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Green-lipped mussel (Perna canaliculus) extract efficacy in knee osteoarthritis and improvement in gastrointestinal dysfunction: a pilot study

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Clinical data demonstrating efficacy for nutraceutical compounds marketed for the symptom relief of osteoarthritis (OA) have been largely contentious. Furthermore, no association has been linked between clinical trial inconsistencies and gastrointestinal (GI) dysfunction. The aim of this study was to primarily investigate the efficacy of a high-dose New Zealand green-lipped mussel (GLM) extract in patients diagnosed with OA of the knee and concurrently assess GLM impact on GI function.


An open label, single group allocation study was conducted, that administered 3,000 mg/day of GLM extract over 8 weeks to 21 subjects diagnosed with knee OA. Outcome measures were scored using the WOMAC, the Lequesne algofunctional index, and the Gastrointestinal Symptom Rating Scale (GSRS) tools. An intention-to-treat analysis was employed and subject data collected at T 0, T 4 and T 8 weeks.


Paired t tests showed significant improvement for the Lequesne, WOMAC (p < 0.001) and GSRS (p = 0.005) scores. A repeated measures ANOVA analysis showed significant improvement in scores for the Lequesne (F = 20.317, p < 0.001), WOMAC (F = 28.383, p < 0.001) and the GSRS (F = 9.221, p = 0.002).


Green-lipped mussel significantly improved knee joint pain, stiffness and mobility. We report for the first time that the administration of GLM extract also significantly improved GI symptoms by 49% in OA patients. Given that GI dysfunction is linked to analgesic medication use, we further conclude that the therapeutic efficacy of the GLM extract used was possibly correlated to its effects on GI function by improving GSRS scores from baseline. Results from this trial highlight the requisite for further clinical investigations of gastrointestinal tract function in OA patients.

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  • Altman R, Asch E, Bloch D 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):1039–1049

    Article  PubMed  CAS  Google Scholar 

  • Armstrong AR, Thiébaut SP, Brown LJ (2011) Australian adults use complementary and alternative medicine in the treatment of chronic illness: a national study. Aust NZ J Public Health 35:384–390

    Article  Google Scholar 

  • Bellamy N (2002) WOMAC: a 20-year experiential review of a patient-centered self-reported health status questionnaire. J Rheumatol 29(12):2473–2476

    PubMed  Google Scholar 

  • Brien S, Prescott P, Coghlan B et al (2008) Systematic review of the nutritional supplement Perna canaliculus (green-lipped mussel) in the treatment of osteoarthritis. QJM 101:167–179

    Article  PubMed  CAS  Google Scholar 

  • Buchanan WW, Kean WF (2002a) Osteoarthritis: II: pathology and pathogenesis. Inflammopharmacol 10:19–48

    Google Scholar 

  • Buchanan WW, Kean WF (2002b) Osteoarthritis: III: radiological and clinical definition. Inflammopharmacol 10:53–78

    Article  Google Scholar 

  • Buchanan WW, Kean WF (2002c) Osteoarthritis IV: clinical therapeutic trials and treatment. Inflammopharmacol 10:75–149

    Google Scholar 

  • Chang J, Locke GR, Schleck CD et al (2007) Risk factors for chronic constipation and a possible role of analgesics. Neurogastroenterol Motil 19:905–911

    Article  PubMed  CAS  Google Scholar 

  • Chong VH, Wang CL (2008) Higher prevalence of gastrointestinal symptoms among patients with rheumatic disorders. Singapore Med J 49:419–424

    PubMed  CAS  Google Scholar 

  • Etienney I, Beaugerie L, Viboud C et al (2003) Non-steroidal anti-inflammatory drugs as a risk factor for acute diarrhoea: a case crossover study. Gut 52:260–263

    Article  PubMed  CAS  Google Scholar 

  • Garcia-Rodriguez LA, Cattaruzzi C et al (1998) Risk of hospitalization for upper gastrointestinal tract bleeding associated with ketorolac, other nonsteroidal anti-inflammatory drugs, calcium antagonists, and other antihypertensive drugs. Arch Intern Med 158:33–39

    Article  PubMed  CAS  Google Scholar 

  • Lequesne MG, Maheu E (2003) Clinical and radiological evaluation of hip, knee and hand osteoarthritis. Aging Clin Exp Res 15(5):380–390

