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

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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.

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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

References

  1. Conaghan PG, Dickson J, Grant RL (2008) Care and management of osteoarthritis in adults: summary of NICE guidance. BMJ 336(7642):502–503

    Article  PubMed  PubMed Central  Google Scholar 

  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):70–74

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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):1125–1135

    Article  PubMed  Google Scholar 

  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):465–474

    Article  CAS  Google Scholar 

  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):375–389

    Article  PubMed  Google Scholar 

  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):169–182

    Article  CAS  PubMed  Google Scholar 

  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):1634–1642

    Article  PubMed  Google Scholar 

  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):1302–1308

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Dieppe P, Marsden D (2013) Managing arthritis: the need to think about whole systems. Rheumatology (Oxford) 52(8):1345–1346

    Article  Google Scholar 

  10. Institute for Public Opinion (2011) Naturheilmittel 2010. Ergebnisse einer bevölkerungsrepräsentativen Befragung. http://www.pandalisde/naturheilmittel.pdf. Accessed 27 August 2012

  11. Jadhav PM, Jadhav MP (2013) Complementary and alternative medicine and conventional medicine: hand in hand. J Clin Rheumatol 19(4):227

    Article  PubMed  Google Scholar 

  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):459–465

    Article  PubMed  PubMed Central  Google Scholar 

  13. Bagla P (2011) Traditional medicine. Piercing the veil of Ayurveda. Science 334(6062):1491

    Article  CAS  PubMed  Google Scholar 

  14. Kessler C, Michalsen A (2012) The role of whole medical systems in global medicine. Forsch Komplementmed 19(2):65–66

    Article  PubMed  Google Scholar 

  15. World Health Organization (2002) Traditional Medicine Strategy. WHO Regional Publications, Geneva

    Google Scholar 

  16. World Health Organization (2002) Traditional Medicine in Asia. WHO Regional Publications, New Delhi

    Google Scholar 

  17. Cooper EL (2008) Ayurveda and eCAM: a Closer Connection. Evid Based Complement Alternat Med 5(2):121–122

    Article  PubMed  PubMed Central  Google Scholar 

  18. Cooper EL (2008) Ayurveda is embraced by eCAM. Evid Based Complement Alternat Med 5(1):1–2

    Article  PubMed  PubMed Central  Google Scholar 

  19. World Health Organization (2010) Benchmarks for training in traditional/complementary and alternative medicine: Benchmarks for training in Ayurveda. World Health Organization, Geneva

    Google Scholar 

  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):1408–1417

    Article  CAS  Google Scholar 

  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):392–393

    Article  PubMed  Google Scholar 

  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):185–192

    Article  PubMed  Google Scholar 

  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 14:149

    Article  PubMed  PubMed Central  Google Scholar 

  24. Manohar PR (2011) Whole system research and ayurveda. Anc Sci Life 31(2):37

    PubMed  PubMed Central  Google Scholar 

  25. Manohar PR, Eranezhath SS, Mahapatra A, Manohar SR (2012) DHARA: digital helpline for Ayurveda research articles. J Ayurveda Integr Med 3(2):97–101

    Article  PubMed  PubMed Central  Google Scholar 

  26. Agarwal V, Abhijnhan A, Raviraj P (2007) Ayurvedic medicine for schizophrenia. Cochrane Database Syst Rev 4:CD006867

    PubMed  Google Scholar 

  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) 41:2p

    Google Scholar 

  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):528–535

    Article  PubMed  Google Scholar 

  29. Park J, Ernst E (2005) Ayurvedic medicine for rheumatoid arthritis: a systematic review. Semin Arthritis Rheum 34(5):705–713

    Article  PubMed  Google Scholar 

  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):876–886

    PubMed  Google Scholar 

  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):685–698

    Article  PubMed  Google Scholar 

  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):22–28

    PubMed  Google Scholar 

  33. Sridharan K, Mohan R, Ramaratnam S, Panneerselvam D (2011) Ayurvedic treatments for diabetes mellitus. Cochrane Database Syst Rev 12:CD008288

    PubMed  Google Scholar 

  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 Delhi

    Google Scholar 

  35. Gupta S, Stapelfeld E (2009) Praxis Ayurveda-Medizin. Kaya cikitsa. Therapiekonzepte für innere Erkrankungen. Haug, Stuttgart

    Google Scholar 

  36. Morandi A, Tosto C (2011) Ayurveda, the paradigm for personalized medicine. EPMA J 2:S152–S153

    Article  Google Scholar 

  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):1039–1049

    Article  CAS  PubMed  Google Scholar 

  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):1288–1292

    Article  CAS  PubMed  Google Scholar 

  39. Feuerstein G (1998) The yoga tradition. Hohm Press, Prescott

    Google Scholar 

  40. Cramer H, Lauche R, Langhorst J, Dobos G (2013) Yoga for rheumatic diseases: a systematic review. Rheumatology (Oxford) 52(11):2025–2030

    Article  Google Scholar 

  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):799–802

    CAS  PubMed  Google Scholar 

  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):1648–1654

    PubMed  Google Scholar 

  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 2012:136245

    Article  PubMed  PubMed Central  Google Scholar 

  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. Babu S, Shetty M (2005) Yoga Ratnakara (Sanskrit Text with English Translation and Explanatory Notes). Chaukhamba Sanskrit Series Office, Varanasi

    Google Scholar 

  46. Murthy S (1998) Bhava Prakasha (Translation). Chaukhamba Orientalia, Varanasi

    Google Scholar 

  47. Murthy SK (2001) Madhava Nidanam (Roga Viniscaya) of Mahavakara (A Treatise on Ayurveda). Chaukambha Orientala, Varanasi

