Rheumatology International

, Volume 35, Issue 2, pp 211–232 | Cite as

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

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

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

Ayurveda Complementary medicine Osteoarthritis Systematic review Meta-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

Notes

Conflict of interest

There are no conflicts of interest related to the manuscript for all authors. No funding sources were provided for this work.

References

  1. 1.
    Conaghan PG, Dickson J, Grant RL (2008) Care and management of osteoarthritis in adults: summary of NICE guidance. BMJ 336(7642):502–503PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Denoeud L, Mazieres B, Payen-Champenois C, Ravaud P (2005) First line treatment of knee osteoarthritis in outpatients in France: adherence to the EULAR 2000 recommendations and factors influencing adherence. Ann Rheum Dis 64(1):70–74PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Fernandes L, Hagen KB, Bijlsma JW, Andreassen O, Christensen P, Conaghan PG, Doherty M, Geenen R, Hammond A, Kjeken I, Lohmander LS, Lund H, Mallen CD, Nava T, Oliver S, Pavelka K, Pitsillidou I, da Silva JA, de la Torre J, Zanoli G, Vliet Vlieland TP (2013) EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheum Dis 72(7):1125–1135PubMedCrossRefGoogle Scholar
  4. 4.
    Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, Towheed T, Welch V, Wells G, Tugwell P (2012) American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken) 64(4):465–474CrossRefGoogle Scholar
  5. 5.
    Larmer PJ, Reay ND, Aubert ER, Kersten P (2014) Systematic review of guidelines for the physical management of osteoarthritis. Arch Phys Med Rehabil 95(2):375–389PubMedCrossRefGoogle Scholar
  6. 6.
    Tramer MR, Moore RA, Reynolds DJ, McQuay HJ (2000) Quantitative estimation of rare adverse events which follow a biological progression: a new model applied to chronic NSAID use. Pain 85(1–2):169–182PubMedCrossRefGoogle Scholar
  7. 7.
    Antman EM, Bennett JS, Daugherty A, Furberg C, Roberts H, Taubert KA (2007) Use of nonsteroidal antiinflammatory drugs: an update for clinicians: a scientific statement from the American Heart Association. Circulation 115(12):1634–1642PubMedCrossRefGoogle Scholar
  8. 8.
    Kearney PM, Baigent C, Godwin J, Halls H, Emberson JR, Patrono C (2006) Do selective cyclo-oxygenase-2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials. BMJ 332(7553):1302–1308PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Dieppe P, Marsden D (2013) Managing arthritis: the need to think about whole systems. Rheumatology (Oxford) 52(8):1345–1346CrossRefGoogle Scholar
  10. 10.
    Institute for Public Opinion (2011) Naturheilmittel 2010. Ergebnisse einer bevölkerungsrepräsentativen Befragung. http://www.pandalisde/naturheilmittel.pdf. Accessed 27 August 2012
  11. 11.
    Jadhav PM, Jadhav MP (2013) Complementary and alternative medicine and conventional medicine: hand in hand. J Clin Rheumatol 19(4):227PubMedCrossRefGoogle Scholar
  12. 12.
    Morandi A, Tosto C, Roberti di Sarsina P, Dalla Libera D (2011) Salutogenesis and Ayurveda: indications for public health management. EPMA J 2(4):459–465PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Bagla P (2011) Traditional medicine. Piercing the veil of Ayurveda. Science 334(6062):1491PubMedCrossRefGoogle Scholar
  14. 14.
    Kessler C, Michalsen A (2012) The role of whole medical systems in global medicine. Forsch Komplementmed 19(2):65–66PubMedCrossRefGoogle Scholar
  15. 15.
