PETER J. ROHDEWALD* 
Westfaelische-Wilhems-University of Muenster, Germany

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids are widely used in treatment of osteoarthritis (OA), despite their well-known unwanted effects. Natural antioxidants present an alternative because of lack of undesired effects and clinically demonstrated improvements of OA. The present review with additional data refers to systematic, comprehensive meta-analysis which identified 7 natural substances and extracts with antioxidative properties providing clinically relevant reduction of pain, improvement of immobility and stiffness in OA patients. Supplementation with these antioxidants allowed for  sparing NSAIDs use. A detailed mode of action of one of the antioxidative, anti-inflammatory supplement ispresented using the example of the French maritime pine bark extract Pycnogenol^®.

Osteoarthritis (OA), especially knee osteoarthritis, has a high prevalence globally. In the US, for example, symptomatic knee osteoarthritis affects 14 million patients according to a survey in 2016 (1). Interestingly, the data revealed that knee OA is a burden not restricted to the elderlies as more than 50% of the patients with knee OA are less than 65 years old. Data from South America, Europe, Asia and the Middle East refer further to the world wide high prevalence of knee OA (2). In OA, synovitis has a high prevalence and contributes significantly to pain and degeneration of cartilage (3).

Knee osteoarthritis causes not only physical symptoms as pain and disability, but frequently produces additional consequences as depressive symptoms (4) and loss of memory because permanent pain at night causes sleep and mood impairments (5). A meta-analysis revealed an increased risk of myocardial infarction for patients with OA (6).

Preferred and effective treatments of OA symptoms and synovitis are corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs). However, both treatments are associated with a high rate of unwanted effec ...