How Curcumin Works for Arthritis

  • 5 Oct 2020
  • Reading time 11 mins
Login to add to reading list

Of all the anti-inflammatory agents curcumin, found in the bright yellow pigment in turmeric has the most positive evidence and almost deserves a chapter in its own right.it has been known about and used medicinally for thousands of years dating back to the early Ayurvedic medicine coming out of India. I recall, when travelling in the ‘80s through Africa, an old man with a yellow stained bandage around his knee. This was a turmeric compress.

Astonishingly, an American company tried to get a patent on turmeric in 1995, claiming it was a ‘new’ discovery for the treatment of inflammation. But the Indian government successfully challenged this on the grounds that the spice had been used for precisely that purpose for generations in India. Turmeric gives a great flavour in curries, stir-fries or add a teaspoon when cooking rice. The only downside is that it can stain, so take care when using in cooking!

What has really brought curcumin-rich supplements into the spotlight is the discovery of ways to enhance its absorption into the bloodstream. Typically, when ground turmeric is eaten there is very little increase in available curcumin in the bloodstream however a new generation of supplements has increased absorption at least a hundred fold. Consequently, early studies often involved injecting it directly into the bloodstream and showing powerful effects that could not then be achieved just by having a teaspoon of turmeric powder.

Plenty of studies show it works as well as anti-inflammatory drugs, but without the side effects1. Like NSAIDs, it blocks the formation of the pro-inflammatory prostaglandins (PGE2), as well as leukotrienes2. In fact, it turns out to be what everyone hoped drugs like Vioxx would be (a mild 5-Lox and Cox-2 inhibitor that not does not affect Cox-1).There is no evidence of any downsides, even in high doses of 8g a day. It also mops up nitric oxide (another inflammatory mediator) and is a powerful anti-oxidant. In addition, it has been shown to promote detoxification. A review of Turmeric in the Journal of Clinical Immunology states that curcumin at low doses can also enhance antibody responses3. This suggests that curcumin's reported beneficial effects in arthritis, allergies, asthma, atherosclerosis, heart disease, Alzheimer's, and cancer might be due in part to its ability to modulate the immune system and dampen down inflammation.

Let’s take a look at the actual results of clinical studies in people suffering from either osteo or rheumatoid arthritis. Many studies focus on knee osteoarthritis since it is easier to quantify beneficial effects. I’ll focus on ‘double blind’ placebo-controlled studies whereby the sufferer doesn’t known whether they’ve been given a dummy pill or the curcumin rich supplements, and nor does the researcher, until the trial is over so they cannot ‘cheat’ in their clinical assessment of improvement. Some trials, instead of comparing the placebo, compare to the best currently offered NSAID drug treatment to see if curcumin is as good as, better or worse compared to NSAIDs.

Curcumin helps osteoarthritis as well as NSAIDs

  • A study in 2019 from the University of Liege in Belgium evaluated the effect of a high and lower dose of a turmeric extract high in curcumin (equivalent to 187 and 280 mg of curcumin ) in 150 patients with knee arthritis4. After 3 months pain was reduced by 47 per cent in the high and 58 per cent in the low turmeric extract dose groups, which was statistically significantly better than placebo. They also needed to use less pain killers In most measures the low dose was just as effective as the high dose of this ‘bio-optimised’ form of curcumin which was measured to raise blood levels of curcumin showing it was effectively absorbed.
  • An earlier study in 2014 from Japan 5 using another highly absorbable form of curcumin called Theracurmin (180mg) in 41 people with knee arthritis reported a significant 62 per cent improvement in pain (versus 50 per cent in the placebo group) and consequently those taking Theracurmin ended up reducing their use of other painkilling medication.
  • Another similar study from India6 comparing 160mg of curcumin versus 400mg ibuprofen in 50 people with knee arthritis found that pain scores more than halved in both groups over the 90 days with no significant difference between groups. In other words curcumin was just as effective as this NSAID drug.
  • Another study conducted in Thailand compared a high dose of curcumin (1500mg) with a with ibuprofen (1,200mg) per day for four weeks in 331 knee arthritis sufferers7. Improvements in pain stiffness and overall functions were similar in both groups but there less gastrointestinal adverse effects in the curcumin group than the drug group which is one of the problems with continuous NSAID use.
  • Another study from India8, this time comparing a higher dose of curcumin (500mg) given three times daily with the NSAID diclonofenac found that pain reduced from 7.8 to 2.2 (out of a maximum score of 10) after 4 weeks in both groups. Function and quality of life also improved to similar extents in both groups. Once again, curcumin was just as effective as this painkiller. This confirmed an earlier pilot study9 involving 19 patients five of which were able to stop their pain medication completely while eleven were able to reduce it. None in the placebo group were able to stop their medication.

