Clinical Overview: Turmeric for the Management of Osteoarthritis

Key Takeaways

1. Osteoarthritis (OA) affects over 32 million adults in the United States, involving the entire joint and causing inflammation, pain, stiffness, and mobility loss, with primary OA being the more common form without a known identifiable cause.
2. Pharmacologic agents like acetaminophen, intra-articular glucocorticoid injections, tramadol, and others are used for OA management, while dietary supplements, including turmeric, though not strongly recommended, may offer some relief based on limited evidence, especially for knee OA.
3. Turmeric has shown potential in reducing knee pain and improving physical function in OA, but caution is advised due to limited high-quality studies, varied product formulations, potential drug interactions, and uncertain optimal dosing, emphasizing the need for a prudent approach when considering its use.

Osteoarthritis (OA) affects more than 32 million adults in the United States.¹ It is a disease of the entire joint, which includes the bone, cartilage, ligaments, fat, and the tissues lining the joint, resulting in inflammation, pain, stiffness, and loss of mobility.²

Primary OA, in which an identifiable cause is not known, is the more common form of the disease.³ In secondary OA, inflammation, trauma, metabolic or endocrine disorders, and/or congenital factors can be identified as the cause of damage to the joint.³

The management of OA is personalized for each patient and it is based on the severity of joint involvement, on comorbid conditions, and on the patient’s overall quality of life. Non-pharmacologic strategies for managing OA include weight loss, when appropriate, exercise programs, and, in severe cases, surgery.³

Pharmacologic agents used in OA include acetaminophen, oral and topical non-steroidal anti-inflammatory drugs (NSAIDs), intra-articular glucocorticoid injections, tramadol, duloxetine, topical capsaicin, intra-articular hyaluronic acid injections, and opioid analgesics.³ Notably, with the exception of chondroitin when used for OA of the hand, dietary supplements are not recommended by the 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.⁴

Nonetheless, patients often resort to using dietary supplements. One such supplement that has been promoted for the management of OA is turmeric.

Turmeric (Curcuma longa) is a plant that has long been used in Chinese and Ayurvedic medicine as an anti-inflammatory agent.⁵ Its primary active component is curcumin, a yellow-colored constituent.

Curcumin has been suggested to possess anti-inflammatory and analgesic effects as well as other health benefits.⁶ As such, turmeric is promoted as a dietary supplement for a variety of conditions, including arthritis, digestive disorders, respiratory infections, allergies, liver disease, depression, and others.⁶

Oral turmeric is generally well-tolerated. The most frequently reported adverse effects (AEs) associated with its active constituent, curcumin, include gastrointestinal symptoms, headache, and dizziness, which are generally mild in nature.⁷ Turmeric should be used with caution in pregnant patients due to possible stimulation of the uterus.⁶

Additionally, consuming large quantities of turmeric may increase the risk of hepatotoxicity.⁶ Although there is limited and conflicting evidence regarding interactions between turmeric and other drugs, practitioners and patients should be made aware of the potential for these interactions.

Turmeric use with anticoagulants and anti-platelets may theoretically increase the risk of bleeding because turmeric is said to have anti-platelet effects. Turmeric might increase the risk of hypoglycemia when taken with anti-diabetic drugs. Theoretically, it might also increase serum levels of drugs metabolized by CYP3A4.⁶

NatMed rates turmeric as being “Possibly Effective” for the management of OA. This rating is based on several meta-analyses of clinical studies showing that turmeric extracts and/or curcuminoid products reduce knee pain and stiffness, improve physical function, and reduce the need for rescue medications when compared with placebo.⁶

The most recent systematic review and meta-analysis found via a PubMed search using the terms “turmeric” and “osteoarthritis” with a filter applied for “systematic reviews” was published in 2022.⁸ The aim of this review was to examine the evidence on the efficacy and safety of curcuminoids alone in the treatment of OA of the knee.

Fifteen studies with a total of 1670 patients were included in the analysis. The investigators reported that curcuminoids were significantly more effective than placebo in improving the visual analog scale (VAS) score for pain, the Western Ontario and McMaster Universities (WOMAC) total score, WOMAC pain score, WOMAC function score, and WOMAC stiffness score.

