loss between the ASU-E group and placebo, fewer progressors (patients with JSW loss of 0.5mm or more) were recorded in the ASU-E group, marking a 20% decrease compared to the placebo group. This indicates a potential therapeutic effect of ASU-E on the structural integrity of hip joints in osteoarthritis patients. However, clinical outcome comparisons did not yield any significant differences between the groups. The safety profile of ASU-E was determined to be excellent.

A Randomised Controlled Trial published in 2012 in the journal Journal of Food Studies found that Tart cherry juice may lessen inflammation, thus reducing pain in women with osteoarthritis, according to changes noted in specific inflammatory serum biomarkers. This study used a randomized, double blind, placebo-controlled trial design, involving twenty women with inflammatory osteoarthritis, aged between 40 to 70 years. The participants were given 10.5 ounce bottles of tart cherry juice or a placebo cherry drink to consume twice daily for a span of 21 consecutive days. Pain was assessed at the start and the end of the intervention period. At these same junctures, blood samples were collected to monitor the influence of the juice on serum biomarkers of inflammation: C-Reactive Protein, Interleukin-6, Interleukin-10, and Tumor Necrosis Factor-alpha. The results depicted that the group consuming tart cherry juice experienced a significant reduction in the serum biomarker, C-Reactive Protein, an indication of lowered inflammation. This is suggestive that tart cherry juice could be an efficient way of reducing inflammation, and subsequently, the pain experienced by women suffering from osteoarthritis.

A Systematic Review published in 2011 in the journal Pain Medicine found that Ginger can reduce the direct activation of type 3 and 4 afferent nerve fibers by substances such as bradykinin and sensitization of afferent fibers by prostaglandins and cytokines. Due to a paucity of well-conducted trials, evidence of the efficacy of Z. officinale to treat pain remains insufficient. However, the available data provide tentative support for the anti-inflammatory role of Z. officinale constituents, which may reduce the subjective experience of pain in some conditions such as osteoarthritis. Further rigorous trials therefore seem to be warranted.

Moderation Tools

---

Topic