Brien, S, Lewith, G, Walker, A.F, Middleton, R, Prescott, P and Bundy, R
Bromelain as an adjunctive treatment for moderate-to-severe osteoarthritis of the knee: a randomized placebo-controlled pilot study
QJM: An International Journal of Medicine, 99, (12), . (doi:10.1093/qjmed/hcl118).
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Background: Osteoarthritis (OA) of the knee is the
most prevalent joint disorder. Previous studies
suggest that bromelain, a pineapple extract, may
be a safer alternative/adjunctive treatment for knee
OA than current conventional treatment.
Aim: To assess the efficacy of bromelain in treating
OA of the knee.
Design: Randomized, double-blind placebocontrolled
Methods: Subjects (n¼47) with a confirmed diagnosis
of moderate to severe knee OA were
randomized to 12 weeks of bromelain 800 mg/day
or placebo, with a 4-week follow-up. Knee (pain,
stiffness and function) and quality-of-life symptoms
were reported monthly in the WOMAC and
SF36 questionnaires, respectively. Adverse events
were also recorded. The primary outcome
measure was the change in total WOMAC score
from baseline to the end of treatment at week 12.
Longitudinal models were used to evaluate
Results: Thirty-one patients completed the trial
(14 bromelain, 17 placebo). No statistically significant
differences were observed between groups for
the primary outcome (coefficient 11.16, p¼0.27,
95%CI 8.86 to 31.18), nor the WOMAC subscales
or SF36. Both treatment groups showed clinically
relevant improvement in the WOMAC disability
subscale only. Adverse events were generally mild
Discussion: This study suggests that bromelain is not
efficacious as an adjunctive treatment of moderate
to severe OA, but its limitations support the need for
a follow-up study.
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