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Improved WOMAC score following 16-week treatment with bromelain for knee osteoarthritis

Clinical Rheumatology volume 35, pages 2531–2540 (2016)Cite this article

Abstract

Treatment with bromelain-containing enzyme preparation for 3–4 weeks is effective for treatment of knee osteoarthritis (OA). Here, we aimed to assess 16-week treatment with bromelain in mild-to-moderate knee OA patients. We performed a randomized, single-blind, active-controlled pilot study. Forty knee OA patients were randomized to receive oral bromelain (500 mg/day) or diclofenac (100 mg/day). Primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) analyzed by Wilcoxon signed rank test. Secondary outcome was the short-form 36 (SF-36). Plasma malondialdehyde (MDA) and nitrite were measured as oxidative stress markers. There was no difference in WOMAC and SF-36 scores compared between bromelain and diclofenac groups after 4 weeks. At week 4, the improvement of total WOMAC and pain subscales from baseline was observed in both groups; however, two patients given diclofenac had adverse effects leading to discontinuation of diclofenac. However, observed treatment difference was inconclusive. At week 16 of bromelain treatment, the patients had improved total WOMAC scores (12.2 versus 25.5), pain subscales (2.4 versus 5.6), stiffness subscales (0.8 versus 2.0), and function subscales (9.1 versus 17.9), and physical component of SF-36 (73.3 versus 65.4) as compared with baseline values. OA patients had higher plasma MDA, nitrite, and prostaglandin E2 (PGE2) in lipopolysaccharide (LPS)-stimulated whole blood but lower plasma α-tocopherol than control subjects. Plasma MDA and LPS-stimulated PGE2 production were decreased at week 16 of bromelain treatment. Bromelain has no difference in reducing symptoms of mild-to-moderate knee OA after 4 weeks when compared with diclofenac.

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Acknowledgments

This work was supported by the Program Strategic Scholarships for Frontier Research Network for the Joint Ph.D. Program, the Office of the Higher Education Commission, Thailand, and Department of Pharmacology, Faculty of Science, Mahidol University. We thank all patients and healthy subjects who participated in this study.

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Authors and Affiliations

  1. Department of Pharmacology, Faculty of Science, Mahidol University, 272 Rama 6 Road, Bangkok, 10400, Thailand

    Thitima Kasemsuk, Nathawut Sibmooh & Supeenun Unchern

  2. Department of Orthopedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama 6 Road, Bangkok, 10400, Thailand

    Nadhaporn Saengpetch

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  1. Thitima Kasemsuk
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  2. Nadhaporn Saengpetch
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  3. Nathawut Sibmooh
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Correspondence to Supeenun Unchern.

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This study was approved by the Ramathibodi Hospital Ethics Committee, Faculty of Medicine Ramathibodi Hospital, Mahidol University, in accordance with Declaration of Helsinki. All patients provided the written informed consent before randomization.

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Kasemsuk, T., Saengpetch, N., Sibmooh, N. et al. Improved WOMAC score following 16-week treatment with bromelain for knee osteoarthritis. Clin Rheumatol 35, 2531–2540 (2016). https://doi.org/10.1007/s10067-016-3363-1

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  • DOI: https://doi.org/10.1007/s10067-016-3363-1

Keywords

  • Bromelain
  • Diclofenac
  • Knee osteoarthritis
  • Malondialdehyde
  • SF-36
  • WOMAC