Oral herbal therapies for osteoarthritis

Responses from the SBU Enquiry Service

Pain, stiffness and loss of flexibility caused by osteoarthritis is a common condition among older people. To maintain function and manage pain over time, the primary recommendation is physical activity. Many patients also use oral herbal therapies for pain management and to increase function.

Reading time approx. 17 minutes Published: Publication type:

SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

Published: Report no: ut202208 Registration no: SBU 2022/246

Question

What systematic reviews are there on effects of oral herbal therapies on osteoarthritis?

Identified literature

Table 1. Systematic reviews with low/medium risk of bias
Included studiesPopulation/InterventionOutcome and Results
Bartels et al, 2015, [4]
Efficacy and safety of ginger in osteoarthritis patients: a meta-analysis of randomized placebo-controlled trials
5 RCTs (593 participants) Population:
Adult patients with osteoarthritis (OA) in any joint

Intervention:
Oral ginger preparation (consisting only of extracts of ginger species)

Control:
Placebo
Ginger vs placebo, 3–12 weeks
Pain (n=5):
SMD –0.30

Disability (n=5):
SMD –0.22
(95% CI, –0.39 to –0.04)
Authors’ conclusion:
“As a conclusion, ginger may be considered as part of the treatment of OA, where the patient is motivated for trying this nutraceutical. As with other complementary and alternative therapies, further studies from independent researchers would be able to show if the effects suggested by the present data will stand in the future. Also, as in all treatment of patients which may take other medication, known possible interaction between medicine and nutraceuticals must be considered.”
Dai et al, 2021, [6]
Effectiveness of Curcuma longa extract versus placebo for the treatment of knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials
10 RCTs Population:
Patients with diagnosed knee osteoarthritis (n=783)

Intervention:
Oral administration of Curcuma Longa-extract. Dose: 80–1 080 mg/day. Treatment duration: 6–16 weeks

Control:
Orally administrated placebo
Curcurmin vs placebo
Pain (n=8):
MD –2.21
(95% CI, –3.15 to –1.28)
Symbol som betyder hög vetenskaplig tillförlitlighet

Function (n=5):
MD –11.93
(95% CI, –16.63 to –7.23)
Symbol som betyder låg vetenskaplig tillförlitlighet

Adverse events (n=7):
No statistically significant difference
Symbol som betyder hög vetenskaplig tillförlitlighet
Authors' conclusion:
“Current evidence indicates that, compared with placebo, Curcuma longa extract has more benefit in pain relief and functional improvement in patients with symptomatic knee OA. However, considering the potential heterogeneity in the included RCTs, these results need to be interpreted with caution. More future high-quality RCTs with large sample sizes are necessary to confirm the benefits of Curcuma longa extract on knee OA.”
Hsiao et al, 2021, [7]
The efficacy of high- and low-dose curcumin in knee osteoarthritis: A systematic review and meta-analysis
11 RCTs
- 5 studies manufacturer-funded
- 2 studies unclear funding
Population:

Intervention:
Orally administered curcuminoid formulations. Dose: 180 mg–1500 mg/day. Treatment duration: 4–16 weeks
  Control:
Placebo (n=8) or NSAID (n=3)
Curcumin vs placebo or NSAID
Pain (n=9):
SMD –1.66
(95% CI –2.56 to –0.76)

Function (n=6):
SMD –1.50
(95% CI –2.69 to –0.31)

Adverse events (n=9)
No statistically significant difference

Curcumin vs placebo
Pain (n=7):
SMD –2.07
(95% CI –3.29 to –0.86)

Curcumin vs NSAID
Pain (n=2):
SMD –0.33
(95% CI –0.59 to 0.07)
Authors' conclusion:
“The results of our meta-analysis suggest that curcuminoids are effective in pain relief in knee OA and that low- and high-dose curcuminoids have similar effects in improving pain and AEs Curcuminoids are also more effective in achieving pain relief than NSAIDs; therefore, using curcuminoids as an adjunctive treatment in knee OA is recommended. However, current evidence is heterogeneous and mostly refers to short-term use. Thus, further high-quality RCTs of different curcuminoid doses with longer follow-up durations are needed.“
Robertson et al, 2020, [8]
Pine bark (Pinus spp.) extract for treating chronic disorders
27 RCTs
3 RCTs on osteoarthritis, all manufacturer-sponsored
Population:
Patients with chronic disorders (n=1 641), n=294 diagnosed with osteoarthritis

