Table 2.
Summary table of included studies evaluating the effect of nutraceutical supplements in osteoarthritis.
| Author (year) | Location | Inclusion criteria | Sample size and treatment (dosage) | Sample size at the end of treatment | Concomitant treatment | Design and study duration | Main outcomes |
|---|---|---|---|---|---|---|---|
| Reginster 200117 | Belgium |
Knee OA(mild to moderate severity according to KLS) Age ≥ 50 years |
1. GS (n = 106) (1500 mg/day) 2. Placebo (n = 106) |
1. GS (n = 68) (1500 mg/day) 2. Placebo (n = 71) |
Symptomatic treatments [Paracetamol 500 mg OR one NSAIDs (diclofenac 50 mg OR piroxicam 20 mg OR proglumetacin 150 mg)] |
RCT 3 years |
JSW, WOMAC index (total, pain, stiffness and physical function) |
| Appelboom 200118 | Belgium |
Knee OA (unknown severity) Age: 45–80 years VAS ≥ 30 mm Lequesne index : 4–12 |
1. ASU (300 mg × 1/day) (n = 86) 2. ASU (600 mg × 1/day) (n = 86) 3.Placebo (n = 88) |
1. ASU (300 mg × 1/day) (n = 74) 2. ASU (600 mg × 1/day) (n = 75) 3.Placebo (n = 76) |
Symptomatic treatments (NSAIDs and analgesics) |
RCT 3 months |
Pain (VAS), LI |
| Jung 200119 | Korea |
Knee OA (unknown severity) Age: 35–75 years VAS ≥ 35 mm |
1. SKI 306X (mixture of Clematis mandshurica, Trichosanthes kirilowii and Prunella vulgaris) (200 mg × 3/day) (n = 24) 2. SKI 306X (400 mg × 3/day) (n = 24) 3. SKI 306X (600 mg × 3/day) (n = 24) 4. Placebo(n = 24) |
1. SKI 306X (200 mg × 3/day) (n = 24) 2. SKI 306X (400 mg × 3/day) (n = 23) 3/ SKI 306X (600 mg × 3/day) (n = 23) 4. Placebo(n = 23) |
– |
RCT 4 weeks |
Pain (VAS), LI |
| Schmid 200120 | Germany |
Hip or knee OA (unknown severity) Age > 18 years (men) or > 50 years (women) |
1. Willow bark extract (240 mg × 1/day) (n = 39) 2. Placebo (n = 39) |
1. Willow bark extract (240 mg × 1/day) (n = 39) 2. Placebo (n = 39) |
– |
RCT 2 weeks |
WOMAC (pain, stiffness and physical function), Pain (VAS) |
| Colker 200221 | USA |
Knee OA (unknown severity) Age ≥ 35 years |
1. Micronutrient-containing beverage (12 oz/day) (n = 20) 2. Placebo (n = 20) |
1. Micronutrient-containing beverage (12 oz/day) (n = 16) 2. Placebo (n = 15) |
– |
RCT 6 wk |
Modified KOOS, WOMAC, Pain (VAS) |
| Zenk 200222 | USA |
OA (unknown severity) Age > 19 years |
1. MPC (2000 mg × 2/day) 2. GS (500 mg × 3/day) 3. Placebo (n = 42) |
1. MPC (2000 mg × 2/day) (n = 12) 2. GS (500 mg × 3/day) (n = 13) 3. Placebo (n = 10) |
Symptomatic treatments (Naproxen 220 mg, ibuprofen 200 mg, acetaminophen 325 mg, and acetylsalicylic acid 325 mg) |
RCT 6 weeks |
WOMAC (total, pain, stiffness and physical function) |
| Lequense 200223 | France |
Hip OA (mild to moderate severity according to KLS) Age: 50–80 years |
1. ASU (300 mg × 1/day) (n = 85) 2. Placebo (n = 78) |
1. ASU (300 mg × 1/day) (n = 45) 2. Placebo (n = 51) |
Symptomatic treatments [NSAIDs (diclofenac, flurbiprofen, ibuprofen, indomethacin, ketoprofen, paroxen, piroxicam, tenoxicam)] AND/OR analgesics |
RCT 2 years |
JSW, LI, Pain (VAS) |
| McAlindon 200424 | England |
Knee OA (mild to severe severity according to KLS) Age ≥ 45 years |
1. GS (1.5 g/d) (n = 101) 2. Placebo (n = 104) |
