Will 12 weeks of complex Ayurvedic treatment be more effective than 12 weeks of conventional standard care – in treating osteoarthritis of the knee?!

That is what this study attempted to find out.

First a bit more about Ayurvedic treatment; from the discussion last week one of the herbal remedies I found to be the most interesting was the Ayurvedic herb Commiphora mukul or Guggul. It is most commonly found in northern India. This small bushy plant with thorny branches has been a key component in the Ancient Indian Ayurvedic system of medicine for years. The IUCN (International Union for Conservation of Nature) has actually placed it on its Red Data List, which is a global comprehensive inventory of biological species.  In India more than 400,000 Ayurveda physicians are officially registered! Also Ayurvedic medicine can be studied and applied at more than 250 government-accredited university and colleges.

            Guggul produces a gum like sap and it is the extract of this gum (gugulipid) that has been used in India for over 2000 years. I thought this particular study was interesting because they used a large amount of human subjects to test the effects of Guggul on osteoarthritis (OA) of the knee. They had about 150 patients between the ages of 40-70 who were diagnosed with OA, using the American College of Rheumatology Criteria. The group of 150 was split into 2 smaller groups an Ayurveda group and a Conventional group. The groups were given 15 treatment sessions over 12 weeks and they were evaluated after 6 weeks, 12 weeks, 6 months, and 12 months. One thing I found really interesting was the notion that Ayurvedic diagnosis goes further than purely symptom detection, and that it includes a broad spectrum of internal and external conditions including: physiological, metabolic, kinetic, excretory functions, lifestyle, food habits etc.

            As mentioned in Sho’s post there are different types of Arthritis and the autoimmune form rheumatoid arthritis was one of the exclusion factors for individuals in this studying. Other excluding factors were: autoimmune diseases, knee surgery, injections with corticosteroids 3 months prior, being pregnant or breastfeeding, being obese (WHO grade II), acute mental disorders, patient are in the process of applying for pension or disability benefits. After being inducted into the trial they were diagnosed by 4 independent Ayurvedic medical specialists. The two treatment patterns can be seen here: Ayruveda-intervention: http://www.trialsjournal.com/content/14/1/149/figure/F2

Conventional Treatment: http://www.trialsjournal.com/content/14/1/149/figure/F3 throughout the study the maximum daily dosage of the NSAID ibuprofen was kept low for safety reasons.

             Overall I was extremely excited by the article until I realized that their results were heavily placed on what they could have done to make the trial better (which is still important) but! I was really hoping to see them discuss how experimentally there was validity to their hypothesis that: Ayruvedic treatment was more beneficial. I’ll admit I was slightly rooting for the latter, and I did indeed want to see results showing statically proven data exemplifying the benefits. But an important aspect in science is trial and error and I think that’s one of the things this journal shows us; which to me elevates its overall importance! Researchers found that the differences between the two groups in a “head-to-head” comparison proved for a difficult experiment trial. They mention that this was the first head-to-head comparison in the west and a different yet possibly more effective way to research the topic would be to run a smaller trial in a more controllable environment before a larger multicenter trial, and to also use a more innovative approach vs. a ‘one treatment fits all’ approach. So as the researchers said while it is possible that the Ayurvedic herb Commiphora muku is widely beneficial experimental procedural studies would need to be tweaked that allow for future research on Ayurveda that allow more flexible interventions from a whole-systems Ayruvedic perspective.

 

Sources:

Singh, BB, LC Mishra, SP Vinjamury, N. Aquilina, VJ Singh, and N. Shepard. "The Effectiveness of Commiphora Mukul for Osteoarthritis of the Knee: An Outcomes Study." Alternative Therapies in Health and Medicine 9.3 (2003): n. pag. Print.

 

The electronic version of this article is the complete one and can be found online at:http://www.trialsjournal.com/content/14/1/149