Intervention:
Pine bark extract containing procyanidin. Treatment duration 12–14 weeks
 
Control:
Placebo
Pine bark extract vs placebo
Pain (n=2):
1 of 2 studies found statistically significant decrease in pain

Function (n=2):
1 of 2 studies found statistically significant increase in function
Authors’ conclusion:
“In adults with osteoarthritis, it is not clear if pine bark supplements improve pain, swelling or stiffness in the knee, or whether it decreases the use of anti‐inflammatory drugs.”
Cameron et al, 2016, [5]
Oral herbal therapies for treating osteoarthritis
49 RCTs
(33 interventions)
Population:
Persons diagnosed with osteoarthritis (n=5980)
 
Intervention:
Orally consumed herbal therapies

Control: Placebo or active control. Placebo (n=40), NSAID (n=12), other control (n=5) (n=9 multiple controls)
Results from meta-analysis reported where applicable
Boswellia serrata vs placebo
8–12 weeks
Pain (n=4):
Larger reductions in pain for intervention group (4 studies)
Function (n=4):
Larger increase in function for intervention group (4 studies)
Harpagophytum vs placebo
17–20 weeks
Pain (n=2):
No difference in improvement in pain (2 studies)
Rosa canina vs placebo
12 weeks
Pain (n=2):
No statistically significant effect on pain (2 studies)
 
Salix vs placebo
2–6 weeks
Pain (n=2): Larger reductions in pain for intervention group (2 studies)
 
ASU vs placebo
3 months
Pain (n=2):
SMD –11.90 (95% CI, –23.95 to –0.15)
No statistically significant effect
3–12 months
Pain (n=4):
SMD –8.47
(95% CI, –15.90 to –1.04)
Function (n=4):
SMD –0.42
(95% CI, –0.73 to –0.11)
Authors’ conclusion:
“There is moderate-quality evidence that in people with OA, Boswellia serrata slightly improved pain and function. The evidence was downgraded to moderate as there is a potential for imprecision due to the small number of participants contributing to these outcomes. There is moderate-quality evidence that avocado-soybean unsaponifiables (ASU) probably improced pain and function slightly but may not preserve joint space. Evidence was downgraded due to inconsistency across results, or imprecision. […]
We are uncertain whether other oral herbal products improve OA pain or function, or slow progression of joint structure damage because the evidence available is limited to single studies only, or studies providing data that cannot be pooled. Some of these studies are of low to very low quality [.]”
“High tolerance of the medicinal plant products was demonstrated in all studies. Caution is warranted in interpreting safety. Although no serious drug-related adverse events occurred in the studies so far, comprehensice safety data are still required for all medicinal plant products except for the mixture Phytodolor.”
ASU = Avocado-Soybean Unsaponifiables; CI = Confidence Interval; MD = Mean difference; NSAID = Non-Steroidal Anti-Inflammatory Drugs; OA = Osteoarthritis; RCT = Randomised Controlled Trial; RoB = Risk of Bias; SMD = Standardised Mean Difference

References

  1. Bartels EM, Folmer VN, Bliddal H, Altman RD, Juhl C, Tarp S, et al. Efficacy and safety of ginger in osteoarthritis patients: a meta-analysis of randomized placebo-controlled trials. Osteoarthritis Cartilage. 2015;23(1):13-21. Available from: https://doi.org/10.1016/j.joca.2014.09.024.
  2. Dai W, Yan W, Leng X, Chen J, Hu X, Ao Y. Effectiveness of Curcuma longa extract versus placebo for the treatment of knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. Phytother Res. 2021;35(11):5921-35. Available from: https://doi.org/10.1002/ptr.7204.
  3. Hsiao AF, Lien YC, Tzeng IS, Liu CT, Chou SH, Horng YS. The efficacy of high- and low-dose curcumin in knee osteoarthritis: A systematic review and meta-analysis. Complement Ther Med. 2021;63:102775. Available from: https://doi.org/10.1016/j.ctim.2021.102775.
  4. Robertson NU, Schoonees A, Brand A, Visser J. Pine bark (Pinus spp.) extract for treating chronic disorders. Cochrane Database Syst Rev. 2020.
  5. Cameron M, Chrubasik S. Oral herbal therapies for treating osteoarthritis. Cochrane Database Syst Rev. 2014(5):CD002947. Available from: https://doi.org/10.1002/14651858.CD002947.pub2.

