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Pine BarkThe purpose of this study was to evaluate the effects of Pycnogenol in reducing symptoms of osteoarthritis (OA) in a double-blind, placebo-controlled, randomized trial. 100 patients older than age 25 (14 men and 36 women in the pycnogenol group and 18 men and 32 women in the placebo group) suffering from mild OA (stage I or II) in at least one knee and mild to moderate pain for at least 3 months prior to the study, and/or morning knee stiffness and /or knee crepitus.

The main outcome criteria were reduction of symptoms of OA using WOMAC scores and reduction of pain using visual analogue scale (VAS). The secondary outcome was a decrease in the use of analgesics. Study subjects were randomly assigned to Pycnogenol 50 mg tid or placebo. Patients were allowed to continue with their medication with NSAIDs or analgesics if they were using them before the start of the study and were allowed to change medication as needed but then reported dosage or frequency changes at each visit. Patients were evaluated at baseline, at 3 months and 4 weeks after completing the treatment. The WOMAC questionnaire for pain, stiffness and daily activities was completed by the patient every 2 weeks during the whole study. The VAS for pain was filled in by each patient weekly during the whole study.

Results: The WOMAC-A score, summarizing pain scores, improved significantly in the Pycnogenol group (p=00004) over the time of the study. The statistical difference for pain reduction compared to baseline in the Pycogenol group was evident after weeks 8,12 and 14 (p < 0.001). The difference between treatment group and placebo was near statistical significant at week 8 (p= 0.08).

The WOMAC-B score, the stiffness score, improved statistically significant (p=0.01) in the Pycnogenol groups versus baselines after weeks 8,12 and 14. Statistically significant differences between treatment group and placebo group were observe at weeks 8 and 12 (p< 0.05).

The WOMAC score in regards to the ability to perform daily activities improved significantly versus baseline in the Pycnogenol group at weeks 8,12 and 14 (p< 0.01). The change in the placebo group was not significant and the difference between the Pycnogenol and placebo groups was not significant.

Pain scores by VAS was somewhat higher in the placebo group than the Pycnogenol group at baseline although not significant. After treatment for 4 weeks, the treatment group reported less pain when compared to the placebo and pain continued to diminish until month 3. The correlation of decreased pain over time was statistically significant (p< 0.04) for the Pycnogenol group, but the correlation was poor for the placebo group (p<0.17). Only a marginal significance was seen between Pycnogenol versus placebo was seen at weeks 4 ( p=0.08) and 8 (p=0.07).

Patients in the Pycnogenol group were able to reduce their use of analgesics or NSAIDs at a higher percentage than those in the placebo group and 10% of placebo group patients had to increase their dose of analgesics whereas no higher doses were needed in the Pycnogenol group.

Cisar P, Jany R, Waczulikova I, et al. Effect of Pine Bark Extract (Pycnogenol) on symptoms of knee osteoarthritis. Phytotherapy Research 2008;22:1087-1092

Commentary: I’m encouraged to see this study and am looking forward to using this in patients with milder to moderate OA symptoms, especially of the knees. Pycnogenol is a special standardized extract from the bark of the French maritime pine. It is composed of polyphenols, several phenolic acids, catechins, taxifolin and procyanidins. In laboratory research Pycnogenol selectively inhibits matrix metalloproteinases (MMPs). MMPs are one of the inflammatory responses in arthritic joints induced by interleukin-1. The matrix degrading activity contributes to the loss of cartilage and is associated with chronic inflammation. Other in nvitro research has shown that Pycnogenol inhibits other inflammatory cells and specifically inhibits COX1 and COX2. These previously observed anti-inflammatory effects as a background to the current study, contributes a body of information that enables us to have another viable alternative treatment in early OA of the knee as well as an approach to possibly reduce the use of analgesics and NSAIDs in pain management.

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