    World Health Organization (2002) Traditional Medicine Strategy. WHO Regional Publications, GenevaGoogle Scholar
  16. 16.
    World Health Organization (2002) Traditional Medicine in Asia. WHO Regional Publications, New DelhiGoogle Scholar
  17. 17.
    Cooper EL (2008) Ayurveda and eCAM: a Closer Connection. Evid Based Complement Alternat Med 5(2):121–122PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Cooper EL (2008) Ayurveda is embraced by eCAM. Evid Based Complement Alternat Med 5(1):1–2PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    World Health Organization (2010) Benchmarks for training in traditional/complementary and alternative medicine: Benchmarks for training in Ayurveda. World Health Organization, GenevaGoogle Scholar
  20. 20.
    Chopra A, Saluja M, Tillu G, Sarmukkaddam S, Venugopalan A, Narsimulu G, Handa R, Sumantran V, Raut A, Bichile L, Joshi K, Patwardhan B (2013) Ayurvedic medicine offers a good alternative to glucosamine and celecoxib in the treatment of symptomatic knee osteoarthritis: a randomized, double-blind, controlled equivalence drug trial. Rheumatology (Oxford) 52(8):1408–1417CrossRefGoogle Scholar
  21. 21.
    Furst DE, Venkatraman MM, Krishna Swamy BG, McGann M, Booth-Laforce C, Ram Manohar P, Sarin R, Mahapatra A, Krishna Kumar PR (2011) Well controlled, double-blind, placebo-controlled trials of classical Ayurvedic treatment are possible in rheumatoid arthritis. Ann Rheum Dis 70(2):392–393PubMedCrossRefGoogle Scholar
  22. 22.
    Furst DE, Venkatraman MM, McGann M, Manohar PR, Booth-LaForce C, Sarin R, Sekar PG, Raveendran KG, Mahapatra A, Gopinath J, Kumar PR (2011) Double-blind, randomized, controlled, pilot study comparing classic Ayurvedic medicine, methotrexate, and their combination in rheumatoid arthritis. J Clin Rheumatol 17(4):185–192PubMedCrossRefGoogle Scholar
  23. 23.
    Witt CM, Michalsen A, Roll S, Morandi A, Gupta S, Rosenberg M, Kronpass L, Stapelfeldt E, Hissar S, Muller M, Kessler C (2013) Comparative effectiveness of a complex Ayurvedic treatment and conventional standard care in osteoarthritis of the knee–study protocol for a randomized controlled trial. Trials 14:149PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Manohar PR (2011) Whole system research and ayurveda. Anc Sci Life 31(2):37PubMedPubMedCentralGoogle Scholar
  25. 25.
    Manohar PR, Eranezhath SS, Mahapatra A, Manohar SR (2012) DHARA: digital helpline for Ayurveda research articles. J Ayurveda Integr Med 3(2):97–101PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Agarwal V, Abhijnhan A, Raviraj P (2007) Ayurvedic medicine for schizophrenia. Cochrane Database Syst Rev 4:CD006867PubMedGoogle Scholar
  27. 27.
    Hardy ML, Coulter I, Venuturupalli S, Roth EA, Favreau J, Morton SC, Shekelle P (2001) Ayurvedic interventions for diabetes mellitus: a systematic review. Evid Rep Technol Assess (Summ) 41:2pGoogle Scholar
  28. 28.
    Kongkeaw C, Dilokthornsakul P, Thanarangsarit P, Limpeanchob N, Norman Scholfield C (2014) Meta-analysis of randomized controlled trials on cognitive effects of Bacopa monnieri extract. J Ethnopharmacol 151(1):528–535PubMedCrossRefGoogle Scholar
  29. 29.
    Park J, Ernst E (2005) Ayurvedic medicine for rheumatoid arthritis: a systematic review. Semin Arthritis Rheum 34(5):705–713PubMedCrossRefGoogle Scholar
  30. 30.
    Shekelle PG, Hardy M, Morton SC, Coulter I, Venuturupalli S, Favreau J, Hilton LK (2005) Are Ayurvedic herbs for diabetes effective? J Fam Pract 54(10):876–886PubMedGoogle Scholar
  31. 31.
    Singh BB, Khorsan R, Vinjamury SP, Der-Martirosian C, Kizhakkeveettil A, Anderson TM (2007) Herbal treatments of asthma: a systematic review. J Asthma 44(9):685–698PubMedCrossRefGoogle Scholar