Curcuminoids were found to be non-inferior to NSAIDs in improving pain- and function-related outcomes. The investigators also reported that AEs associated with the use of curcuminoids were mainly gastrointestinal in nature and that their incidence did not differ significantly from that reported with placebo.

The investigators concluded that curcuminoids can be expected to achieve considerable analgesic and functional promotion effects for patients with symptomatic knee OA in the short term without increasing the incidence of AEs. However, investigators acknowledged that because of the low quality of the studies included in the meta-analysis and a substantial heterogeneity among them, a cautious approach should be used when considering the use of curcuminoids for knee OA.

The optimal dose of turmeric for the management of OA has not been determined, which is primarily due to the difficulty in quantifying the amount of curcumin found in the various formulations used in clinical trials.⁹

Doses typically used in clinical trials range from 1000-2000 mg per day. Turmeric products are available on the market in different dosage forms, including capsules, tablets, powder, and liquid, and in a variety of strengths.

In summary, when asked about turmeric’s use for managing osteoarthritis, pharmacists should be cautious in their recommendations and recognize the limited evidence that exists to support such use. Nonetheless, the evidence, although weak, does suggest that turmeric may provide some benefit in the management of OA of the knee.

About the Authors

Jenna Deng, PharmD Candidate; Zayda Habib, PharmD Candidate; Dana Persaud, PharmD Candidate; Joseph P. Nathan, PharmD, MS (corresponding author), LIU Pharmacy (Arnold & Marie Schwartz College of Pharmacy and Health Sciences), Brooklyn, New York.

References

1. Osteoarthritis (OA). Centers for Disease Control and Prevention. July 27, 2020. Accessed August 9, 2023. https://www.cdc.gov/arthritis/basics/osteoarthritis.htm
2. Osteoarthritis. Arthritis Foundation. Accessed August 9, 2023. https://www.arthritis.org/diseases/osteoarthritis
3. Buys LM, Wiedenfeld SA. Osteoarthritis. In: DiPiro JT, Yee GC, Haines ST, Nolin TD, Ellingrod VL, Posey L. eds. DiPiro’s Pharmacotherapy: A Pathophysiologic Approach, 12th Edition. McGraw Hill; 2023. Accessed August 08, 2023. https://0-accesspharmacy-mhmedical-com.liucat.lib.liu.edu/content.aspx?bookid=3097&sectionid=267341739
4. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee [published correction appears in Arthritis Care Res (Hoboken). 2021 May;73(5):764]. Arthritis Care Res (Hoboken). 2020;72(2):149-162. doi:10.1002/acr.24131
5. Daily JW, Yang M, Park S. Efficacy of Turmeric Extracts and Curcumin for Alleviating the Symptoms of Joint Arthritis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. J Med Food. 2016;19(8):717-729. doi:10.1089/jmf.2016.3705
6. Turmeric. NatMed. December 9, 2022. Accessed August 8, 2023. https://naturalmedicines.therapeuticresearch.com/
7. Panknin TM, Howe CL, Hauer M, Bucchireddigari B, Rossi AM, Funk JL. Curcumin Supplementation and Human Disease: A Scoping Review of Clinical Trials. Int J Mol Sci. 2023;24(5):4476. Published 2023 Feb 24. doi:10.3390/ijms24054476
8. Feng J, Li Z, Tian L, et al. Clinical significance of curcuminoids alone in alleviating pain and dysfunction for knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. BMC Complementary Medicine and Therapies. 2022;22:276. doi:10.21203/rs.3.rs-1749512/v1
9. Paultre K, Cade W, Hernandez D, Reynolds J, Greif D, Best TM. Therapeutic effects of turmeric or curcumin extract on pain and function for individuals with knee osteoarthritis: a systematic review. BMJ Open Sport Exerc Med. 2021;7(1):e000935. Published 2021 Jan 13. doi:10.1136/bmjsem-2020-000935