1. GS (1.5 g/d) (n = 93) 2. Placebo (n = 93) |
Symptomatic treatments (Acetaminophen) |
RCT 12-week, |
WOMAC (total, pain, stiffness and physical function) |
| Miller 200525 | India |
Knee OA(mild to moderate severity according to KLS) Age ≥ 20 years VAS ≥ 50 mm |
1. Sierrasil (containing silicate minerals of calcium, magnesium, potassium, sodium and aluminum, among others) (n = 25) (3 g/day) 2. Sierrasil (n = 24) (2 g/day) 3. sierrasil (2 g/day) + cat's claw extract (100 mg/ day) (n = 29) 4. Placebo (n = 29) |
1. Sierrasil (n = 20) (3 g/day) 2. Sierrasil (n = 22) (2 g/day) 3. sierrasil (2 g/day) + cat's claw extract (100 mg/ day) (n = 26) 4. Placebo (n = 23) |
Symptomatic treatments (Acetaminophen up to 2 g/day) |
RCT 8 weeks |
WOMAC (total, pain, stiffness and physical function) |
| Kim 200626 | USA |
Knee OA (mild to moderate severity according to KLS) Age > 40 years VAS > 40 mm global assessment (GA) > 2 |
1. MSM (1 g × 2/day for 3 days, 2 g × 2/day for 4 days, then 3 × 2 g/day) (n = 25) 2. Placebo (n = 25) |
1. MSM (1 g × 2/day for 3 days, 2 g × 2/day for 4 days, then 3 × 2 g/day) (n = 21) 2. Placebo (n = 19) |
Symptomatic treatments (Acetaminophen up to 2.6 g/day) |
RCT 12-week |
Pain (VAS), WOMAC (total, pain, stiffness and physical function) |
| Pavelka 200727 | Czech Republic and Slovak Republic |
Knee OA (mild to moderate severity according to KLS) Age: 40–75 years VAS ≥ 40 mm WOMAC pain ≥ 2 |
1.Diacerein (50 mg × 1/day) (n = 84) 2. Placebo (n = 84) |
1.Diacerein (50 mg × 1/day) (n = 76) 2. Placebo (n = 76) |
Symptomatic treatments (Acetaminophen up to 1500 mg/day) |
RCT 3 months |
WOMAC (total, pain, stiffness and physical function) |
| Farid 200728 | Iran |
Knee OA (mild severity according to ACR) Age: 25- 65 years WOMAC ≥ 40 Pain ≥ 50% of the time in last 3 months |
1. Pycnogenol (n = 19) (150 mg × 1/day) 2. Placebo (n = 18) |
1. Pycnogenol (n = 18) (150 mg × 1/day) 2. Placebo (n = 17) |
Symptomatic treatments (NSAIDs and COX-2 inhibitors) |
RCT 90 days |
WOMAC (total, pain, stiffness and physical function) |
| Mehta 200729 | India |
Knee OA (mild to moderate severity according to KLS) VAS: ≥ 40 mm and ≤ 80 mm Age ≥ 20 years |
1. GS (750 mg × 2/day) (n = 47) 2.Reparagen (blend of vincaria: an extract of Uncaria guianensis (300 mg) and RNI 249: an extract of Lepidium meyenii (1500 mg)) (900 mg × 2/day) (n = 48) |
1. GS (750 mg × 2/day) (n = 41) 2.Reparagen (900 mg × 2/day) (n = 38) |
Symptomatic treatments (Acetaminophen up to 1500 mg/day for the first 4 weeks and 1000 mg/day for the last 4 weeks) |
RCT 8 weeks |
WOMAC (total, pain, stiffness and physical function), Pain (VAS) |
| Alishiri GH.H.200730 | Iran |
Knee OA (mild severity according to KLS) Age: 50–80 years VAS: ≥ 40 mm |
1. Elaeagnus Angustifolia extract (100 mg × 2/day) (n = 40) 2.Acetaminophen (500 mg × 2/day) (n = 40) 3. Placebo(n = 40) |
1. Elaeagnus Angustifolia extract (100 mg × 2/day) (n = 38) 2.Acetaminophen (500 mg × 2/day) (n = 37) 3. Placebo(n = 40) |
– |
RCT 7 weeks |
Pain (VAS), LI |
| Sengupta 20088 | India |
Knee OA (mild to moderate symptoms) Age: 40–80 years VAS: 40–70 mm LF Index score > 7 Ability to walk |
