Rheumatology International

, Volume 35, Issue 2, pp 211–232

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

  • Christian S. Kessler
  • Lea Pinders
  • Andreas Michalsen
  • Holger Cramer
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


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.


AyurvedaComplementary medicineOsteoarthritisSystematic reviewMeta-analysis



American College of Rheumatology


Complementary and alternative medicine


Controlled clinical trial


Confidence interval


Digital helpline for Ayurveda research articles




Non-steroidal anti-inflammatory drug


Randomized controlled trial


Risk ratio


Standardized mean difference


Traditional Chinese medicine


Traditional Indian medicine


Traditional medicine


World Health Organization


Whole medical system


Western Ontario and McMaster Universities Osteoarthritis Index

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Christian S. Kessler
    • 1
    • 2
  • Lea Pinders
    • 2
  • Andreas Michalsen
    • 1
    • 2
  • Holger Cramer
    • 3
  1. 1.Department of Internal and Complementary MedicineImmanuel Hospital BerlinBerlinGermany
  2. 2.Institute of Social Medicine, Epidemiology and Health EconomicsCharité University Medical CentreBerlinGermany
  3. 3.Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of MedicineUniversity of Duisburg-EssenEssenGermany