Efficacy of bromelain and curcumin combination as an add-on therapy in outpatients with knee osteoarthritis: a randomized clinical trial

Tajdari, Mobina; Norouzi, Pooya; Kalvandi, Hosein; Andarzbakhsh, Kamyab; Mirzabeigi, Parastoo; Khanmohamadi, Behzad; Rezazadeh, Amir

doi:10.22038/ajp.2026.27735

Efficacy of bromelain and curcumin combination as an add-on therapy in outpatients with knee osteoarthritis: a randomized clinical trial

Articles in Press

Document Type : Original Research Article

Authors

Mobina Tajdari ¹

Pooya Norouzi ²

Hosein Kalvandi ³

Kamyab Andarzbakhsh ¹

Parastoo Mirzabeigi ²

Behzad Khanmohamadi ³

Amir Rezazadeh ²

¹ Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran

² Department of Clinical Pharmacy, Faculty of Pharmacy, Iran University of Medical Sciences, Tehran, Iran

³ Department of Orthopedics, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran

10.22038/ajp.2026.27735

Abstract

Objective: Knee osteoarthritis (KOA), a prevalent degenerative joint disease, often requires long-term management with nonsteroidal anti-inflammatory drugs (NSAIDs) which carry adverse effects. Bromelain and curcumin, with anti-inflammatory and analgesic properties, offer a safer adjunct treatment. This study investigates the efficacy of a bromelain-curcumin supplement combined with NSAID therapy in KOA patients.
Materials and Methods: A 4-week randomized controlled trial enrolled 60 KOA outpatients divided into three groups via block randomization: First group received celecoxib (200 mg once daily) plus bromelain (200 mg)-curcumin (300 mg) (twice daily) (Cele L + Sup), second group received celecoxib (200 mg once daily) (Cele L), and the last group received celecoxib (200 mg twice daily) (Cele H). Outcomes were assessed using WOMAC and Visual Analog Scale (VAS) scores at baseline, week 2, and week 4. The trial was registered in the Iranian Registry of Clinical Trials (IRCT20230629058615N4).
Results: Group Cele L + Sup showed greater reductions in pain (VAS) and functional improvement (WOMAC) versus Cele L (p<0.05). Cele L + Sup also showed comparable efficacy to Cele H, indicating enhanced symptom relief with lower NSAID use. No severe adverse events were reported, showing good tolerability.
Conclusion: Bromelain-curcumin with celecoxib improved KOA symptoms and function within 4 weeks, potentially reducing reliance on higher NSAID doses and associated risks. These findings support the bromelain-curcumin promise as a complementary therapy, though larger, longer-term studies with biomarker analysis are needed to confirm clinical benefits and mechanisms.

Keywords

Bromelain

Knee Osteoarthritis

Pain

NSAID

Effectiveness

Subjects