Osteoarthritis is the most common joint disorder affecting over 300 million people worldwide. It typically affects the knees and the hips, and is characterized by a loss in normal joint movement, stiffness, swelling, and
pain in patients. The current gold standard
therapy for
osteoarthritis targets
pain management using nonsteroidal anti-inflammatory drugs (
NSAIDs).
NSAIDs are associated with several potentially serious side effects, the most common being gastrointestinal perforation and
bleeding. Owing to the side effects,
NSAID treatment doses need to be as low as possible and should be continued for the shortest duration possible, which is problematic in a
chronic condition like
osteoarthritis, which requires long-term management. Numerous clinical trials have examined oral
enzyme combinations as a potential new approach in managing
pain in patients with
osteoarthritis. Oral
enzyme combinations containing
bromelain in combination with
trypsin, both
proteolytic enzymes, as well as the plant
flavonoid rutin, may be an effective alternative to typical
NSAIDs. The aim of this narrative review is to summarize and discuss the evidence on the efficacy of oral
enzyme combinations compared to the gold standard (
NSAID) in the management of
osteoarthritis symptoms. Nine randomized controlled trials identified in this review assessed the efficacy and safety of the oral
enzyme combination containing
bromelain,
trypsin, and
rutin in patients with
osteoarthritis. Most of the studies assessed the impact of the oral
enzyme combination on the improvement of the Lequesne Algofunctional index score, treatment-related
pain intensity alterations and adverse events compared to patients receiving
NSAIDs. Although largely small scale, the study outcomes suggest that this combination is as effective as
NSAIDs in the management of
osteoarthritis, without the adverse events associated with
NSAID use. INFOGRAPHIC.