Topical Effects of Artemisia Absinthium Ointment and Liniment in Comparison with Piroxicam Gel in Patients with Knee Joint Osteoarthritis: A Randomized Double-Blind Controlled Trial.

Iran J Med Sci. 2017 Nov;42(6):524-531. Basiri Z1, Zeraati F2,3, Esna-Ashari F4, Mohammadi F5, Razzaghi K2, Araghchian M3, Moradkhani S2,6. Author information 1 Department of Internal Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. 2 Medicinal Plants and Natural Product Research Center, Hamadan University of Medical Sciences, Hamadan, Iran. 3 Department of Pharmacology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran. 4 Department of Community Medicine, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. 5 School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. 6 Department of Pharmacognosy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran. Abstract Background: Pain alleviation and improvement of functional status are the main objectives in the treatment of osteoarthritis. Artemisia absinthium (AA) was used traditionally in reducing pain and inflammation. The aim of the present study was to compare the effects of topical formulations of AA and piroxicam gel (PG) among patients with knee osteoarthritis. Methods: In total, 90 outpatients aged 30-70 years with the diagnosis of primary osteoarthritis in at least one knee were enrolled in a randomized double-blind clinical trial. The patients referred to the Rheumatology Clinic at Shahid Beheshti Hospital in Hamadan province during 2012-2013. The patients were randomly assigned into three groups, 30 patients per group, and respectively received AA ointment (AAO) 3%, AA liniment (AAL) 3%, and PG; three times daily (TID) for 4 weeks. The patients were visited at baseline, week 4, and week 6. The effectiveness criteria were pain severity which was assessed with a 10-point visual analog scale (VAS), the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) for total pain score (WTPS), total physical function score (WTPFS), and total stiffness score (WTSS). Repeated measure ANOVA, paired t test and post hoc were used to compare variables. Statistical analysis was performed using the SPSS software, version 13.0 (SPSS Inc., Chicago, Illinois). Results: All groups had similar patient demographics. The administration of PG significantly improved all tested criteria with no recurrence after discontinuing the treatment protocol. AAO alleviated all tested factors except for WTSS. Alleviation was comparable to PG. AAL only reduced pain factors (VAS, WTPS) in week 4 with recurrence in week 6. Conclusion: Administration of Artemisia ointment may have beneficial effects in the treatment of osteoarthritis. Trial Registration Number: IRCT201202123109N3. KEYWORDS: Artemisia absinthium; Osteoarthritis; Piroxicam