  32. 32.
    Singh BB, Vinjamury SP, Der-Martirosian C, Kubik E, Mishra LC, Shepard NP, Singh VJ, Meier M, Madhu SG (2007) Ayurvedic and collateral herbal treatments for hyperlipidemia: a systematic review of randomized controlled trials and quasi-experimental designs. Altern Ther Health Med 13(4):22–28PubMedGoogle Scholar
  33. 33.
    Sridharan K, Mohan R, Ramaratnam S, Panneerselvam D (2011) Ayurvedic treatments for diabetes mellitus. Cochrane Database Syst Rev 12:CD008288PubMedGoogle Scholar
  34. 34.
    Dash B, Sharma R (2001) Caraka Samhita: Text with English Translation and Critical Exposition based o Cakrapani Datta’s Ayurveda Dipika. Chaukhamba Sanskrit Series Office, New DelhiGoogle Scholar
  35. 35.
    Gupta S, Stapelfeld E (2009) Praxis Ayurveda-Medizin. Kaya cikitsa. Therapiekonzepte für innere Erkrankungen. Haug, StuttgartGoogle Scholar
  36. 36.
    Morandi A, Tosto C (2011) Ayurveda, the paradigm for personalized medicine. EPMA J 2:S152–S153CrossRefGoogle Scholar
  37. 37.
    Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, Christy W, Cooke TD, Greenwald R, Hochberg M et al (1986) Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum 29(8):1039–1049PubMedCrossRefGoogle Scholar
  38. 38.
    Belo JN, Berger MY, Koes BW, Bierma-Zeinstra SM (2009) The prognostic value of the clinical ACR classification criteria of knee osteoarthritis for persisting knee complaints and increase of disability in general practice. Osteoarthritis Cartilage 17(10):1288–1292PubMedCrossRefGoogle Scholar
  39. 39.
    Feuerstein G (1998) The yoga tradition. Hohm Press, PrescottGoogle Scholar
  40. 40.
    Cramer H, Lauche R, Langhorst J, Dobos G (2013) Yoga for rheumatic diseases: a systematic review. Rheumatology (Oxford) 52(11):2025–2030CrossRefGoogle Scholar
  41. 41.
    Bellamy N, Kirwan J, Boers M, Brooks P, Strand V, Tugwell P, Altman R, Brandt K, Dougados M, Lequesne M (1997) Recommendations for a core set of outcome measures for future phase III clinical trials in knee, hip, and hand osteoarthritis. Consensus development at OMERACT III. J Rheumatol 24(4):799–802PubMedGoogle Scholar
  42. 42.
    Pham T, Van Der Heijde D, Lassere M, Altman RD, Anderson JJ, Bellamy N, Hochberg M, Simon L, Strand V, Woodworth T, Dougados M (2003) Outcome variables for osteoarthritis clinical trials: the OMERACT-OARSI set of responder criteria. J Rheumatol 30(7):1648–1654PubMedGoogle Scholar
  43. 43.
    Juhl C, Lund H, Roos EM, Zhang W, Christensen R (2012) A hierarchy of patient-reported outcomes for meta-analysis of knee osteoarthritis trials: empirical evidence from a survey of high impact journals. Arthritis 2012:136245PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Bayerische Staatsbibliothek München (2014) Bayerische Staatsbibliothek. http://rzblx10.uni-regensburg.de/dbinfo/dbliste.php?bib_id=bsb&lett=f&gebiete=8). Accessed January 15th 2014
  45. 45.
    Babu S, Shetty M (2005) Yoga Ratnakara (Sanskrit Text with English Translation and Explanatory Notes). Chaukhamba Sanskrit Series Office, VaranasiGoogle Scholar
  46. 46.
    Murthy S (1998) Bhava Prakasha (Translation). Chaukhamba Orientalia, VaranasiGoogle Scholar
  47. 47.
    Murthy SK (2001) Madhava Nidanam (Roga Viniscaya) of Mahavakara (A Treatise on Ayurveda). Chaukambha Orientala, VaranasiGoogle Scholar
  48. 48.
    Higgins J, Green S (2008) Cochrane handbook for systematic reviews of interventions. Wiley, West SussexCrossRefGoogle Scholar
  49. 49.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    The Nordic Cochrane Centre (2013) Review Manager 5 software (Version 5.1), CopenhagenGoogle Scholar