Literature search

CINAHL via EBSCO 14 February 2022

Title: Dietary supplements for treating osteoarthritis
The final search result, usually found at the end of the documentation, forms the list of abstracts.

AB = Abstract; AU = Author; DE = Term from the thesaurus; MH = Exact Subject Heading from CINAHL Subject Headings; MM = Major Concept; TI = Title; TX = All Text. Performs a keyword search of all the database's searchable fields; ZC = Methodology Index; * = Truncation; “ “ = Citation Marks; searches for an exact phrase; N = Near Operator (N) finds the words if they are a maximum of x words apart from one another, regardless of the order in which they appear.; W = Within Operator (W) finds the words if they are within x words of one another, in the order in which you entered them.
Search termsItems found
Population: Osteoarthritis
1. TI ( osteoarthritis OR gonarthrosis OR coxarthrosis OR arthrosis OR osteoarthrosis OR osteo-arthritis OR ( degenerative N2 arthritis ) ) OR AB ( osteoarthritis OR gonarthrosis OR coxarthrosis OR arthrosis OR osteoarthrosis OR osteo-arthritis OR ( degenerative N2 arthritis ) ) OR SU ( osteoarthritis OR gonarthrosis OR coxarthrosis OR arthrosis OR osteoarthrosis OR osteo-arthritis OR ( degenerative N2 arthritis ) ) 43,059
Intervention: Dietary supplements
2. TI ( glucosamine OR acetylglucosamine OR "n-acetylglucosamine" OR "n-acetyl-d-glucosamine" OR chondroitin OR nutraceutical* OR pharmaconutraceutical OR pharmaconutrition OR nutrient* OR curcumin OR demethoxycurcumin OR didemethoxycurcumin OR bisdemethoxycurcumin OR turmeric ) OR AB ( glucosamine OR acetylglucosamine OR "n-acetylglucosamine" OR "n-acetyl-d-glucosamine" OR chondroitin OR nutraceutical* OR pharmaconutraceutical OR pharmaconutrition OR nutrient* OR curcumin OR demethoxycurcumin OR didemethoxycurcumin OR bisdemethoxycurcumin OR turmeric ) OR SU ( glucosamine OR acetylglucosamine OR "n-acetylglucosamine" OR "n-acetyl-d-glucosamine" OR chondroitin OR nutraceutical* OR pharmaconutraceutical OR pharmaconutrition OR nutrient* OR curcumin OR demethoxycurcumin OR didemethoxycurcumin OR bisdemethoxycurcumin OR turmeric ) OR TI ( "diet* supplement*" OR "functional food*" OR herb* OR plant OR collagen OR harpagophytum OR "hyaluronic acid" OR vitamin* OR mineral ) OR AB ( "diet* supplement*" OR "functional food*" OR herb* OR plant OR collagen OR harpagophytum OR "hyaluronic acid" OR vitamin* OR mineral ) OR SU ( "diet* supplement*" OR "functional food*" OR herb* OR plant OR collagen OR harpagophytum OR "hyaluronic acid" OR vitamin* OR mineral ) OR TI ( "fish oil*" OR "omega 3" OR "n-3 fatty acid*" OR pufa OR "Green-lipped mussel" OR "Perna canaliculus" OR ( ( rose N1 ( hip OR heb ) ) OR rosehip OR roseheb OR rosehaw ) OR methylsulfonylmethane OR "methyl sulfonmethane" OR "methyl sulfone" OR "dimethyl sulfone" ) OR AB ( "fish oil*" OR "omega 3" OR "n-3 fatty acid*" OR pufa OR "Green-lipped mussel" OR "Perna canaliculus" OR ( ( rose N1 ( hip OR heb ) ) OR rosehip OR roseheb OR rosehaw ) OR methylsulfonylmethane OR "methyl sulfonmethane" OR "methyl sulfone" OR "dimethyl sulfone" ) OR SU ( "fish oil*" OR "omega 3" OR "n-3 fatty acid*" OR pufa OR "Green-lipped mussel" OR "Perna canaliculus" OR ( ( rose N1 ( hip OR heb ) ) OR rosehip OR roseheb OR rosehaw ) OR methylsulfonylmethane OR "methyl sulfonmethane" OR "methyl sulfone" OR "dimethyl sulfone" ) 263,621
Study types: Systematic reviews
3. TI ( (systematic N3 review) OR "meta analys*" OR metaanalys* ) OR AB ( (systematic N3 review) OR "meta analys*" OR metaanalys* ) OR PT ( (systematic N3 review) OR "meta analys*" OR metaanalys* )  
Combined sets:
4. 1 AND 2 4,700
5. 3 AND 4 370
Limits:
6. From 2011 - 294
Final result
  5 AND 6 294

KSR Evidence 10 February 2022

Title: Dietary supplements for treating osteoarthritis
The final search result, usually found at the end of the documentation, forms the list of abstracts.

