Curcumin and osteoarthritis

Ross Hauser, MD, Danielle Matias, PA-C, Marion Hauser, MS, RD

In this article we will briefly discuss some of the research that suggests that the curcumin family (curcuminoids), compounds of the spice turmeric, display what scientists have called “amazing” antioxidant properties. We will translate this research into a closer look at turmeric’s ability to alleviate and possibly stop osteoarthritis progression.

Do you have questions about the role of foods in inflammation? You can get help and information from our Caring Medical staff.

The anti-oxidant and anti-inflammatory properties of curcumin

Turmeric is a tradition Indian spice derived from the rhizomes (the trademark horizontal underground stem from which roots grow) of the tropical plant Curcuma longa Linn, a member of the ginger family. Its bright yellow-orange color comes mainly from the curcumin family.

While turmeric, in addition to its use as a spice in foods, has been used in India for medicinal purposes for centuries, modern researchers have found that curcumin may have anti-inflammatory and anticancer activities. This discovery has lead to an incredible amount of research surrounding the turmeric spice and its components.

Before we start looking at the research, a quick disclaimer. While the research does sound positive, doctors in July 2022, writing in the journal Frontiers in immunology (7) remind us “Curcumin and Curcuma longa Extract may improve symptoms and inflammation levels in people with arthritis. However, due to the low quality and small quantity of randomized control trials, the conclusions need to be interpreted carefully.” Having said that, let’s look at some peer-reviewed studies.

The various aspects of anti-inflammatory and pain reducing factors of curcumin

In November 2022, researchers writing in the journal Rheumatology international (4) discussed the various aspects of anti-inflammatory and pain reducing factors of curcumin. “Several studies have shown (Curcumin’s) potent antioxidant and anti-inflammatory effect, non-toxicity, and safety at high daily doses. In addition to blocking chondrocyte apoptosis (death of cartilage cells), curcumin also blocks the expression of cyclooxygenase (acts as a “COX inhibitor”), prostaglandin E-2 (which would act to block pain and inflammation) and proinflammatory cytokines in chondrocytes, potentially alleviating symptomatic diseases. Although there are significant variations in quality, methodology, and research results conducted on curcumin efficiency in osteoarthritis  treatment, curcumin is primarily recommended as systematic short-term and medium-term adjuvant therapy that reduces inflammatory biochemical factors. Reducing inflammation leads to better pain regulation and improved joint function, significantly reducing standard prescribed doses of drugs. The most researched daily doses of curcumin intake are 1000-2000 mg/day, which would also be the doses that most of the authors recommend.”

Research on patients with knee osteoarthritis

A September 2022 study in the journal Therapeutic advances in musculoskeletal disease (5) summarized the findings of previously published research of 11 randomized controlled trials comparing the efficacy of turmeric extracts versus placebo and five trials comparing efficacy versus NSAIDs in 1810 adults with knee osteoarthritis. The researchers here suggest “turmeric significantly reduced knee pain and improved physical function compared with placebo.” They also found turmeric had effects similar to NSAIDs and the rates of adverse events were lower in the turmeric extract groups versus those for NSAIDs. Further, “An additional study suggests that long-term use of curcumin supplements for the management of osteoarthritis  is preferred to improve pain and reduce stiffness. Therefore, curcumin at doses between 160 and 2000 mg/day was effective in the management of osteoarthritis and demonstrated similar efficacy to NSAIDs, including diclofenac (100 mg day) and ibuprofen (400–1200 mg/day).

Researchers make recommendation for doseage

In the Journal of dietary supplements, (1) researchers write about their randomized double-blind placebo-controlled study investigated the efficacy of curcuminoids (the curcumin family) in reducing systemic oxidative burden in patients suffering from knee osteoarthritisOxidative stress is implicated in the development and progression of osteoarthritis.

  • Nineteen patients with mild-to-moderate primary knee osteoarthritis were given curcuminoid capsules (1500 mg/day in 3 divided doses) and twenty-one matched placebo capsules for a period of 6 weeks.
  • Curcuminoids were co-administered with piperine (a bioactive compound of black pepper) (15 mg/day) in order to improve the bioavailability (absorption).
  • In the curcumin group there was a significant elevation in serum superoxide dismutase activities (superoxide dismutase is a primary antioxidant).
  • An elevation in GSH (Glutathione) concentrations was found. Glutathione has been called the body’s “master antioxidant.”
  • And a significant reduction in MDA concentrations (MDA malondialdehyde is a free radical linked to cholesterol metabolism. Steroid interaction is part of  cholesterol metabolism.

The researchers concluded that curcuminoid capsules (1500 mg/day in 3 divided doses) co-administered with piperine (15 mg/day) reduced systemic oxidative stress in patients with osteoarthritis. These antioxidant effects may account for the reported therapeutic effects of curcuminoids in relieving osteoarthritis symptoms.

Will change in diet and supplementation of Turmeric be beneficial for your osteoarthritic joint pain? That you need to find out for your health care provider.

How does Curcumin act as an anti-inflammatory?

Writing in the Journal of interferon and cytokine research (2) (a journal on the science of inflammation), medical university researchers in China says that Curcumin has shown protective potential on osteoarthritis, but research does not suggest how protective it is in regards to its acting as an anti-inflammatory. So the Chinese team set out to answer that question.