  51. 51.
    Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634PubMedCrossRefPubMedCentralGoogle Scholar
  52. 52.
    Chopra A, Saluja M, Tillu G, Venugopalan A, Sarmukaddam S, Raut AK, Bichile L, Narsimulu G, Handa R, Patwardhan B (2011) A randomized controlled exploratory evaluation of standardized Ayurvedic formulations in symptomatic osteoarthritis knees: a Government of India NMITLI project. Evid Based Complement Alternat Med 2011:724291PubMedCrossRefPubMedCentralGoogle Scholar
  53. 53.
    Rastogi S, Sivaraman ST (2003) Evaluating the safety and efficacy of Rumalaya forte: a double-blind clinical trial. Orthopaedics Today 5(1):63–65Google Scholar
  54. 54.
    Singh U, Kishore K, Seth S (1997) Comparative clinical study of indigenous drug with Ibuprofen in patients of osteoarthritis. Indian J Phys Med Rehabil (IJPMR) 8–9(April):29–30Google Scholar
  55. 55.
    Srivastava KC, Mustafa T (1992) Ginger (Zingiber officinale) in rheumatism and musculoskeletal disorders. Med Hypotheses 39(4):342–348PubMedCrossRefGoogle Scholar
  56. 56.
    Kimmatkar N, Thawani V, Hingorani L, Khiyani R (2003) Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee–a randomized double blind placebo controlled trial. Phytomedicine 10(1):3–7PubMedCrossRefGoogle Scholar
  57. 57.
    Sengupta K, Alluri KV, Satish AR, Mishra S, Golakoti T, Sarma KV, Dey D, Raychaudhuri SP (2008) A double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin for treatment of osteoarthritis of the knee. Arthritis Res Ther 10(4):R85PubMedCrossRefPubMedCentralGoogle Scholar
  58. 58.
    Sengupta K, Krishnaraju AV, Vishal AA, Mishra A, Trimurtulu G, Sarma KV, Raychaudhuri SK, Raychaudhuri SP (2010) Comparative efficacy and tolerability of 5-Loxin and Aflapin against osteoarthritis of the knee: a double blind, randomized, placebo controlled clinical study. Int J Med Sci 7(6):366–377PubMedCrossRefPubMedCentralGoogle Scholar
  59. 59.
    Gupta I, Gupta S, Parihar A (1993) S-compound: a traditional drug for osteoarthritis patients. Indian Practitioner 46(1):69–72Google Scholar
  60. 60.
    Gupta PK, Samarakoon SM, Chandola HM, Ravishankar B (2011) Clinical evaluation of Boswellia serrata (Shallaki) resin in the management of Sandhivata (osteoarthritis). Ayu 32(4):478–482PubMedCrossRefPubMedCentralGoogle Scholar
  61. 61.
    Sontakke S, Thawani V, Pimpalkhute S, Kabra P, Babhulkar S, Hingorani L (2007) Open, randomized, controlled clinical trial of Boswellia serrata extract as compared to valdecoxib in osteoarthritis of knee. Indian J Pharmacol 39(1):27CrossRefGoogle Scholar
  62. 62.
    Kulkarni RR, Patki PS, Jog VP, Gandage SG, Patwardhan B (1991) Treatment of osteoarthritis with a herbomineral formulation: a double-blind, placebo-controlled, cross-over study. J Ethnopharmacol 33(1–2):91–95PubMedCrossRefGoogle Scholar
  63. 63.
    Raval ND, Pandya TN (2009) Clinical Trial of Lepidium Sativum Linn (Chandrashura) in the Management of Sandhivata (Osteoarthritis). AYU (An international quarterly journal of research in Ayurveda) 30(2):153Google Scholar
  64. 64.
    Das B, Padhi MM, Singh OP, Deep VC, Tewari NS, Panda N (2003) Clinical evaluation of nirgundi taila in the management of sandhivata. Anc Sci Life 23(1):22–34PubMedPubMedCentralGoogle Scholar
  65. 65.
    Akhtar B, Mahto RR, Dave AR, Shukla VD (2010) Clinical study on Sandhigata Vata w.s.r. to Osteoarthritis and its management by Panchatikta Ghrita Guggulu. Ayu 31(1):53–57PubMedCrossRefPubMedCentralGoogle Scholar
  66. 66.
