Bromelain as a Treatment for Osteoarthritis: a Review of Clinical Studies

Sarah Brien, George Lewith, Ann Walker, Stephen M Hicks, Dick Middleton, Sarah Brien, George Lewith, Ann Walker, Stephen M Hicks, Dick Middleton

Abstract

Bromelain, an extract from the pineapple plant, has been demonstrated to show anti-inflammatory and analgesic properties and may provide a safer alternative or adjunctive treatment for osteoarthritis. All previous trials, which have been uncontrolled or comparative studies, indicate its potential use for the treatment of osteoarthritis. This paper reviews the mechanism of its putative therapeutic actions, those clinical trials that have assessed its use in osteoarthritis to date, as well as considering the safety implications of this supplement for osteoarthritis and reviewing the evidence to date regarding the dosage for treating this condition. The data available at present indicate the need for trials to establish the efficacy and optimum dosage for bromelain and the need for adequate prospective adverse event monitoring in such chronic conditions as osteoarthritis.

References

    1. Lawrence RC, Helmich CG, Arnett F, et al. Estimates of prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum. 1998;41:778–799.
    1. Felson DT, Lawrence RC, Dieppe PR, et al. Osteoarthritis: New Insights. Part 1. The disease and its risk factors. Ann Intern Med. 2000;133:635–646.
    1. Guccione AA, Felson DT, Anderson JJ, et al. The effects of specific medical conditions on the functional limitations of elders in the Framington study. Am J Public Health. 1994;84:351–358.
    1. Doherty M. Risk factors for the progression of knee osteoarthritis. Lancet. 2001;358:775–776.
    1. Anderson JJ, Felson DT. Factors associated with osteoarthritis of the knee in the first national Health and Nutrition Examination Survey (HANES I). Evidence for an association with overweight, race, and physical demands of work. Am J Epidem. 1988;128:179–189.
    1. Minor MA, Hewitt JE, Webel RR, Anderson SK, Kay DR. Efficacy physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis. Arthritis Rheum. 1989;32:1396–1405.
    1. Singh G. Recent considerations in nonsteroidal anti-inflammatory drug gastropathy. Am J Med. 1998;105(16):315–385.
    1. Griffin MR. Epidemiology of nonsteroidal anti-inflammatory drug-associated gastrointestinal injury. Am J Med. 1998;104(3A):23S–29S.
    1. Wright JM. The double-edged sword of COX-2 selective NSAIDs. Can Med Assoc J. 2002;167:1131–1137.
    1. Cooreman WM, Scharpe S, Demeester J, Lauwers A. Bromelain, biochemical and pharmacological properties. Pharm Acta Helv. 1976;51:73–97.
    1. Maurer HR. Bromelain: biochemistry, pharmacology and medical use. Cell Mol Life Sci. 2001;58:1234–1245.
    1. Taussig SJ, Batkin S. Bromelain, the enzyme complex of Pineapple (Ananas comusus) and its clinical application. An update. J Ethnopharmacol. 1988;22:191–230.
    1. Pirotta F, de Giuli-Morghen C. Bromelain: anti-inflammatory and serum fibronolytic activity after oral administration in the rat. Drugs Exp Clin Res. 1978;4:1–20.
    1. Livio M, Bertoni MP, De Gaetano G, Donati MB. Effects of bromelain on fibrinogen level, pothrombin complex and platelet aggregation in the rat—a preliminary report. Drugs Exp Clin Res. 1978;4:49–53.
    1. Kumakura S, Yamashita M, Tsurufuji S. Effect of Bromelain or kaolin-induced inflammation in rats. Eur J Pharmacol. 1988;150:295–301.
    1. Hale LP, Hayes BF. Bromelain treatment of human T cells removes CD44, CD45RA, E2/MIC2, CD6, CD7, CD8 and Leu 8/LAM1 surface molecules and markedly enhances CD-2Mediated T cell activation. J Immunol. 1992;149:3809–3816.
    1. Kleef R, Delohery TM, Bovbjerg DH. Selective modulation of cell adhesion molecules on lymphocytes by Bromelain protease 5. Pathobiology. 1996;64:339–346.
    1. Mynott T, Ladhams A, Scarmato P, Engwerda C. Bromelain from pineapple stems, proteolytically blocks activation of extracellular regulated kinase-2 in T cells. J Immunol. 1999;163:2568–2575.
    1. Hale LP, Greer PK, Sempowski GD. Bromelain treatment alters leukocyte expression of cell surface molecules involved in cellular adhesion and activation. Clin Immunol. 2002;104:183–190.
    1. Hale LP. Proteolytic activity and immunogenicity of oral bromelain within the gastrointestinal tract of mice. Int Immunopharm. 2004;4:255–264.
    1. Mojcik C, Shevach E. Adhesion molecules: a rheumatologic perspective. Arthritis Rheum. 1997;40:991–1004.
    1. Bodi T. The effects of oral bromelains on tissue permeability to antibiotics and pain response to bradykinin: double blind studies on human subjects. Clin Med. 1966;73:61–65.
    1. Uhlig G, Seifert J. Die Wirkung proteolytischer Enzyme auf das posttraumatische Syndrom. Fortschritte der Medizin. 1981;15:554–556.
    1. Cohen A, Goldman J. Bromelain therapy in rheumatoid arthritis. Penn Med J. 1964;67:27–30.
    1. Leipner J, Iten F, Saller R. Therapy with proteolytic enzymes in rheumatic disorders. Biodrugs. 2001;15:779–789.
    1. Singer F, Oberleitner H. Drug therapy of activated arthrosis. On the effectiveness of an enzyme mixture versus diclofenac. Wien Med Wochenschr. 1996;146:55–58.
    1. Klein G, Kullich W. Short-term treatment of painful osteoarthritis of the knee with oral enzymes: a randomised, double-blind study versus Diclofenac. Clin Drug Invest. 2000;19:15–23.
    1. Singer F, Singer C, Oberleitner H. Phlyoenzym versus diclofenac in the treatment of activated osteoarthritis of the knee. Int J Immunother. 2001;17:135–141.
    1. Tilwe GH, Beria S, Turakhia NH, Daftary GV, Schiess W. Efficacy and tolerability of oral enzyme therapy as compared to diclofenac in active osteoarthritis of the knee joint: an open randomised controlled clinical trial. Journal of the Association of Physicians of India. JAPI. 2001;49:621.
    1. Walker AF, Bundy R, Hicks SM, Middleton RW. Bromelain reduces mild acute knee pain and improves well being in a dose dependant fashion in an open study of otherwise healthy adults. Phytomedicine. 2002;9:681–686.
    1. Klein G, Kullich W, Brugger A. Phlogenzym in der Behandlung der Periarthropathia humeroscapularis tendopathica simplex. Arzt Praxis. 1997;51:879–885.
    1. Bellamy N, Buchanan W, Goldsmith C, Campbell J, Stitt L. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to anti-rheumatic drug therapy in patients with osteoarthritis of the hip or knee. Rheumatology. 1988;15:1833–1840.
    1. Stenton SB, Bungard TJ, Ackman ML. Interactions between warfarin and herbal products, minerals, and vitamins: A pharmacist's guide. Can J Hosp Pharm. 2001;54:184–190.

Source: PubMed

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