Rheumatology International

, Volume 35, Issue 2, pp 211–232

Ayurvedic interventions for osteoarthritis: a systematic review and meta-analysis

Authors

    • Department of Internal and Complementary MedicineImmanuel Hospital Berlin
    • Institute of Social Medicine, Epidemiology and Health EconomicsCharité University Medical Centre
  • Lea Pinders
    • Institute of Social Medicine, Epidemiology and Health EconomicsCharité University Medical Centre
  • Andreas Michalsen
    • Department of Internal and Complementary MedicineImmanuel Hospital Berlin
    • Institute of Social Medicine, Epidemiology and Health EconomicsCharité University Medical Centre
  • Holger Cramer
    • Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of MedicineUniversity of Duisburg-Essen
Review Article

DOI: 10.1007/s00296-014-3095-y

Cite this article as:
Kessler, C.S., Pinders, L., Michalsen, A. et al. Rheumatol Int (2015) 35: 211. doi:10.1007/s00296-014-3095-y

Abstract

Ayurveda is one of the fastest growing systems within complementary and alternative medicine. However, the evidence for its effectiveness is unsatisfactory. The aim of this work was to review and meta-analyze the effectiveness and safety of different Ayurvedic interventions in patients with osteoarthritis (OA). 138 electronic databases were searched through August 2013. Randomized controlled trials, randomized crossover studies, cluster-randomized trials, and non-randomized controlled clinical trials were eligible. Adults with pre-diagnosed OA were included as participants. Interventions were included as Ayurvedic if they were explicitly labeled as such. Main outcome measures were pain, physical function, and global improvement. Risk of bias was assessed using the Cochrane risk of bias tool. 19 randomized and 14 non-randomized controlled trials on 12 different drugs and 3 non-pharmaceutical interventions with a total of 2,952 patients were included. For the compound preparation, Rumalaya, large and apparently unbiased effects beyond placebo were found for pain (standardized mean difference [SMD] −3.73; 95 % confidence interval [CI] −4.97, −2.50; P < 0.01) and global improvement (risk ratio 12.20; 95 % CI 5.83, 25.54; P < 0.01). There is also some evidence that effects of the herbal compound preparation Shunti-Guduchi are comparable to those of glucosamine for pain (SMD 0.08; 95 % CI −0.20, 0.36; P = 0.56) and function (SMD 0.15; 95 % CI −0.12, 0.36; P = 0.41). Based on single trials, positive effects were found for the compound preparations RA-11, Reosto, and Siriraj Wattana. For Boswellia serrata, Lepidium Sativum, a Boswellia serrata containing multicomponent formulation and the compounds Nirgundi Taila, Panchatikta Ghrita Guggulu, and Rhumayog, and for non-pharmacological interventions like Ayurvedic massage, steam therapy, and enema, no evidence for significant effects against potential methodological bias was found. No severe adverse events were observed in all trials. The drugs Rumalaya and Shunti-Guduchi seem to be safe and effective drugs for treatment of OA-patients, based on these data. However, several limitations relate to clinical research on Ayurveda. Well-planned, well-conducted and well-published trials are warranted to improve the evidence for Ayurvedic interventions.

Keywords

AyurvedaComplementary medicineOsteoarthritisSystematic reviewMeta-analysis

Abbreviations

ACR

American College of Rheumatology

CAM

Complementary and alternative medicine

CCT

Controlled clinical trial

CI

Confidence interval

DHARA

Digital helpline for Ayurveda research articles

OA

Osteoarthritis

NSAID

Non-steroidal anti-inflammatory drug

RCT

Randomized controlled trial

RR

Risk ratio

SMD

Standardized mean difference

TCM

Traditional Chinese medicine

TIM

Traditional Indian medicine

TM

Traditional medicine

WHO

World Health Organization

WMS

Whole medical system

WOMAC

Western Ontario and McMaster Universities Osteoarthritis Index

Copyright information

© Springer-Verlag Berlin Heidelberg 2014