The Effect of Combination of Turmeric and Black Pepper Extracts in Osteoarthritis of the Knee - Open Journal Systems
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Indian Journal of Forensic Medicine & Toxicology, July-September 2021, Vol. 15, No. 3 4507
The Effect of Combination of Turmeric and Black Pepper
Extracts in Osteoarthritis of the Knee
Zahraa Matheel Nasir1, Haidar M. Jawad1, Sami S. Salman2
1MSc Student, Prof., Pharmacologist, College of Medicine, University of Baghdad/Iraq,
2
Prof., Rheumatologist, College of Medicine, University of Baghdad/Iraq
Abstract
The management of osteoarthritis (OA) remains a challenge. Curcumin is basically a spice that is known
for its anti-inflammatory properties. In vitro studies suggest that curcumin could be beneficial for cartilage
in OA. Piperine, derived from black pepper, is added to Curcumin to increase its bioavailability. The aim
of this randomized, double blind trial was to evaluate the effects of combination curcumin plus piperine in
knee OA patients.
A total of 43patients were randomly assigned to receive the fixed dose combination (curcumin 500 mg plus
piperine 5 mg) or placebo twice daily for three months and was evaluated using a Western Ontario MacMaster
(WOMAC) score. Results revealed the serum levels of High Sensitivity C - reactive protein (HS-CRP)and
Human Cross Linked C-Telopeptide of Type II Collagen (CTX-II) were changedafter 3 months of treatment.
In conclusions: The treatment with curcumin was globally well tolerated. It significantly decreased the
WOMAC score and NSAIDS uses. Serum level of CTXII significantly reduced (p4508 Indian Journal of Forensic Medicine & Toxicology, July-September 2021, Vol. 15, No. 3
In an arthritis animal model study, piperine Curcuma longa andBlack pepper powder purchased
inhibits the IL-6, MMP-13, activator protein 1 (AP-1) from local market in Baghdad, Iraq and identified by the
and reduces PGE2 in a dose-dependent manner, and National Iraqi Institute for Herbs and was extracted by
significantly reduced nociceptive and arthritic symptoms Soxhelt apparatus with 70 % ethanol,in Baghdad College
in piperine-treated rats.(9).Comblain et al 2015 found that laboratory of pharmacy,according tothe reference
curcuminoids decreased the gene expressions of MMP- method.(12,13).Then tested by Gas chromatography–mass
3, COX-2, PGE-2, and IL-6(10).Ultimately, curcumin’s spectrometry (GC-MS).
cartilage-protective and anti-inflammatory activity may
Patients were interviewed to assess the symptoms of
be derived from its activity on the NF-3B system that
OA and the total WOMAC index score was calculated
mediates the inflammatory cellular response. It phosph/
at baseline and after 1, 2, and 3 months. Furthermore,
orylates IKB and, through ubiquitination, causes it to
the use of NSAIDS (Etoricoxib 60 mg), number and
degrade. The liberated NF-βB complex then reaches
duration was reported. HS-CRP level and CTXII level in
the nucleus and transfers to inflammation-responsible
serum and body mass index were calculated at baseline
genes(11).
and after 3 months.