1.5-Loxin (Boswellia serrata extract contain at least 30 percent 3-O-Acetyl-11-keto-β-boswellic acid) (250 mg × 1/day) (n = 25) 2. 5-Loxin (100 mg × 1/day) (n = 25) 3.Placebo (n = 25) |
1.5-Loxin (250 mg × 1/day) (n = 23) 2.5- Loxin (100 mg × 1/day) (n = 24) 3.Placebo (n = 23) |
Symptomatic treatments (ibuprophen up to 1,200 mg/day) |
RCT 90-day |
Pain (VAS), LI, WOMAC (pain, stiffness and physical function) |
| Kalman 200831 |
United States |
Knee OA (mild to severe severity according to KLS) Age ≥ 40 years |
1. Chicken comb extract (80 mg × 1/day) (n = 11) 2. Placebo (n = 9) |
1. Chicken comb extract (80 mg × 1/day) (n = 8) 2. Placebo (n = 8) |
Symptomatic treatments (paracetamol up to 2000 mg/daY) |
RCT 8 weeks |
WOMAC (total, pain, stiffness and physical function), QOL (SF-36) |
| Frestedt 2008 32 | USA |
Knee OA (moderate to severe severity according to ACR) Age: 25–75 years WOMAC total ≤ 75 |
1. Aquamin (2400 mg × 1/day) (n = 20) 2.Glucosamine sulfate (1500 mg × 1/d) (n = 19) 3. Glucosamine sulfate (1500 mg × 1/day) + Aquamin (2400 mg × 1/day) (n = 15) 4.Placebo (n = 16) |
1. Aquamin (2400 mg × 1/day) (n = 15) 2.Glucosamine sulfate (1500 mg × 1/d) (n = 14) 3. Glucosamine sulfate (1500 mg × 1/day) + Aquamin (2400 mg × 1/day) (n = 12) 4.Placebo (n = 9) |
Symptomatic treatments (Acetaminophen, 325 mg, 1–2 tablets every 4–6 h) |
RCT 12 weeks |
WOMAC (total, pain, stiffness and physical function), 6 MWD |
| Jacquet 200933 | France |
Knee or hip (unknown severity) Age: 40–80 years |
1. Phytalgic (fish-oil, vitamin E, Urtica dioica) (n = 41) 2. Placebo (n = 40) |
1. Phytalgic (fish-oil, vitamin E, Urtica dioica) (n = 40) 2. Placebo (n = 36) |
Symptomatic treatments (analgesics and/or NSAIDs) |
RCT 3 months |
WOMAC (total, pain, stiffness and physical function) |
| Frestedt 200934 | USA |
Knee OA (moderate to severe severity according to ACR) Age: 35–75 years WOMAC total ≤ 75 |
1.Aquamin (A calcium and magnesium-rich seaweed-derived multi-mineral supplement) (801 mg × 3/day) (n = 8) 2.Placebo (n = 14) |
1 .Aquamin (801 mg × 3/day) (n = 5) 2.Placebo (n = 9) |
Symptomatic treatments (NSAIDs) |
Pilot RCT 12 weeks |
6 MWD, ROM WOMAC (total, pain, stiffness and physical function) |
| Ruff 200935 | USA |
Knee OA (mild to severe severity according to ACR) Age ≥ 18 years VAS ≥ 30 mm |
1. NEM (500 mg × 1/d) (n = 29) 2. Placebo (n = 31) |
1. NEM (500 mg × 1/d) (n = 20) 2. Placebo (n = 18) |
Symptomatic treatments (Acetaminophen) |
RCT 8 weeks |
WOMAC (total, pain, stiffness and physical function) Pain (VAS) |
| Farid 201036 | Iran |
Knee OA (mild to severe severity according to ACR) Age: 25–65 years WOMAC pain subscale index ≥ 40 |
1. PFP (150 mg × 1/d) (n = 20) 2. Placebo (n = 20) |
1. PFP (150 mg × 1/d) (n = 17) 2. Placebo (n = 16) |
Symptomatic treatments (NSAIDs and COX-2 inhibitor) |
RCT 2 months |
WOMAC (total, pain, stiffness and physical function) |
| Sengupta 201037 | India |
Knee OA(unknown severity) Age: 40–80 years VAS: 40–70 mm LF Index > 7 Ability to walk |
1. 5-Loxin (100 mg × 1/day) (n = 20) 2. 100 mg of Aflapin (Boswellia serrata extract) (100 mg × 1/day) (n = 20) 3. Placebo (n = 20) |