    PubMed  Google Scholar 

  • Lequesne MG, Mery C, Samson M et al (1987) Indexes of severity for osteoarthritis of the hip and knee. Validation value in comparison with other assessment tests. Scand J Rheumatol Suppl 65:85–89

    Article  PubMed  CAS  Google Scholar 

  • Locke GR, Zinsmeister AR, Talley NJ et al (2000) Risk factors for irritable bowel syndrome: role of analgesics and food sensitivities. Am J Gastroenterol 95:905–911

    Google Scholar 

  • Peuhkuri K, Vapaatalo H, Korpela R (2010) Even low-grade inflammation impacts on small intestinal function. World J Gastroenterol 16:1057–1062

    Article  PubMed  Google Scholar 

  • Possemiers S, Bolca S, Verstraete W et al (2011) The intestinal microbiome: a separate organ inside the body with the metabolic potential to influence the bioactivity of botanicals. Fitoterapia 82:53–66

    Article  PubMed  CAS  Google Scholar 

  • Rahme E, Pettitt D, LeLorier J (2002) Determinants and sequelae associated with utilization of acetaminophen versus traditional nonsteroidal antiinflammatory drugs in an elderly population. Arthritis Rheum 46:3046–3054

    Article  PubMed  CAS  Google Scholar 

  • Rainsford KD, Whitehouse MW (1980) Gastroprotective and anti-inflammatory properties of green lipped mussel (Perna canaliculus) preparation. Arzneimittelforschung 30:2128–2132

    PubMed  CAS  Google Scholar 

  • Roderiguez GL, Hernandez-Diaz S (2001) Risk of upper gastrointestinal complications among users of acetaminophen and non-steroidal anti-inflammatory drugs. Epidemiology 12:570–576

    Article  Google Scholar 

  • Scarpignato C, Hunt RH (2010) Nonsteroidal antiinflammatory drug-related injury to the gastrointestinal tract: clinical picture, pathogenesis and prevention. Gastroenterol Clin N Am 39:433–464

    Article  Google Scholar 

  • Svedlund J, Sjodin I, Dotevall G (1988) GSRS: a clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease. Dig Dis Sci 33:129–134

    Article  PubMed  CAS  Google Scholar 

  • Tucker G, Adams R, Wilson D (2010) New Australian population scoring coefficients for the old version of the SF-36 and SF-12 health status questionnaires. Qual Life Res 19:1069–1076

    Article  PubMed  Google Scholar 

  • Wandel S, Juni P, Tendal B et al (2010) Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis. BMJ 341:c4675

    Article  PubMed  Google Scholar 

  • Ware JE, Kosinski M, Keller SD (1996) A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 34(3):220–233

    Article  PubMed  Google Scholar 

  • Whitehouse MW, Macrides TA, Kalafatis N et al (1997) Anti-inflammatory activity of a lipid fraction (lyprinol) from the NZ green-lipped mussel. Inflammopharmacology 5:237–246

    Article  PubMed  CAS  Google Scholar 

  • Wieland HA, Michaelis M, Kirschbaum BJ et al (2005) Osteoarthritis—an untreatable disease? Nat Rev Drug Discov 4:331–344

    Article  PubMed  CAS  Google Scholar 

  • Wolfe MM, Lichtenstein DR, Singh G (1999) Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs. N Engl J Med 340:1888–1899

    Article  PubMed  CAS  Google Scholar 

  • Zhang W, Moskowitz RW, Nuki G et al (2008) The placebo effect and its determinants in osteoarthritis: meta-analysis of randomised controlled trials. Ann Rheum Dis 67:1716–1723

    Article  PubMed  CAS  Google Scholar 

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We thank Shoshannah Beck and Janet Schloss from The University of Queensland for reading the manuscript and assisting with data entry and subject recruitment.

Conflicts of interest

Funding and study medication for the project was received from the clinical trial sponsor Aroma New Zealand Ltd. The sponsor had no involvement in the collection, analysis or interpretation of the data; writing the report; or the decision to submit the paper for publication.

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Correspondence to Luis Vitetta.

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Coulson, S., Vecchio, P., Gramotnev, H. et al. Green-lipped mussel (Perna canaliculus) extract efficacy in knee osteoarthritis and improvement in gastrointestinal dysfunction: a pilot study. Inflammopharmacol 20, 71–76 (2012).

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