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• Turmeric for Arthritis

Common Names: curcumin, curcuminoids, turmeric root
Scientific Names: curcuma longa, curcuma domestica

What is turmeric?

• Turmeric is a spice that comes from the turmeric root. It is used to flavor and color some curry powders, mustards, butters, and cheeses.  Curcumin is a yellow pigment used in food coloring.  It is one of the major active ingredients from the turmeric root called curcuminoids.

What is it used for in people with rheumatic conditions?

• Turmeric has been used for the management of osteoarthritis and rheumatoid arthritis to reduce joint pain and improve function.

How is it thought to work?

• The active part of turmeric, curcumin, has been shown to reduce inflammation and act as an antioxidant.

Does it Work? What the Science Says:

Osteoarthritis and rheumatoid arthritis 500 mg 2–4 times daily:

• Limited research suggests that turmeric extract may be modestly effective in reducing pain and improving functionality in patients with OA and RA after 6 – 8 weeks of treatment.
  • Lack of reliable evidence to support use of turmeric in RA.
• A small study showed a commercial formulation of turmeric (Meriva®) used at 500 mg twice daily modestly reduced pain and improved functionality in patients with knee OA.
  • Long-term efficacy and safety are unknown.
• A four week long randomized control study with 367 patients with knee OA showed that taking turmeric extract 500 mg three times daily demonstrated non-inferiority to ibuprofen 400 mg three times daily for reducing knee pain in OA.  Both groups showed clinical improvement on a 10 point WOMAC pain scale (change (percent improvement) from baseline): -2.23 (41.3%) ibuprofen vs -1.94 (36.6%) turmeric.  There was similar use of rescue tramadol between groups (2/185 1.1% ibuprofen group vs 5/185 2.7% turmeric group).  Patients taking turmeric had less abdominal pain/discomfort than the ibuprofen group, but more loose stools.
  • Small well conducted trial showed turmeric was effective for reducing OA pain with a good safety profile over 4 weeks.
• A systematic review and meta-analysis of 8 RCTs examined the use of turmeric in patients with any arthritic pain (7 of 8 in OA). Results from 3 studies demonstrated a mean difference of -2 on a 10cm pain VAS compared to placebo.
  • Small well conducted systematic review with meta-analysis that found benefits of turmeric on pain

Flexofytol (bio-optimized curcuma longa extract (BCL))

• A randomized controlled trial compared high dose BCL (2 capsules three times daily) vs low dose BCL (2 capsules twice daily) vs placebo on pain reduction in knee OA measured using Patient Global Assessment of Disease Activity (100mm). The change from baseline (~67) was 27, 28, and 14 respectively (all p<0.05). There was no change in serum Coll2-1 levels (biomarker of cartilage degradation). More patients on BCL experienced abdominal discomfort and diarrhea.
  • A small trial of BCL turmeric extract showed some benefit in pain.

What are possible side effects and what can I do about them?

• Turmeric products are generally well tolerated if taken orally. Common side effects reported include: constipation, changes in stool color, heartburn, bloating, diarrhea, nausea, and vomiting.
• Less common side effects are itching, and fluid build-up.

Interactions

With drugs:

• Turmeric may cause low blood sugar (hypoglycemia) when used with other medication for diabetes. This is due to the possible blood sugar lowering effects of turmeric. Blood sugar levels should be monitored closely.
• Turmeric may inhibit the liver enzymes that metabolize many other medications (CYP 1A2, and 3A4). This may increase the side effects of those medications. Check with your pharmacist before using turmeric.
• Turmeric may reduce the amount platelets clump together (platelet aggregation). It may interact with anticoagulant/antiplatelet drugs by increasing risk of bruising and/or bleeding.  
  • Common antiplatelet and anticoagulant drugs may include: warfarin (Coumadin), ASA (Aspirin), and clopidogrel (Plavix), ticagrelor (Brilinta), prasugrel (Effient), enoxaparin (Lovenox), dalteparin (Fragmin), dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis) and others.

With Other Diseases:

• May induce gallbladder contraction, which may worsen symptoms and cause abdominal pain in patients with gallbladder or gallstone disease.
• May cause acid reflux and heartburn, which may worsen GERD symptoms.
• Has antiplatelet effects, which may increase risk of bleeding during surgeries. Stop turmeric at least 2 weeks prior to surgical procedures.

With other natural health products:

• Turmeric may reduce the amount platelets clump together (platelet aggregation). It may interact with other natural health products that affect the way platelets clump together (platelet aggregation), increasing the risk of bruising and/or bleeding.
  • Such as: garlic, ginger, ginkgo, certain types of ginseng, and red clover, and others.

Visit albertarheumatology.com to learn more.
For more information about turmeric, consult your physician and pharmacist.