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Efficacy of Oral Enzyme Combination vs. Diclofenac in the Management of Large Joint Osteoarthritis: A Systematic Review

9 August 2012


Background: Osteoarthritis is the most common joint disorder in the world today and affects over 27 million individuals in the US. The standard treatment of osteoarthritis is the use of NSAIDs, which come with a list of potentially serious side effects, the most common being GI perforation and bleeding. Bromelain, a proteolytic enzyme that is found in the stem of the pineapple plant may be an effective alternative to typical NSAID therapy with a lower risk profile. Bromelain is currently sold as a combination with other enzymes such as rutin and trypsin. The purpose of this review is to evaluate the efficacy of oral enzyme combinations to the potent NSAID diclofenac in the management of osteoarthritis.

Method: An extensive literature search was done using CINHAL, Medline, Evidence-Based Medicine Reviews Multifile, and Web of Science. The search included the terms Bromelain, Arthritis and Non-Steroidal Anti-inflammatory agents.

Results: Five randomized control trials met the inclusion criteria. Each study was very similar with respect to study design and results. Primary outcomes were pain and function measured most often with the Lequesne Index, the VAS or a variation of the two. Each of the 5 studies showed that the oral enzyme combination was as effective as diclofenac in the treatment of osteoarthritis with regards to the primary outcome.

Conclusion: This review showed that Oral enzyme therapy is as effective as diclofenac in the treatment of osteoarthritis and can be recommended to patients because of its efficacy and low risk-to-benefit ratio.


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