1. 5 -Loxin (100 mg × 1/day) (n = 19) 2. 100 mg of Aflapin (100 mg × 1/day) (n = 19) 3. Placebo (n = 19) |
Symptomatic treatments (ibuprofen up to 1200 mg/day) |
RCT 90-day |
Pain (VAS), LI, WOMAC (pain, stiffness and physical function) |
| Debbi 201138 | Israel |
Knee OA (unknown severity) Age: 45–90 years |
1. MSM (1.125 g × 3/day) (n = 25) 2. Placebo (n = 25) |
1. MSM (1.125 g × 3/day) (n = 25) 2. Placebo (n = 25) |
Unknown |
RCT 12 weeks |
WOMAC (total, pain, stiffness, physical function), Pain (VAS), QOL (SF-36), KSKS, KSFS |
| Notarnicola 201139 | Italy |
Knee OA (moderate severity according to KLS) Age: > 45 and < 85 years VAS ≥ 2 cm on a 10 cm LI > 2 |
1. MSM 5 gr and 7.2 mg of titred Boswellic Acids (n = 30) 2. Placebo (n = 30) |
1. MSM 5 gr and 7.2 mg of titred Boswellic Acids (n = 30) 2. Placebo (n = 30) |
Symptomatic treatments (paracetamol 500 mg) OR NSAIDs (pyroxicam 20 mg, diclofenac 50 mg)/day |
RCT 60 days |
Pain (VAS), LI |
| Schauss 201240 | United States |
Knee and/or hip OA (unknown severity) Age: 40–70 years VAS ≥ 4 |
1. BioCell Collagen (500 mg × 4/day) (n = 40) 2. Placebo (n = 40) |
1. BioCell Collagen (500 mg × 4/day) (n = 35) 2. Placebo (n = 33) |
Symptomatic treatments ( Paracetamol up to 4 gr/day) |
RCT 70 days |
Pain (VAS), WOMAC (total, pain, stiffness and physical function) |
| McAlindon 201341 | United States |
Age ≥ 45 years (mild to severe severity according to KLS) Knee OA |
1.Cholecalciferol (initial dose 2000 IU/day)(n = 73) 2. Placebo (n = 73) |
1.Cholecalciferol (initial dose 2000 IU/day)(n = 64) 2.Placebo (n = 60) |
Conventional treatments ( Acetaminophen & NSAIDs |
RCT 2 years |
WOMAC (pain and function ) |
| Ebrahimi 201442 | Iran |
Knee OA (mild to moderate severity according to KLS) Sex: female Age: 40–70 years BMI: 25–34.9 kg/m2 |
1. Whole fruit powder of Elaeagnus angustifolia L. (n = 30) (15 g × 1/day) 2. Medulla powder of Elaeagnus angustifolia L. (n = 30) (15 g × 1/day) 3. Placebo (n = 30) |
1. Whole fruit powder of Elaeagnus angustifolia L. (n = 26) (15 g × 1/day) 2. Medulla powder of Elaeagnus angustifolia L. (n = 27) (15 g × 1/day) 3. Placebo (n = 25) |
Conventional treatments ( Acetaminophen & NSAIDs (Celecoxib, Ibuprofen, Naproxen) |
RCT 8 weeks |
WOMAC (total, pain, stiffness and physical function) |
| Kolahi 201543 | Iran |
Knee OA (mild to moderate severity according to KLS) Age: 40 to 60 years Sex: female BMI: 25–34.9 kg/m2 |
1. L-carnitine ( 250 mg × 3/day) (n = 36) 2. Placebo (n = 36) |
1. L-carnitine (250 mg × 3/day) (n = 33) 2. Placebo (n = 36) |
Symptomatic treatments (Acetaminophen) |
RCT 8 weeks |
WOMAC (total, pain, stiffness and physical function) |
| Kumar 201544 | India |
Knee OA (mild to severe severity according to KLS) Age: 30–65 years |
1. PCP daily twice (5 g dissolved in 250 mL of milk or water) (n = 20) 2. Placebo (n = 10) |
1. PCP daily twice (5 g dissolved in 250 mL of milk or water) (n = 19) 2. Placebo (n = 11) |
Symptomatic treatments (Aceclofenac sodium 100 mg/day) |
RCT 13 weeks |
WOMAC, Pain (VAS), QOL |
| Dehghan 201545 | Iran |
