Systematic review of the effects of pomegranate (Punica granatum) on osteoarthritis

Malek Mahdavi A, Javadivala Z · Health Promotion Perspectives

Twenty-three papers: five human reports from two Iranian knee trials, six animal and seven cell studies, with five doing both. The human results split: 1 g a day of pomegranate peel extract for 8 weeks improved KOOS, pain scores and antioxidant markers against placebo, while 200 mL a day of juice for 6 weeks did not move WOMAC or physical function, though the review credits it with lower serum MMP-1 and MMP-13. The animal and cell work reads one way, with lower inflammatory, oxidative-stress and apoptosis markers. The authors call this convincing and a justification for larger clinical studies.

Population

23 human, animal and in-vitro studies of pomegranate in osteoarthritis, searched to February 2021

Intervention

Pomegranate juice, extract or isolated constituents

Comparator

Varies

Limitations

Registered in PROSPERO, but pools human, animal and in-vitro studies into a single narrative conclusion, and no meta-analysis was attempted; the discussion says pomegranate improved clinical symptoms when one of its two trials did not. Risk of bias was unclear for randomisation in 19 of the studies and for allocation concealment in all 23. Both authors are at Tabriz University of Medical Sciences, which ran the peel-extract trial behind three of the five human reports and funded the review.