Bromelain Containing Enzyme-Rutosid Combination Therapy is as Effective as Nonsteroidal Antiinflammatory Agents for Treatment of Osteoarthritis

Background: Osteoarthritis (OA) affects 20 million Americans and OA of the knee is the number one disability in the US. OA is due to inflammation and dysfunction of the immune system. One commonly used therapy for OA is nonsteroidal antiinflammatory drugs (NSAIDs) but they have adverse reactions that affect the gastrointestinal, renal, and cardiovascular systems. Combination oral enzyme therapy contains naturally extracted enzymes (bromelain and trypsin) and combines them with the antioxidant rutosid, extracted from buckwheat or the pagoda tree, as an alternative treatment for OA. The combination oral enzyme therapy has antiinflammatory, antiedematous, antihistaminic, antiviral, antithrombotic, and fibrinolytic properties. Is this combination oral enzyme therapy as effective as NSAIDs in the treatment of OA? Methods: An exhaustive search of available medical literature was conducted through Medline-OVID, CINAHL, and Web of Science using the keywords: bromelain, nonsteroidal antiinflammatory agents, and osteoarthritis. Studies were screened for use of the English language and use of randomized controlled trial design. Relevant articles were assessed for quality using GRADE. Results: Four studies met inclusion criteria and were included in the systematic review. Four randomized controlled trials demonstrated that combination oral enzyme therapy was as effective as diclofenac (NSAID) in management of active osteoarthritis. The studies showed no significant differences when comparing NSAIDs to combination oral enzyme therapy where regarding pain at rest, pain with movement, Lequesne’s Functional Index, joint stiffness, range of motion, and swelling in the affected joint. Conclusion: Combination enzyme therapy has been shown to be as effective as NSAIDs in treatment of active osteoarthritis. More studies need to be done to evaluate long term efficacy and tolerance. Recommend use of combination oral enzyme therapy in patients that cannot tolerate NSAIDs or have contraindications to NSAID therapy. Keywords: Bromelain, nonsteroidal antiinflammatory agents, osteoarthriti