Bromelain Suppresses Osteoarthritis (OA) Similar to Those of Diclofenac with No Side Effects

Osteoarthritis (OA), a form of arthritis, is a condition associated with aging-induced wear and tear on a joint or joints.

Tne condition is very common in older adults, affecting over 25 million people in the US with no sign of stopping.

According to the University of Porto Medical School, the differences in prevalence and incidence estimates of osteoarthritis (OA), according to the case definition, are in the knee, hip and hand joints(3).

The characteristics of osteoarthritis are aching pain(5), stiffness(6), or difficulty of moving the joint or joints(7). The pain usually gets worse in a change of weather, at night.

In the advanced diseases, the pain can occur even at rest(8).


Today management of osteoarthritis (OA) focuses on pain relief and improved physical function through pharmacological, nonpharmacological, and surgical treatments(4).

Some researchers suggested that OA is not simply a disease related to aging or mechanical stress of joints but rather a “metabolic disorder(70)(71)” interrelated to lipid, metabolic, and humoral mediators(70).

Indeed, OA has been linked not only to obesity(46)(47) but also to other cardiovascular risk factors(72)(73), namely, diabetes(74), dyslipidemia, hypertension, and insulin resistance(75).


More precisely, the majority of patients with OA also suffer from one or more of below conditions
* Hypertension
According to the University Health Network Research Institute, the economic burden incurred by RA significantly exceeds that related to OA and HBP(76)(77).

* Cardiovascular disease
According to Erasmus University Medical Centre, there is an association of atherosclerosis with osteoarthritis of the knee and hand joints in women(72)(73)(78).

*Peripheral vascular disease
According to Himchan Hospital, patient with due to osteoarthritis are associated with risk of asymptomatic peripheral vascular disease(80). The average vessel wall thickness of the popliteal artery was 1.09 mm in patients with generalized OA, and 0.96 mm in the matched normal reference population(79).

* Congestive heart failure
Hypertension, diabetes, and older age have shown to increased risk of Congestive heart failure modestly(81).

* Renal function impairment
According to the Southampton University Hospitals NHS Trust, pain pharmacotherapies such as osteoarthritis (OA) or mixed OA and rheumatoid arthritis may increase the risk of adverse events in patients with concurrent cardiovascular (CV) or renal disease(83).

6. Diabetes
Several epidemiological and experimental data support the hypothesis that diabetes could be an independent risk factor for osteoarthritis (OA)(76)(85).

* Respiratory disease
People with respiratory disease are also at a higher risk to develop osteoarthritis (OA), including chronic cough and bilateral infiltrates on chest roentgenogram(86).

* High serum of cholesterol
There is an association between high serum cholesterol level and both knee and generalized OA, according to the study of 113 females and 133 males with average ages 46 14.2 and 51.54 16.0 years by King Khalid University Hospital(87).

Bromelain, a proteolytic enzyme found in pineapples (Ananas comosus) has been used in traditional medicine as an inflammatory agent and to treat pains, strains, and muscle aches and pains and ease back pain and chronic joint pain, skin diseases, etc.

On finding a natural compound from healthy food for the treatment of inflammatory diseases, researchers examined the effects of bromelain on patients with osteoarthritis of the knee.

The randomized, double-blind placebo-controlled trial included 47 patients with a confirmed diagnosis of moderate to severe knee OA randomized to 12 weeks of bromelain 800 mg/day or placebo, with a 4-week follow-up.

According to the results from 31 patients completed the trial, including 14 in the bromelain group and 17 in the placebo group, both treatment groups showed clinically relevant improvement in the WOMAC disability subscale only with a mild adverse outcome.

In order to reveal and confirm the effects of bromelain on OA, a joint a randomized, single-blind, active-controlled pilot study. led by the Mahidol University was conducted in patients with OA for 16 weeks.
40 knee OA patients enrolled in the study were randomized to receive oral bromelain (500 mg/day) or diclofenac (100 mg/day).

According to the tested assays,
* At week 4, the improvement of total WOMAC and pain subscales from baseline was observed in both groups, however, two patients in the diclofenac treatment group showed adverse effects that lead to discontinuation of diclofenac.


* At week 16, bromelain treatment group showed a significant improvement of all aspects, including 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), compared to baseline values.

* Also compared to the based line, the bromelain-treated group also showed a decrease of plasma MDA and LPS-stimulated PGE2 production,

* Bromelain exerted a similar effect to those of diclofenac after 4 weeks.

Taken altogether, bromelain used alone may be considered supplements for the prevention and treatment of osteoarthritis, pending to the confirmation of the larger sample size and multicenter human study.

Intake of bromelain in the form of supplement should be taken with extreme care to prevent overdose acute liver toxicity.

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Author Biography
Kyle J. Norton (Scholar, Master of Nutrition, All right reserved)
Health article writer and researcher; Over 10.000 articles and research papers have been written and published online, including worldwide health, ezine articles, article base, health blogs, self-growth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bioscience, ISSN 0975-6299.

Sources
(1) Bromelain as an adjunctive treatment for moderate-to-severe osteoarthritis of the knee: a randomized placebo-controlled pilot study by Brien S1, Lewith G, Walker AF, Middleton R, Prescott P, Bundy R. (PubMed)
(2) Improved WOMAC score following 16-week treatment with bromelain for knee osteoarthritis by Kasemsuk T1, Saengpetch N2, Sibmooh N1, Unchern S. (PubMed)
(3) Most Common Disease of Elder: The Clinical Trials and Studies of musculoskeletal disorders(MSDs) - Osteoarthritis: Diseases associated with Osteoarthritis by Kyle J. Norton