Pomegranate (Punica granatum) as an adjunctive therapy in rheumatic diseases: A systematic review

de Carvalho JF, Hautz E · Clinical Nutrition ESPEN

Four randomized trials in osteoarthritis reported improvement in WOMAC, KOOS and VAS alongside lower IL-6 and TNF-α; the rheumatoid trials moved DAS28, ESR and CRP. No serious adverse events across the clinical trials. The authors grade the overall certainty of the evidence as low to very low, on small samples, heterogeneous interventions and short follow-up.

Population

Seven studies — five clinical trials (four randomized), one animal study, one in-vitro study — in rheumatoid arthritis and osteoarthritis

Intervention

Pomegranate juice or extract

Comparator

Placebo or usual care

Limitations

Seven studies, appraised with RoB 2, NOS, AMSTAR 2 and GRADE — and the GRADE verdict is the finding: low to very low certainty. Trials pool juice and extract together despite very different doses.