In their study, the researchers  aimed to determine whether curcumin could alleviate osteoarthritis symptoms and the underlying mechanisms that causes it. To answer the question, they looked at mice with destabilized medial meniscus who were administered curcumin.

  • In the damaged mice meniscus and cartilage, curcumin was shown to increase levels of inflammatory cytokines (messengers that call for more inflammation. In fact curcumin affected various other messenger and inflammatory cells to induce inflammation.
  • Administration of curcumin significantly reduced osteoarthritis disease progression by interfering with the degenerative breakdown process of cartilage.
  • Curcumin also helped suppressed inflammation. In a highlight of this research, this study provides the first evidence that curcumin exerts protection on osteoarthritis by inhibition to the release of inflammasome NLRP3, leading to the downregulation of inflammatory cytokines.
    • Simply NLRP3 in a gene that controls Macrophages. Macrophages are cells that eat biomaterial debris from damaged cells to give room for healing cells to do their work. Macrophages are part of the inflammatory process, curcumin provided the chemicals to help the Macrophages know when to shut down, i.e, stop the inflammation.

Curcumin brings oxygen to damaged tissue

An August 2022 paper in the journal Current issues in molecular biology (6) discusses the healing actions of oxygen on damaged tissue and how curcumin may increase oxygen flow to osteoarthritic joints.

Let’s start with some definitions of some of this article’s subjects.

  • Erythrocytes are red blood cells. They are in fact responsible for the red color. They are also responsible for transporting oxygen to and carbon dioxide away from tissues. It is oxygen to the cells that starts reactive oxygen species (ROS) production (inflammation).
  • Reactive oxygen species (ROS) is a chemical reaction that leads to oxidant damage and the breakdown of cells. It is suppose to be a temporary function of the body to break down damaged tissue so it can be transported away and replaced by new tissue, simply it is part of the natural healing process. If tissue damage becomes permanent, as in osteoarthritis, the immune system will continue to try to heal it. We then enter a state of chronic inflammation.

Now to the research: Here the authors write: “Erythrocytes, the most abundant blood cells, have as their primary function oxygen transport, which induces reactive oxygen species (ROS) production. For this reason, the erythrocytes have several mechanisms to counteract ROS injuries (that is the production of too much inflammation or simply oxidative stress or oxidant damage. This is why doctors suggest anti-oxidants).” To continue with the research: “Oxidative stress and inflammation are highly correlated and are both causes of joint disorders. In the synovial fluid and blood of osteoarthritis patients, erythrocyte antioxidant enzyme expression is decreased. (Simply our anti-oxidants can not over take the oxidants and damage occurs). The researchers noted curcumin, by bringing oxygen into the cells, helps regulate the release of inflammatory mediators (or anti-inflammatory factors). Research has shown that curcumin mitigated oxidative stress by reducing the ROS synthesis, increasing Glutathione (anti-oxidant) concentration. This all, with the help of increased oxygen.

Osteoarthritis in Postmenopausal Women. The role of estrogen and curcumin

A 2016 study in the journal Genes and nutrition (3) explored the connection of inflammation and menopausal symptoms and how curcumin and tetrahydrocurcumin would help symptoms in women. Tetrahydrocurcumin is a compound that helps make the curcumin metabolic process go. The researchers speculated that tetrahydrocurcumin may have its own benefits.

In studying estrogen-deficient rats with symptoms created to mimic knee osteoarthritis, the researchers were able to compare the effects of curcumin and tetrahydrocurcumin.

Here are the very interesting findings:

  • Tetrahydrocurcumin helped prevent glucose intolerance, which might be involved in worsening osteoarthritis.
  • Tetrahydrocurcumin and  curcumin protected against osteoarthritis symptoms and pain.
  • Tetrahydrocurcumin and  curcumin prevented the deterioration of articular cartilage.
  • They also maintained lean body mass and lowered fat mass.
  • As in the research above, Tetrahydrocurcumin and  curcumin improved osteoarthritis symptoms by influencing pro and anti-inflammatory factors in articular cartilage.

Curcumin and NSAIDs

A November 2023 study (8) in the Journal of ethnopharmacology (a journal of traditional medicinal use of plants and other substances in combination) reviewed 23 previously published medical studies with 2175 knee osteoarthritis patients to assess the effectiveness of curcumin in the treatment of knee osteoarthritis. In this study, interventions such as placebo, curcumin, and NSAIDs were used.

The results showed that:

  • compared with placebo, curcumin significantly reduced the visual analogue scale pain score (0 – 10 pain score) and total WOMAC score (patient surveys measuring pain, stiffness, and physical function).
  • Compared with placebo, curcumin, curcumin + NSAIDs and NSAIDs reduced the use of rescue medication (acute flare up).
  • Compared with NSAIDs, curcumin and curcumin + NSAIDs had a reduced incidence of adverse reactions.

Conclusions: “Curcumin, either alone or in combination with other treatments, is considered to have good clinical efficacy and safety in knee osteoarthritis treatment. Drug combinations containing curcumin may have the dual effect of enhancing efficacy and reducing adverse reactions, but this possibility still needs to be confirmed by further clinical and basic research.”

Do you have questions about the role of foods in inflammation? You can get help and information from our Caring Medical staff


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