Some patients with osteoarthritis have localized effusion or synovitis of the knee; this group suggests an inflammatory phenotype of osteoarthritis that may benefit from anti-inflammatory therapy. Curcuma longa, an Ayurvedic and Chinese traditional medicine, has anti-inflammatory and analgesic properties. This randomized controlled trial examined the efficacy of Curcuma longa extract for treating patients with symptomatic knee osteoarthritis and evidence of knee effusion or synovitis.
Abstract
Background:
Current pharmacologic therapies for patients with osteoarthritis are suboptimal.
Objective:
To determine the efficacy of Curcuma longa extract (CL) for reducing knee symptoms and effusion–synovitis in patients with symptomatic knee osteoarthritis and knee effusion–synovitis.
Design:
Randomized, double-blind, placebo-controlled trial. (Australian New Zealand Clinical Trials Registry: ACTRN12618000080224)
Setting:
Single-center study with patients from southern Tasmania, Australia.
Participants:
70 participants with symptomatic knee osteoarthritis and ultrasonography-defined effusion–synovitis.
Intervention:
2 capsules of CL (n = 36) or matched placebo (n = 34) per day for 12 weeks.
Measurements:
The 2 primary outcomes were changes in knee pain on a visual analogue scale (VAS) and effusion–synovitis volume on magnetic resonance imaging (MRI). The key secondary outcomes were change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and cartilage composition values. Outcomes were assessed over 12 weeks.
Results:
CL improved VAS pain compared with placebo by −9.1 mm (95% CI, −17.8 to −0.4 mm [P = 0.039]) but did not change effusion–synovitis volume (3.2 mL [CI, −0.3 to 6.8 mL]). CL also improved WOMAC knee pain (−47.2 mm [CI, −81.2 to −13.2 mm]; P = 0.006) but not lateral femoral cartilage T2 relaxation time (−0.4 ms [CI, −1.1 to 0.3 ms]). The incidence of adverse events was similar in the CL (n = 14 [39%]) and placebo (n = 18 [53%]) groups (P = 0.16); 2 events in the CL group and 5 in the placebo group may have been treatment related.
Limitation:
Modest sample size and short duration.
Conclusion:
CL was more effective than placebo for knee pain but did not affect knee effusion–synovitis or cartilage composition. Multicenter trials with larger sample sizes are needed to assess the clinical significance of these findings.
Primary Funding Source:
University of Tasmania and Natural Remedies Private Limited.
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Author, Article, and Disclosure Information
Zhiqiang Wang,
University of Tasmania, Hobart, Tasmania, Australia (Z.W., G.J., T.W., G.C., L.L.L., D.A., A.S., B.A.)
Monash University, Melbourne, Victoria, Australia (I.H.)
Royal Hobart Hospital, Hobart, Tasmania, Australia (R.J.)
University of Queensland, Brisbane, Queensland, Australia (J.F.)
University of Tasmania, Hobart, Tasmania, Australia, and Southern Medical University, Guangzhou, China (C.D.)
Acknowledgment: The authors thank the participants who kindly took part in CurKOA (A Randomised Trial of Curcuma longa for Treating Symptoms and Effusion–Synovitis of Knee Osteoarthritis). They thank Gudrun Wells and Kathy Buttigieg for their work as clinical trial coordinators and Leigh Blizzard for additional statistical advice.
Financial Support: This investigator-initiated trial received partial funding from Natural Remedies Private Limited (Bengaluru). Curcuma longa extract and placebo capsules were supplied by Natural Remedies, according to the investigators' requirements. The company had no role in the design, implementation, or data analyses of the study. None of the investigators have received any other financial support from the company.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-0990.
Data Sharing Statement: The following data may be made available at the discretion of the principal investigator beginning 12 March 2020 and ending 12 March 2022: deidentified participant data (contact Benny Antony; e-mail, Benny.
Corresponding Author: Benny Antony, PhD, Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania 7000, Australia; e-mail, Benny.
Current Author Addresses: Mr. Wang; Drs. G. Jones, Winzenberg, Cai, Laslett, Aitken, Ding, and Antony; and Mr. Singh: Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania 7000, Australia.
Dr. Hopper: The Alfred Centre, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia.
Dr. R. Jones: Royal Hobart Hospital, 48 Liverpool Street, Hobart, Tasmania 7000 Australia.
Dr. Fripp: Health Sciences Building 901/16, University of Queensland, Herston, Queensland 4029, Australia.
Author Contributions: Conception and design: B. Antony.
Analysis and interpretation of the data: Z. Wang, B. Antony, G. Jones, T. Winzenberg, G. Cai, L.L. Laslett, D. Aitken, I. Hopper, A. Singh, R. Jones, J. Fripp, C. Ding.
Drafting of the article: Z. Wang, B. Antony. G. Jones, T. Winzenberg, L.L. Laslett, D. Aitken, I. Hopper, A. Singh, J. Fripp, C. Ding.
Critical revision for important intellectual content: B. Antony, G. Jones, T. Winzenberg, G. Cai, L.L. Laslett, D. Aitken, I. Hopper, A. Singh, C. Ding.
Final approval of the article: Z. Wang, G. Jones, T. Winzenberg, G. Cai, L.L. Laslett, D. Aitken, I. Hopper, A. Singh, R. Jones, J. Fripp, C. Ding, B. Antony.
Provision of study materials or patients: G. Jones, B. Antony.
Statistical expertise: Z. Wang, G. Cai, B. Antony.
Obtaining of funding: B. Antony.
Collection and assembly of data: Z. Wang, B. Antony.
This article was published at Annals.org on 15 September 2020.
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