    Sharma A, Sharma R, Mohite K (2003) Management of Sandhigata vata (OA) with Shamana and Shodhana therapy—a Pilot study. J Res Ayurveda Siddha CCRAS XXIV: 1–2Google Scholar
  67. 67.
    Chopra A, Lavin P, Patwardhan B, Chitre D (2004) A 32-week randomized, placebo-controlled clinical evaluation of RA-11, an Ayurvedic drug, on osteoarthritis of the knees. J Clin Rheumatol 10(5):236–245PubMedCrossRefGoogle Scholar
  68. 68.
    Nachinolcar UC, Prasad DP, Prasad SR, Mitra SK (2007) Rumalaya forte and Reosto in Osteoarthritis: a combined study. Med Update 15(4):27–35Google Scholar
  69. 69.
    Agarwal ND, Gureja Y, Khosla AC, Agarwal JR (1971) Rumalaya in rheumatoid arthritis and osteo arthritis (a double-blind trial). Probe 10:45–49Google Scholar
  70. 70.
    Chandanwale AS, Kulkarni KS (2003) Clinical evaluation of Rumalaya forte in osteoarthrosis. Med Update 10:23–26Google Scholar
  71. 71.
    Khare KD, Khare R, Kolhapure SA (2004) Evaluation of the efficacy and safety of JT-2000* in Osteoarthritis: a randomized controlled clinical trial. Indian J Clin Pract 14(10):42–47Google Scholar
  72. 72.
    Jamdar J, Singh K, Kulhalli P, Chakma T (2004) Study of ayurvedic drug (rhumayog) compared to brufen in osteoarthritis. Antiseptic 101(2):62–65Google Scholar
  73. 73.
    Singh U, Kishore K, Seth S (1997) Comparative clinical study of indigenous drug with Ibuprofen in patients of osteoarthritis. Indian J Phys Med Rehabil (IJPMR) 8–9(April):29–30Google Scholar
  74. 74.
    Srivastava N, Sadh R, Jain B, Kolhapure S (2005) Evaluation and comparative clinical efficacy and safety of Rumalaya forte in patients suffering from osteoarthritis of the knee. Indian J Clin Prac 16:19–30Google Scholar
  75. 75.
    Upadhyay L, Tripathi K (2004) Clinical evaluation of the efficacy of JT-2000 (Rumalaya forte) in the management of osteoarthritis: a double-blind placebo-controlled trial. Med Update 11(10):31Google Scholar
  76. 76.
    Mathur HH, Khurana A, Mathur DD, Kolhapure SA (2004) Evaluation of the efficacy and safety of JT-2000 in osteoarthritis: a comparative clinical trial. Med Update 11(9):31–37Google Scholar
  77. 77.
    Sandhu HS, Kaler JS (1978) Rumalaya therapy in rheumatoid arthritis, osteoarthritis and periarthritis shoulder. Antisep 10:63–66Google Scholar
  78. 78.
    Sen B, Banerjee S, Mazumder N, Sarkar N, Roychowdury A, Majumdar P (1980) Studies on effects of Rumalaya in osteoarthritis. Indian Med J 74:151Google Scholar
  79. 79.
    Taneja DK, Chara GU (1975) Rumalaya in osteoarthritis. Antisep 72(10):527–533Google Scholar
  80. 80.
    Jamdar J, Singh K, Kulhalli P, Chakma T (2004) Study of ayurvedic drug (rhumayog) compared to brufen in osteoarthritis. Antisep 101(2):62–65Google Scholar
  81. 81.
    Chopra A, Manjit S, Tillu G, Venugopalan A, Narsimulu G, Sarmukaddam S, Patwardhan B (2012) Evaluating higher doses of Shunti-Guduchi formulations for safety in osteoarthritis knees: a government of India NMITLI arthritis project. J Ayurveda Integr Med 3(1):38–44PubMedCrossRefPubMedCentralGoogle Scholar
  82. 82.
    Chopra A, Saluja M, Tillu G, Sarmukkaddam S, Venugopalan A, Narsimulu G, Handa R, Sumantran V, Raut A, Bichile L, Joshi K, Patwardhan B (2013) Ayurvedic medicine offers a good alternative to glucosamine and celecoxib in the treatment of symptomatic knee osteoarthritis: a randomized, double-blind, controlled equivalence drug trial. Rheumatology (Oxford) 52(8):1408–1417CrossRefGoogle Scholar
  83. 83.
    Chopra A, Saluja M, Tillu G, Venugopalan A, Sarmukaddam S, Raut AK, Bichile L, Narsimulu G, Handa R, Patwardhan B (2011) A randomized controlled exploratory evaluation of standardized Ayurvedic formulations in symptomatic osteoarthritis knees: a Government of India NMITLI Project. Evid Based Complement Alternat Med 2011:724291PubMedCrossRefPubMedCentralGoogle Scholar