Patients and Methods
Statistical analysis of data was performed using SAS
A randomized, double-blind, placebo-controlled (Statistical Analysis System - version 9.1). Independent
study in two treatment groups: curcumin extract and and dependent t test was used to assess significant
placebo. Patients were recruited from the outpatient differences between means. PIndian Journal of Forensic Medicine & Toxicology, July-September 2021, Vol. 15, No. 3 4509
Cont... Table 1: Demographic and baseline clinical characteristics of patients in the two treatment groups
Body mass index (Kg/m2) 29.15±4.78 29.83±5.08 0.65NS
CTXII serum level ng/ml 1.81±0.66 2.06±0.67 0.22 NS
High sensitive-C-Reactive protein (mg/ml)
7.12±3.44 8.77±2.20 0.06NS
serum level
The primary symptom outcome measure represented in the placebo group improved, albeit less dramatically,
by the Western Ontario and McMaster Universities and the differences between the group averages showed
(WOMAC) score index of severity for OA of the knee in a non significant differences of WOMAC scores at
the patients treated over 1, 2 and 3 months are depicted baseline and after 1 month follow up between both study
in table (2 ). There was a progressive and significant groups. Ahighly significant improvement in WOMAC
improvement in the primary symptom outcome measure score in form of reduction of pain, decrease stiffness and
in the patients receiving curcumin who were assessed increase functional capacitywas found after 2 ,3 month
for 1, 2, and 3 months. However, symptoms of patients follow up between both groups and within group B than
that with group A (p4510 Indian Journal of Forensic Medicine & Toxicology, July-September 2021, Vol. 15, No. 3
the palliative impact of avoiding cognitive impairment, energy loss / exhaustion, mood changes and anxiety.(18)
Table 3 : (NSAID) uses at baseline and after treatment
NSAID Placebo Curcumin P-value
After 1 month 19.95±7.20 18.43±2.06 0.37 NS
2 months 16.90±4.05 6.65±2.87Indian Journal of Forensic Medicine & Toxicology, July-September 2021, Vol. 15, No. 3 4511
did not show any deterioration, the percentage change MMP-9.Combination treatment with curcumin and
in curcumin group with dose (160 mg/day) showed less piperineleads to important protective value on articular
dispersion or in other words more consistent results. cartilage. Incurrent study curcumin treatment for patient
While in current study use combination of curcumin with OA, was correlated with a highly significantly
extract 1000 mg plus 10 mg piperine. Fengyan Gong et decline in body mass index BMI by 1.77%, while
al (23), showed that administration of piperine improved significant increase in placebo group as shown in Table
the morphological structure of tendon, increased 6.This study may point toward that curcuminoids plus
glycosaminoglycans and hydroxyproline levels, and piperine has a role in weight reduction and, hence, lower
inhibited the expression and activities of MMP-2 and risk of OA.
Table 6 : Effect of BMI before and after 3 months
BMI Placebo A Curcumin B P-value
Baseline 29.15±4.87 29.83±5.08 0.65 NS
After 3 months 29.75±4.97 29.30±5.00 0.76 NS
Rate of change 1.09% -1.77%
P-value4512 Indian Journal of Forensic Medicine & Toxicology, July-September 2021, Vol. 15, No. 3
Mkrtchyan , Naira Minasyan , SrbuhiGasparyan, 1;173(11):861-869. Epub 2020 Sep 15. PMID:
Aida Sargsyan , Mikael Narimanyan and 32926799.
AregHovhannisyan ,Efficacy and safety of 15. Faruqui A.F. Curcumin and piperine: a novel
curcumin and its combination with boswellic acid in therapy in the management of osteoarthritis in
osteoarthritis: a comparative, randomized, double- Indian patient. Pacific Journal of Medical Sciences,
blind, placebo-controlled study Haroyan et al. 2018;18(1):36-43
BMC Complementary and Alternative Medicine,
16. Fernández-Lázaro D., Mielgo-Ayuso J., SecoCalvo
2018; 18:7.
J., CórdovaMartínez A., Caballero García A.,
8. Salehi, B.; Zakaria, Z.A.; Gyawali, R.; Ibrahim, Fernandez-Lazaro C. I. Modulation of exercise-
S.A.; Rajkovic, J.; Shinwari, Z.K.; Khan, T.; induced muscle damage, inflammation, and
Sharifi-Rad, J.; Ozleyen, A.; Turkdonmez, E.; oxidative markers by curcumin supplementation
et al. Piper species: A comprehensive review on in a physically active population: a systematic
their phytochemistry, biological activities and review. Nutrients. 2020;12(2):p. 501.
applications. Molecules 2019; 24, 1364.