:au = Author; MeSH = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; this term only = Does not include terms found below this term in the MeSH hierarchy; :ti = Title; :ab = Abstract; :kw = Keyword; * = Truncation; “ “ = Citation Marks; searches for an exact phrase; CDSR = Cochrane Database of Systematic Review; Cochrane Protocols = Protocols of systematic reviews registered in Cochrane Library; CENTRAL = Cochrane Central Register of Controlled Trials, “trials”
Search termsItems found
Population: Osteoarthritis
1. osteoarthritis OR gonarthrosis OR coxarthrosis OR arthrosis OR osteoarthrosis OR osteo-arthritis OR ( degenerative NEAR/2 arthritis ) in All text 2,370
Intervention: Dietary supplements
2. glucosamine OR acetylglucosamine OR "n-acetylglucosamine" OR "n-acetyl-d-glucosamine" OR chondroitin OR nutraceutical* OR pharmaconutraceutical OR pharmaconutrition OR nutrient* OR curcumin OR demethoxycurcumin OR didemethoxycurcumin OR bisdemethoxycurcumin OR turmeric OR zingibera*OR "diet* supplement*" OR "functional food*" OR phytotherapy* OR herb* OR plant OR collagen OR harpagophytum OR "hyaluronic acid" OR vitamin* OR mineral OR "fish oil*" OR "omega 3" OR "n-3 fatty acid*" OR pufa OR "Green-lipped mussel" OR "Perna canaliculus" OR ( ( rose NEAR/1 ( hip OR heb ) ) OR rosehip OR roseheb OR rosehaw ) OR methylsulfonylmethane OR "methyl sulfonmethane" OR "methyl sulfone" OR "dimethyl sulfone" in All text 9,430
Combined sets
3. 1 AND 2 343
Limits:
4. From 2011 -  
Final result
  3 AND 4 340

Embase via Elsevier 10 February 2022

Title: Dietary supplements for treating osteoarthritis
The final search result, usually found at the end of the documentation, forms the list of abstracts.