  84. 84.
    Joshi A, Mehta CS, Dave AR, Shukla VD (2011) Clinical effect of Nirgundi Patra pinda sweda and Ashwagandhadi Guggulu Yoga in the management of Sandhigata Vata (Osteoarthritis). Ayu 32(2):207–212PubMedCrossRefPubMedCentralGoogle Scholar
  85. 85.
    Pathak B, Dwivedi KK, Shukla KP (1992) Clinical evaluation of snehana Swedana and an Ayurvedic compound drug in sandhivata vis-a-vis osteoarthritis. JREIM 11(2):27–34Google Scholar
  86. 86.
    Rajoria K, Singh SK, Sharma RS, Sharma SN (2010) Clinical study on Laksha Guggulu, Snehana, Swedana & Traction in Osteoarthritis (Knee joint). Ayu 31(1):80–87PubMedCrossRefPubMedCentralGoogle Scholar
  87. 87.
    Prameshwa KA, SK T (2002) Comparative study of therapeutic efficacy of Samshodana and Samshamana Chikitsa in Sadhigatavata vis-a-vis osteo arthritis. JRAS 24(1–2):21–32Google Scholar
  88. 88.
    Shah M, Shukla V, Dave A, Bhatt N (2010) A Clinical study of Matra Vasti and an ayurvedic indigenous compound drug in the management of Sandhigatavata (Osteoarthritis). Ayu 31(2):210–217PubMedCrossRefPubMedCentralGoogle Scholar
  89. 89.
    Nuesch E, Trelle S, Reichenbach S, Rutjes AW, Tschannen B, Altman DG, Egger M, Juni P (2010) Small study effects in meta-analyses of osteoarthritis trials: meta-epidemiological study. BMJ 341:c3515PubMedCrossRefPubMedCentralGoogle Scholar
  90. 90.
    Zhang W, Nuki G, Moskowitz RW, Abramson S, Altman RD, Arden NK, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P (2010) OARSI recommendations for the management of hip and knee osteoarthritis: part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage 18(4):476–499PubMedCrossRefGoogle Scholar
  91. 91.
    Nelson AE, Allen KD, Golightly YM, Goode AP, Jordan JM (2013) A systematic review of recommendations and guidelines for the management of osteoarthritis: The Chronic Osteoarthritis Management Initiative of the U.S. Bone and Joint Initiative. Semin Arthritis RheumGoogle Scholar
  92. 92.
    Kessler C (2007) Wirksamkeit von Ayurveda bei chronischen Erkrankungen. Systematische Analysen klinischer Ayurveda-Studien. KVC Verlag, EssenGoogle Scholar
  93. 93.
    Schulz KF, Altman DG, Moher D (2010) CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med 152(11):726–732PubMedCrossRefGoogle Scholar
  94. 94.
    Kales SN, Christophi CA, Saper RB (2007) Hematopoietic toxicity from lead-containing Ayurvedic medications. Med Sci Monit 13(7):CR295–CR298PubMedPubMedCentralGoogle Scholar
  95. 95.
    Kales SN, Saper RB (2009) Ayurvedic lead poisoning: an under-recognized, international problem. Indian J Med Sci 63(9):379–381PubMedCrossRefGoogle Scholar
  96. 96.
    Saper RB, Kales SN, Paquin J, Burns MJ, Eisenberg DM, Davis RB, Phillips RS (2004) Heavy metal content of ayurvedic herbal medicine products. JAMA 292(23):2868–2873PubMedCrossRefGoogle Scholar
  97. 97.
    Saper RB, Phillips RS, Sehgal A, Khouri N, Davis RB, Paquin J, Thuppil V, Kales SN (2008) Lead, mercury, and arsenic in US- and Indian-manufactured Ayurvedic medicines sold via the Internet. JAMA 300(8):915–923PubMedCrossRefPubMedCentralGoogle Scholar
  98. 98.
    Raviraja A, Vishal Babu GN, Sehgal A, Saper RB, Jayawardene I, Amarasiriwardena CJ, Venkatesh T (2010) Three cases of lead toxicity associated with consumption of ayurvedic medicines. Indian J Clin Biochem 25(3):326–329PubMedCrossRefPubMedCentralGoogle Scholar

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

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