Knee OA (mild to moderate severity according to the Ahlback classification) VAS ≥ 4 cm Age: 30–60 years |
1. Vitamin B Complex (× 2/day) (n = 40) 2. Placebo (n = 40) |
1. Vitamin B Complex (× 2/day) (n = 38) 2. Placebo (n = 35) |
Symptomatic treatments (Diclofenac 100 mg /day) |
RCT 21 days |
Pain (VAS), WOMAC (pain, stiffness and physical function) |
| Jin 201646 | Australia |
Knee OA (mild to moderate severity according to the Altman and Gold atlas) Age: 50–79 years old VAS ≥ 20 mm Serum vitamin D level: > 12.5 and < 60 nmol/L |
1. Vitamin D3 (50,000 IU × 1/month)(n = 209) 2. Placebo (n = 204) |
1. Vitamin D3 (50,000 IU × 1/month)(n = 209) 2. Placebo (n = 204) |
Unknown |
RCT 24 months |
WOMAC (total, pain, stiffness and physical function), Pain (VAS) |
| Stebbings 201647 | New Zealand |
Knee or hip OA (unknown severity) Age: 35–75 years BMI < 40 kg/m2 VAS ≥ 30 mm on a 100-mm |
1. ART (150 mg × 1/day) (n = 14) 2 ART high dose (300 mg × 1/day) (n = 14) 3. Placebo (n = 14) |
1. ART (150 mg × 1/day) (n = 12) 2 ART high dose (300 mg × 1/day) (n = 9) 3. Placebo (n = 13) |
Symptomatic treatments (NSAIDs and analgesics) |
RCT 12 weeks |
WOMAC (total, pain, stiffness and physical function), Pain (VAS) |
| Lugo 201648 | India |
Knee OA (mild severity according to KLS) Age: 40–75 years BMI: 18–30 kg/m2 LI score: 6–10 VAS score: 40–70 mm |
1. UC- II (40 mg × 1/day) (n = 63) 2. GS (1500 mg × 1/day) + CS (1200 mg × 1/day) (n = 65) 3. Placebo(n = 58) |
1. UC- II (40 mg × 1/day) (n = 54) 2. GS (1500 mg × 1/day) + CS (1200 mg × 1/day) (n = 57) 3. Placebo(n = 53) |
Symptomatic treatments (Acetaminophen 1000 mg daily) |
RCT 180-day |
WOMAC (total, pain, stiffness and physical function), LI, Pain (VAS), ROM |
| Lubis 201749 | Indonesia | Knee OA (mild severity according to KLS) |
1. GS (1500 mg × 1/day) + CS (1200 mg × 1/day) + saccharumlactis (500 mg × 1/day) (n = 49) 2. GS (1500 mg × 1/day) + CS (1200 mg × 1/day) + MSM (500 mg × 1/day) (n = 50) 3. Placebo (n = 48) |
1. GS (1500 mg × 1/day) + CS (1200 mg × 1/day) + saccharumlactis (500 mg × 1/day) (n = 49) 2. GS (1500 mg × 1/day) + CS (1200 mg × 1/day) + MSM (500 mg × 1/day) (n = 50) 3. Placebo (n = 48) |
Unknown |
RCT 3 months |
WOMAC, Pain (VAS) |
| Rafarf 201750 | Iran |
Knee OA (mild severity according to KLS) Age: 38–60 years old Sex: female BMI: between 30–35 kg/m2 |
1. Pomegranate peel extract (PPE) (1000 mg/day) (n = 33) 2. Placebo (n = 33) |
1. Pomegranate peel extract (PPE) (1000 mg/day) (n = 30) 2. Placebo (n = 30) |
Symptomatic treatments (Acetaminophen 1000 mg + Glucosamine 500 mg per day) |
RCT 8 weeks |
KOOS (Total and subscales), Pain (VAS) |
| Lei 201751 | China |
Knee OA (mild severity according to KLS) Age < 80 years |
1. Skimmed milk containing probiotic LcS (n = 230) 2. Placebo (plain skimmed milk) (n = 231) |
1. Skimmed milk containing probiotic LcS (n = 215) 2. Placebo (plain skimmed milk) (n = 218) |
Unknown |
RCT 6 months |
WOMAC (total, pain, stiffness and physical function), Pain (VAS) |
| Shin 201852 | New Zealand |
Knee OA (moderate to severe severity according to KLS) Age ≥ 50 years WOMAC pain score ≥ 5.0 |