For practical reasons most studies are up to 3 months long but one Italian study looked at the effect of a bioavailable form of curcumin over 8 months, compared to those on the best available drug treatment in a hundred osteoarthritis sufferers10. Pain, stiffness, physical, social and emotional functions all improved by more than 50% in the curcumin group, with no significant improvements in the control group on medication. There were also a significant improvements in inflammatory markers including ESR and IL-6 and a 63% decrease in NSAID use in the curcumin group with very few and minor adverse effects11.

There are other studies but suffice it to say that curcumin works for osteoarthritis. Even by 2016 a systematic review combining the results of eight studies concluded that turmeric extracts high in curcumin were significantly better than placebo and equal to common painkilling medication and therefore superior given their very low incidence of adverse effects. Curcumin works for rheumatoid arthritis.

But what about rheumatoid arthritis? A ‘good standard’ double-blind placebo-controlled trial gave rheumatoid arthritis suffers either a placebo or a low dose (250mg) or high dose (500mg) of a curcumin preparation for 90 days12. Both the low and the high curcumin groups experienced a statistically and clinically significant improvements in disease activity (53%-66% improvement), symptoms (62%-72%), inflammatory markers measuring both ESR and CRP (30%-89%) and rheumatoid factor (80%-84%). There were no improvements in the placebo group. Although the high dose group had slightly better average improvements the difference was not great enough to be statistically significant but this was probably to do with the relatively small study size – 12 in each group. (It’s a bit like tossing coins: if you tossed 5 heads and 8 tails you good say it was just luck. But if you tossed 500 heads and 800 tails that would be significant.)

This confirmed an earlier study from Kerala in India in 2012, which compared improvement in rheumatoid arthritis suffers either on the painkiller diclofenac or curcumin or both and found that, not only did the curcumin only group show more improvements than the drug group they also had much less adverse effects.13

I highly recommend curcumin extracts in both osteoarthritis and rheumatoid arthritis. One slight challenge is comparing doses in many different formulations.

The graph below shows a comparison of the different most bio-available forms of curcumin. As you can see Theracurmin is not only the one that most raises blood levels of curcumin but it also keeps those levels raised for at least 4, if not 8 hours. Also, the higher the dose, the greater the increase, with no drop off at 2,000mg dose. This means its method of delivery hasn’t hit a maximum threshold.

 

For this reason I prefer Theracurmin and recommend it for people struggling with inflammation. It absorbs several times better then its competitors at the same dose. For example, if you look at Theracurmin 1,000mg (actually 100mg of colloidal curcumin) it achieves a blood level, after 4 hours, of 86 ng/ml, compared to Meriva 1,000mg (actually 200mg of curcimun) which achieves a blood level of 51ng/ml. After eight hours the effects are even more striking. Theracurmin blood levels remain high at 76ng/ml, while Meriva has dropped to 22. So, plasma levels are more than three times higher. Studies on another supplement called Longvida show that a 2,000mg dose still only achieves a maximum saturation of about 32.5ng/ml, compared to 2,100mg Theracurmin achieving a maximum plasma level of 275ng/ml. If you look at the orange line – curcumin plus piperine, which is the active component in black pepper that helps absorption – the plasma level after 3 hours of 2,000mg is 32.5ng/ml compared to over 250ng/ml and, after 4 hours, is 12.5ng/ml compared to 240ng/ml. So we can say that Theracurmin is ten times more effective in raising plasma levels. In comparison to standard curcumin it is well over a hundred times better absorbed. These results were published in a study in 201514.

My recommendation, if you’re in pain, is to take three ‘double strength’ Theracurmin a day for a week. if that makes a major difference to your pain then experiment with two capsules and see if that works as well.

References

1. N. Chainani-Wu, ‘Safety and Anti-Inflammatory Activity of Curcumin: A Component of Tumeric (Curcuma longa)’, Journal of Alternative and Complementary Medicine, vol. 9 (1), 2003, pp. 161-168

2. B. Joe and B. R. Lokesh, ‘Effect of curcumin and capsaicin on arachidonic acid metabolism and lysosomal enzyme secretion by rat peritoneal macrophages’, Lipids, vol. 32(11), 1997, pp. 1173–80

3. G. C. Jagetia & B. B. Aggarwal, ‘Spicing up of the immune system by curcumin’, Journal of Clinical Immunology, vol. 27 (1), 2007, pp. 19-35.