17. Zhang Y., Zeng Y. Curcumin reduces inflammation
9. Stojanovi´c-Radi´cZ, Pejˇci´c M, Dimitrijevi´cM, in knee osteoarthritis rats through blocking TLR4/
Aleksi´cA, Nanjangud V, Kumar A , SalehiB, MyD88/NF-κB signal pathway. Drug Development
Cho WC,Sharifi-Rad J.Piperine-A Major Principle Research. 2019;80(3):353–359.
of Black Pepper: A Review of Its Bioactivity and
18. Heidari S., Mahdiani S., Hashemi M., Kalalinia F.
Studies Appl. Sci. 2019; 9, 4270; doi:10.3390/
Recent advances in neurogenic and neuroprotective
app9204270
effects of curcumin through the induction of
10. Comblain F, Sanchez C, Lesponne I, Balligand neural stem cells. Biotechnology and Applied
M, Serisier S, Henrotin Y. Curcuminoids extract, Biochemistry. 2020;67(3):430-441
hydrolyzed collagen and green tea extract
19. Buhrmann, C.; Shayan, P.; Banik, K.;
synergically inhibit inflammatory and catabolic
Kunnumakkara, A.B.; Kubatka, P.; Koklesova,
mediator’s synthesis by normal bovine and
L.; Shakibaei, M. Targeting NF-κB Signaling
osteoarthritic human chondrocytes in monolayer.
by Calebin A, a Compound of Turmeric,
PLoS One. 2015;10(3):e0121654 .
in Multicellular Tumor Microenvironment:
11. Van Delft MA, Huitema LF, Tas SW. The Potential Role of Apoptosis Induction in CRC
contribution of NF-kappaBsignalling to immune Cells. Biomedicines 2020; 8: 236.
regulation and tolerance. Eur J Clin Invest. 2015;
20. Atabaki M, Shariati-Sarabi Z, Tavakkol-Afshari J,
45(5):529–539.
Mohammadi M. Significant immunomodulatory
12. PranaliWaghmare, DheerajPatingrao and Dr. properties of curcumin in patients with
PramodKadu. Extraction, isolation, purification osteoarthritis; a successful clinical trial in Iran.
and identification of curcumin: A review article. IntImmunopharmacol. 2020 Aug;85:106607. doi:
European Journal of Biomedical and Pharmaceutical 10.1016/j.intimp.2020.106607. Epub 2020 Jun 12.
sciences.2015; 2 (3), 108-123. PMID: 32540725.
13. Azmir J, Zaidul I, Rahman M, Sharif K, Mohamed 21. Rahimnia AR, Panahi Y, Alishiri G, Sharafi M,
A, Sahena F, Jahurul M, Ghafoor K, Norulaini N, Sahebkar A. Impact of Supplementation with
Omar A. Techniques for extraction of bioactive Curcuminoids on Systemic Inflammation in
compounds from plant materials: a review. J Food Patients with Knee Osteoarthritis: Findings from
Eng,2013; 117:426–36. a Randomized Double-Blind Placebo-Controlled
14. Wang Z, Jones G, Winzenberg T, Cai G, Laslett Trial. Drug Res (Stuttg). 2015;65(10):521-525.
LL, Aitken D, Hopper I, Singh A, Jones R, Fripp 22. Gupte P.A.,Giramkar S.A,Harke S.M,Kulkarni
J, Ding C, Antony B. Effectiveness of Curcuma S.K. ,Deshmukh A.P, Hingorani L.L., Mahajan
longa Extract for the Treatment of Symptoms M.P., Bhalerao S.S., Evaluation of the efficacy
and Effusion-Synovitis of Knee Osteoarthritis : and safety of Capsule Longvida((R)) Optimized
A Randomized Trial. Ann Intern Med. 2020 Dec Curcumin (solid lipid curcumin particles) in kneeIndian Journal of Forensic Medicine & Toxicology, July-September 2021, Vol. 15, No. 3 4513
osteoarthritis: a pilot clinical study, J Inflamm Res Y. Piperine ameliorates collagenase-induced
2019;12: 145–152. Achilles tendon injury in the rat. Connective Tissue
23. Gong F, Cui L, Zhang X, Zhan X, Gong X, Wen Research, 2018; 59:1, 21-29.You can also read