1. DBE (550 mg/day) (n = 30) 2. Placebo (n = 30) |
1. DBE (550 mg/day) (n = 26) 2. Placebo (n = 24) |
Symptomatic treatments (Acetaminophen 2000 mg daily not more than twice per week) |
RCT 12 weeks |
WOMAC (total, pain, stiffness and physical function), Pain (VAS) |
| Dehghani 201853 | Iran |
Knee OA (mild severity according to KLS) Age: 50–75 years Sex: female BMI: 25–40 kg/m2) |
1. Garlic tablets (1000 mg × 1/day) (n = 40) 2. Placebo (n = 40) |
1. Garlic tablets (1000 mg × 1/day) (n = 39) 2. Placebo (n = 37) |
– |
RCT 12-week |
Pain (VAS) |
| Salimzadeh 201854 | Iran |
Knee OA (unknown severity) Age: 50–75 years Sex: female BMI: 25–40 kg/m2) |
1. Garlic tablet (1000 mg × 1/day) (n = 39) 2. Placebo (n = 37) |
1. Garlic tablet (1000 mg × 1/day) (n = 38) 2. Placebo (n = 34) |
– |
RCT 12 weeks |
WOMAC (total, pain, stiffness and physical function), body composition (weight, WC, BMI, FFM, FM, VAT) |
| Hancke 201955 | India |
Knee OA(mild severity according to KLS) Age: 40–70 BMI ≥ 25 and ≤ 29.9 kg/m2 WOMAC pain score: 10–16 |
1. ParActin (300 mg × 1/day) (n = 37) 2. ParActin (600 mg × 1/day) (n = 35) 3. Placebo (n = 36) |
1. ParActin (300 mg × 1/day) (n = 35) 2. ParActin (600 mg × 1/day) (n = 33) 3. Placebo (n = 35) |
– |
RCT 12 week |
WOMAC (total, pain, stiffness and physical function), QOL (SF-36), FACIT score |
| Majeed 201956 | India |
Knee OA (mild to moderate severity according to KLS) Age: 35–75 years VAS score > 4 cm |
1. Boswellin: (β‐boswellic acids 87.3 mg × 2/day) (n = 24) 2. Placebo (n = 24) |
1. Boswellin: (β‐boswellic acids 87.3 mg × 2/day) (n = 22) 2. Placebo (n = 20) |
– |
RCT 120 days |
WOMAC, 6 MW, Pain (VAS), QOL(European Quality of life‐5 Dimension, JSW |
| Rondanelli 201957 | Italy |
Knee OA (mild to moderate according to KLS) Aged ≥ 55 years BMI: 25–30 kg/m2 VAS: 40–70 mm |
1. CS (600 × 1/mg) (n = 30) 2. Placebo (n = 30) |
1. CS (600 × 1/mg) (n = 30) 2. Placebo (n = 30) |
– |
Pilot RCT 12 weeks |
WOMAC, Pain (VAS), TLKS scale, QOL (SF-36), Body Composition (Weight, BMI, FFM, FM, VAT) |
6 MW 6 min walking test, ACR American College of Rheumatology Classification Criteria for Knee Osteoarthritis, ART Artemisia annua extract, ASU Avocado soybean unsaponifiable, BMI body mass index, CS chondroitin sulfate, DBE Deer bone extract, FACIT Functional Assessment of Chronic Illness Therapy, FFM free fat mass, FM fat mass, GS Glucosamine sulphate, JSW joint space width, KLS Kellgren and Lawrence scoring system for classification of knee OA, KOOS Knee Injury and Osteoarthritis Outcome Score, KSFS Function Score, LcS Lactobacillus casei Shirota, KSKS, Knee Society Clinical Rating System for Knee Score, LI Lequesne's Index, MPC milk protein concentrate, MSM Methylsulfonylmethane, NEM natural egg membrane, NSAIDs Non-steroidal anti-inflammatory drugs, ParActin A. paniculata purified extract, PFP extract of the skin of the passion fruit, PCP Collagen peptides isolated from pork skin, QOL quality of life, ROM range of motion, TLKS Tegner Lysholm Knee Scoring, VAS Visual analogue scale, VAT visceral adipose tissue, WOMAC Western Ontario and McMaster Universities Arthritis.