Abstract
OBJECTIVE—There is a putative role for antioxidant treatment in osteoarthritis (OA) based on animal, epidemiological, and human clinical studies. Vitamin E, a fat soluble vitamin, is one of the major dietary antioxidants. Short term clinical studies using vitamin E in the form of α-tocopherol suggested a benefit over placebo of similar dimension to that of diclofenac for relief of OA pain. METHODS—A six month, double blind, randomised, placebo controlled study of vitamin E 500 IU/day was carried out. Primary outcome measures were pain, stiffness, and function. Statistical analysis was performed on an intention to treat basis. RESULTS—77 patients were included in the study. Vitamin E showed no benefit over placebo at one month, three months, or six months for any of the outcome measures. The placebo group had higher pain levels (p=0.15) and body mass index (p=0.03) at baseline, and lower pain levels (p=0.02) at completion of the study. Radiological score, exercise score, age, or antioxidant intake at baseline or six months did not differ between the groups. The reasons for the better performance of the placebo group are uncertain but may relate to the initially higher pain score and subsequent regression to the mean. CONCLUSIONS—Vitamin E shows no benefit for the management of symptomatic knee OA. The role of vitamin E in preventing OA progression is currently under investigation.
Full Text
The Full Text of this article is available as a PDF (123.9 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Altman R., Asch E., Bloch D., Bole G., Borenstein D., Brandt K., Christy W., Cooke T. D., Greenwald R., Hochberg M. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986 Aug;29(8):1039–1049. doi: 10.1002/art.1780290816. [DOI] [PubMed] [Google Scholar]
- Azzi A., Boscoboinik D., Hensey C. The protein kinase C family. Eur J Biochem. 1992 Sep 15;208(3):547–557. doi: 10.1111/j.1432-1033.1992.tb17219.x. [DOI] [PubMed] [Google Scholar]
- Bellamy N. Outcome measurement in osteoarthritis clinical trials. J Rheumatol Suppl. 1995 Feb;43:49–51. [PubMed] [Google Scholar]
- Black J., Shadle C. A., Parsons J. R., Brighton C. T. Articular cartilage preservation and storage. II. Mechanical indentation testing of viable, stored articular cartilage. Arthritis Rheum. 1979 Oct;22(10):1102–1108. doi: 10.1002/art.1780221009. [DOI] [PubMed] [Google Scholar]
- Blankenhorn G. Klinische Wirksamkeit von Spondyvit (Vitamin E) bei aktivierten Arthrosen. Eine multicentrische placebokontrollierte Doppelblindstudie. Z Orthop Ihre Grenzgeb. 1986 May-Jun;124(3):340–343. doi: 10.1055/s-2008-1044572. [DOI] [PubMed] [Google Scholar]
- David M. J., Vignon E., Peschard M. J., Broquet P., Louisot P., Richard M. Effect of non-steroidal anti-inflammatory drugs (NSAIDS) on glycosyltransferase activity from human osteoarthritic cartilage. Br J Rheumatol. 1992;31 (Suppl 1):13–17. [PubMed] [Google Scholar]
- Edmonds S. E., Winyard P. G., Guo R., Kidd B., Merry P., Langrish-Smith A., Hansen C., Ramm S., Blake D. R. Putative analgesic activity of repeated oral doses of vitamin E in the treatment of rheumatoid arthritis. Results of a prospective placebo controlled double blind trial. Ann Rheum Dis. 1997 Nov;56(11):649–655. doi: 10.1136/ard.56.11.649. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Felson D. T., Naimark A., Anderson J., Kazis L., Castelli W., Meenan R. F. The prevalence of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum. 1987 Aug;30(8):914–918. doi: 10.1002/art.1780300811. [DOI] [PubMed] [Google Scholar]
- Griffin M. R., Piper J. M., Daugherty J. R., Snowden M., Ray W. A. Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons. Ann Intern Med. 1991 Feb 15;114(4):257–263. doi: 10.7326/0003-4819-114-4-257. [DOI] [PubMed] [Google Scholar]
- Hawkey C. J. COX-2 inhibitors. Lancet. 1999 Jan 23;353(9149):307–314. doi: 10.1016/s0140-6736(98)12154-2. [DOI] [PubMed] [Google Scholar]
- Kowsari B., Finnie S. K., Carter R. L., Love J., Katz P., Longley S., Panush R. S. Assessment of the diet of patients with rheumatoid arthritis and osteoarthritis. J Am Diet Assoc. 1983 Jun;82(6):657–659. [PubMed] [Google Scholar]
- Machtey I., Ouaknine L. Tocopherol in Osteoarthritis: a controlled pilot study. J Am Geriatr Soc. 1978 Jul;26(7):328–330. doi: 10.1111/j.1532-5415.1978.tb01345.x. [DOI] [PubMed] [Google Scholar]
- McAlindon T. E., Jacques P., Zhang Y., Hannan M. T., Aliabadi P., Weissman B., Rush D., Levy D., Felson D. T. Do antioxidant micronutrients protect against the development and progression of knee osteoarthritis? Arthritis Rheum. 1996 Apr;39(4):648–656. doi: 10.1002/art.1780390417. [DOI] [PubMed] [Google Scholar]
- McCarty C. A., De Paola C., Livingston P. M., Taylor H. R. Reliability of a food frequency questionnaire to assess dietary antioxidant intake. Ophthalmic Epidemiol. 1997 Mar;4(1):33–39. doi: 10.3109/09286589709058059. [DOI] [PubMed] [Google Scholar]
- Meyers D. G., Maloley P. A., Weeks D. Safety of antioxidant vitamins. Arch Intern Med. 1996 May 13;156(9):925–935. [PubMed] [Google Scholar]
- Scheen A. J. Vitamines anti-oxydantes dans la prévention des maladies cardio-vasculaires. 2ème partie: le point sur les essais cliniques. Rev Med Liege. 2000 Feb;55(2):105–109. [PubMed] [Google Scholar]
- Scherak O., Kolarz G., Schödl C., Blankenhorn G. Hochdosierte Vitamin-E-Therapie bei Patienten mit aktivierter Arthrose. Z Rheumatol. 1990 Nov-Dec;49(6):369–373. [PubMed] [Google Scholar]
- Spector T. D., Harris P. A., Hart D. J., Cicuttini F. M., Nandra D., Etherington J., Wolman R. L., Doyle D. V. Risk of osteoarthritis associated with long-term weight-bearing sports: a radiologic survey of the hips and knees in female ex-athletes and population controls. Arthritis Rheum. 1996 Jun;39(6):988–995. doi: 10.1002/art.1780390616. [DOI] [PubMed] [Google Scholar]
- Wittenborg A., Petersen G., Lorkowski G., Brabant T. Wirksamkeit von Vitamin E im Vergleich zu Diclofenac-Natrium in der Behandlung von Patienten mit chronischer Polyarthritis. Z Rheumatol. 1998 Aug;57(4):215–221. doi: 10.1007/s003930050094. [DOI] [PubMed] [Google Scholar]