    Google Scholar 

  48. Higgins J, Green S (2008) Cochrane handbook for systematic reviews of interventions. Wiley, West Sussex

    Book  Google Scholar 

  49. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560

    Article  PubMed  PubMed Central  Google Scholar 

  50. The Nordic Cochrane Centre (2013) Review Manager 5 software (Version 5.1), Copenhagen

  51. Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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 2011:724291

    Article  PubMed  PubMed Central  Google Scholar 

  53. Rastogi S, Sivaraman ST (2003) Evaluating the safety and efficacy of Rumalaya forte: a double-blind clinical trial. Orthopaedics Today 5(1):63–65

    Google Scholar 

  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):29–30

    Google Scholar 

  55. Srivastava KC, Mustafa T (1992) Ginger (Zingiber officinale) in rheumatism and musculoskeletal disorders. Med Hypotheses 39(4):342–348

    Article  CAS  PubMed  Google Scholar 

  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):3–7

    Article  CAS  PubMed  Google Scholar 

  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):R85

    Article  PubMed  PubMed Central  Google Scholar 

  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):366–377

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Gupta I, Gupta S, Parihar A (1993) S-compound: a traditional drug for osteoarthritis patients. Indian Practitioner 46(1):69–72

    Google Scholar 

  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):478–482

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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):27

    Article  Google Scholar 

  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):91–95

    Article  CAS  PubMed  Google Scholar 

  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):153

    Google Scholar 

  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):22–34

    CAS  PubMed  PubMed Central  Google Scholar 

  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):53–57

    Article  PubMed  PubMed Central  Google Scholar 

  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: 1–2

  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):236–245

    Article  PubMed  Google Scholar 

  68. Nachinolcar UC, Prasad DP, Prasad SR, Mitra SK (2007) Rumalaya forte and Reosto in Osteoarthritis: a combined study. Med Update 15(4):27–35

    Google Scholar 

  69. Agarwal ND, Gureja Y, Khosla AC, Agarwal JR (1971) Rumalaya in rheumatoid arthritis and osteo arthritis (a double-blind trial). Probe 10:45–49

    Google Scholar 

  70. Chandanwale AS, Kulkarni KS (2003) Clinical evaluation of Rumalaya forte in osteoarthrosis. Med Update 10:23–26

    Google Scholar 

  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):42–47

    Google Scholar 

  72. Jamdar J, Singh K, Kulhalli P, Chakma T (2004) Study of ayurvedic drug (rhumayog) compared to brufen in osteoarthritis. Antiseptic 101(2):62–65

    Google Scholar 

  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):29–30

    Google Scholar 

  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 16:19–30

    Google Scholar 

  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):31

    Google Scholar 

  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):31–37

    Google Scholar 

  77. Sandhu HS, Kaler JS (1978) Rumalaya therapy in rheumatoid arthritis, osteoarthritis and periarthritis shoulder. Antisep 10:63–66

    Google Scholar 

  78. Sen B, Banerjee S, Mazumder N, Sarkar N, Roychowdury A, Majumdar P (1980) Studies on effects of Rumalaya in osteoarthritis. Indian Med J 74:151

    Google Scholar 

  79. Taneja DK, Chara GU (1975) Rumalaya in osteoarthritis. Antisep 72(10):527–533

    Google Scholar 

  80. Jamdar J, Singh K, Kulhalli P, Chakma T (2004) Study of ayurvedic drug (rhumayog) compared to brufen in osteoarthritis. Antisep 101(2):62–65

    Google Scholar 

  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):38–44

    Article  PubMed  PubMed Central  Google Scholar 

  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):1408–1417

    Article  CAS  Google Scholar 

  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 2011:724291

    Article  PubMed  PubMed Central  Google Scholar 

  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):207–212

    Article  PubMed  PubMed Central  Google Scholar 

  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):27–34

    CAS  Google Scholar 

  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):80–87

    Article  PubMed  PubMed Central  Google Scholar 

  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):21–32

    Google Scholar 

  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):210–217

    Article  PubMed  PubMed Central  Google Scholar 

  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:c3515

    Article  PubMed  PubMed Central  Google Scholar 

  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):476–499

    Article  CAS  PubMed  Google Scholar 

  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 Rheum

  92. Kessler C (2007) Wirksamkeit von Ayurveda bei chronischen Erkrankungen. Systematische Analysen klinischer Ayurveda-Studien. KVC Verlag, Essen

    Google Scholar 

  93. Schulz KF, Altman DG, Moher D (2010) CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med 152(11):726–732

    Article  PubMed  Google Scholar 

  94. Kales SN, Christophi CA, Saper RB (2007) Hematopoietic toxicity from lead-containing Ayurvedic medications. Med Sci Monit 13(7):CR295–CR298

    CAS  PubMed  PubMed Central  Google Scholar 

  95. Kales SN, Saper RB (2009) Ayurvedic lead poisoning: an under-recognized, international problem. Indian J Med Sci 63(9):379–381

    Article  PubMed  Google Scholar 

  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):2868–2873

    Article  CAS  PubMed  Google Scholar 

  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):915–923

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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):326–329

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Königstraße 63, 14109, Berlin, Germany

    Christian S. Kessler & Andreas Michalsen

  2. Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Centre, Berlin, Germany

    Christian S. Kessler, Lea Pinders & Andreas Michalsen

  3. Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany

    Holger Cramer

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  1. Christian S. Kessler
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Kessler, C.S., Pinders, L., Michalsen, A. et al. Ayurvedic interventions for osteoarthritis: a systematic review and meta-analysis. Rheumatol Int 35, 211–232 (2015). https://doi.org/10.1007/s00296-014-3095-y

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  • DOI: https://doi.org/10.1007/s00296-014-3095-y

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