4. Henrotin, Y., Malaise, M., Wittoek, R., de Vlam, K., Brasseur, J.-P., Luyten, F. P., … Dierckxsens, Y. (2019). Bio-optimized Curcuma longa extract is efficient on knee osteoarthritis pain: a double-blind multicenter randomized placebo controlled three-arm study. Arthritis Research & Therapy, 21(1), 179. https://doi.org/10.1186/s13075-019-1960-5

5. Nakagawa, Y., Mukai, S., Yamada, S., Matsuoka, M., Tarumi, E., Hashimoto, T., … Nakamura, T. (2014). Short-term effects of highly-bioavailable curcumin for treating knee osteoarthritis: a randomized, double-blind, placebo-controlled prospective study. Journal of Orthopaedic Science : Official Journal of the Japanese Orthopaedic Association, 19(6), 933–939. https://doi.org/10.1007/s00776-014-0633-0

6. Gupte, P. A., Giramkar, S. A., Harke, S. M., Kulkarni, S. K., Deshmukh, A. P., Hingorani, L. L., … Bhalerao, S. S. (2019). Evaluation of the efficacy and safety of Capsule Longvida((R)) Optimized Curcumin (solid lipid curcumin particles) in knee osteoarthritis: a pilot clinical study. Journal of Inflammation Research, 12, 145–152. https://doi.org/10.2147/JIR.S205390

7. Kuptniratsaikul, V., Dajpratham, P., Taechaarpornkul, W., Buntragulpoontawee, M., Lukkanapichonchut, P., Chootip, C., … Laongpech, S. (2014). Efficacy and safety of Curcuma domestica extracts compared with ibuprofen in patients with knee osteoarthritis: a multicenter study. Clinical Interventions in Aging, 9, 451–458. https://doi.org/10.2147/CIA.S58535

8. Shep, D., Khanwelkar, C., Gade, P., & Karad, S. (2019). Safety and efficacy of curcumin versus diclofenac in knee osteoarthritis: a randomized open-label parallel-arm study. Trials, 20(1), 214. https://doi.org/10.1186/s13063-019-3327-2

9. Panahi, Y., Rahimnia, A.-R., Sharafi, M., Alishiri, G., Saburi, A., & Sahebkar, A. (2014). Curcuminoid treatment for knee osteoarthritis: a randomized double-blind placebo-controlled trial. Phytotherapy Research : PTR, 28(11), 1625–1631. https://doi.org/10.1002/ptr.5174

10. Belcaro, Gianni, Cesarone, M. R., Dugall, M., Pellegrini, L., Ledda, A., Grossi, M. G., … Appendino, G. (2010). Efficacy and safety of Meriva(R), a curcumin-phosphatidylcholine complex, during extended administration in osteoarthritis patients. Alternative Medicine Review : A Journal of Clinical Therapeutic, 15(4), 337–344

11. Daily, J. W., Yang, M., & Park, S. (2016). Efficacy of Turmeric Extracts and Curcumin for Alleviating the Symptoms of Joint Arthritis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Journal of Medicinal Food, 19(8), 717–729. https://doi.org/10.1089/jmf.2016.3705

12. Amalraj, A., Varma, K., Jacob, J., Divya, C., Kunnumakkara, A. B., Stohs, S. J., & Gopi, S. (2017). A Novel Highly Bioavailable Curcumin Formulation Improves Symptoms and Diagnostic Indicators in Rheumatoid Arthritis Patients: A Randomized, Double-Blind, Placebo-Controlled, Two-Dose, Three-Arm, and Parallel-Group Study. Journal of Medicinal Food, 20(10), 1022–1030. https://doi.org/10.1089/jmf.2017.3930

13. Chandran, B., & Goel, A. (2012). A randomized, pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis. Phytotherapy Research : PTR, 26(11), 1719–1725. https://doi.org/10.1002/ptr.4639

14. Sunagawa Y, Hirano S, Katanasaka Y, et al. Colloidal submicron-particle curcumin exhibits high absorption efficiency-a double-blind, 3-way crossover study. J Nutr Sci Vitaminol (Tokyo). 2015;61(1):37-44. doi:10.3177/jnsv.61.37

Top