/de = Term from the EMTREE controlled vocabulary; /exp = Includes terms found below this term in the EMTREE hierarchy; /mj = Major Topic; :ab = Abstract; :au = Author; :ti = Article Title; :ti,ab = Title or abstract; * = Truncation; ' ' = Citation Marks; searches for an exact phrase; NEAR/n = Requests terms that are within 'n' words of each other in either direction; NEXT/n = Requests terms that are within 'n' words of each other in the order specified
Search termsItems found
Population: Osteoarthritis
1. 'osteoarthritis'/exp OR 'arthrosis':ti,ab,kw OR 'osteo-arthritis':ti,ab,kw OR 'osteo-arthrosis':ti,ab,kw OR 'osteoarthritis':ti,ab,kw OR 'osteoarthrosis':ti,ab,kw OR 'gonarthrosis':ti,ab,kw OR 'coxarthrosis':ti,ab,kw 164,542
2. (degenerative NEXT/2 arthritis):ti,ab,kw 1,736
3. 1 OR 2 165,144
Intervention: Dietary supplements
4. 'glucosamine'/exp OR 'chondroitin sulfate'/de 32,234
5. 'glucosamine':ti,ab,kw OR 'acetylglucosamine':ti,ab,kw OR 'n-acetylglucosamine':ti,ab,kw OR 'n-acetyl-d-glucosamine':ti,ab,kw OR 'chondroitin':ti,ab,kw 42,758
6. 'diet supplementation'/de OR 'vitamin supplementation'/de OR 'mineral supplementation'/de OR 'diet* supplement*':ti,ab,kw 149,105
7. 'functional food'/de OR 'functional food':ti,ab,kw 10,161
8. 'nutraceutical*':ti,ab,kw OR 'pharmaconutraceutical':ti,ab,kw OR 'pharmaconutrition':ti,ab,kw OR 'nutrient*':ti,ab,kw OR 'pharmaconutrition'/de 207,647
9. 'herb*':ti,ab,kw OR 'plant':ti,ab,kw OR 'plant extract'/exp 763,069
10. 'curcumin'/exp OR 'curcuma longa'/exp OR 'curcuma longa extract'/exp 449,306
11. 'fish oil'/exp OR 'omega 3 fatty acid'/exp OR 'polyunsaturated fatty acid'/exp OR 'perna canaliculus'/exp 65,817
12. 'fish oil*':ti,ab,kw OR 'omega 3':ti,ab,kw OR 'n-3 fatty acid*':ti,ab,kw OR 'pufa':ti,ab,kw OR 'green-lipped mussel':ti,ab,kw OR 'perna canaliculus':ti,ab,kw 46,527
13. 'rose':ti,ab,kw AND next:ti,ab,kw AND ('hip':ti,ab,kw OR 'heb':ti,ab,kw) OR 'rosehip':ti,ab,kw OR 'roseheb':ti,ab,kw OR 'rosehaw':ti,ab,kw 204
14. 'harpagophytum'/exp OR 'harpagophytum':ti,ab,kw OR 'devil claw':ti,ab,kw OR 'devil`s claw':ti,ab,kw OR 'devils claw':ti,ab,kw 492
15. 'vitamin'/exp OR 'mineral'/de OR 'vitamin*':ti,ab,kw OR 'minerals':ti,ab,kw 852,968
16. 'hyaluronic acid'/de OR 'hyaluronic acid':ti,ab,kw 52,747
17. 'collagen'/de OR 'collagen':ti,ab,kw 298,931
18. 'dimethyl sulfone'/de OR 'dimethyl sulfone' OR 'dimethylsulfone' OR 'methyl sulfone' OR 'methylsulfonylmethane' 956
19. 4 OR 5 OR 6 OR 7 OR 8 OR 9 OR 10 OR 11 OR 12 OR 13 OR 14 OR 15 OR 16 OR 17 OR 18 2,348,120
Study types: Systematic reviews
20. 'systematic review'/de OR 'meta analysis'/exp OR 'cochrane database syst rev':ta OR ((systematic NEAR/3 review):ti,ab) OR 'meta analys*':ti,ab OR metaanalys*:ti,ab 63,012
Combined sets
21. 3 AND 19 24,305
22. 21 AND 20 1,243
Limits
23. 22 AND (2011:py OR 2012:py OR 2013:py OR 2014:py OR 2015:py OR 2016:py OR 2017:py OR 2018:py OR 2019:py OR 2020:py OR 2021:py OR 2022:py) 940
Final result
  23 940

Medline via OvidSP 10 February 2022

Title: Dietary supplements for treating osteoarthritis
The final search result, usually found at the end of the documentation, forms the list of abstracts.

.ab. = Abstract; .ab,ti. = Abstract or title; .af. = All fields; Exp = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; .sh. = Term from the Medline controlled vocabulary; .ti. = Title; / = Term from the Medline controlled vocabulary, but does not include terms found below this term in the MeSH hierarchy; * = Focus (if found in front of a MeSH-term); * or $ = Truncation (if found at the end of a free text term); .mp = Text, heading word, subject area node, title; “ “ = Citation Marks; searches for an exact phrase; ADJn = Positional operator that lets you retrieve records that contain your terms (in any order) within a specified number (n) of words of each other.
Search termsItems found
Population: Osteoarthritis
1. exp osteoarthritis/ 70,684
2. (Osteoarthritis or Gonarthrosis or Coxarthrosis or Arthrosis or Osteoarthrosis or Osteo-arthritis).tw,kw. 85,517
3. (degenerative adj2 arthritis).tw,kw. 1,482
4. or/1–3 106,384
Intervention: Dietary supplements
5. exp Glucosamine/ or Chondroitin/ 17,836
6. (glucosamine or acetylglucosamine or "n-acetylglucosamine" or "n-acetyl-d-glucosamine" or chondroitin).tw,kw 37,456
7. exp Dietary Supplements/ 90,842
8. diet* supplement*.tw,kw. 32,817
9. Functional Food/ 2,476
10. functional food.tw,kw. 6,149
11. (nutraceutical* or pharmaconutraceutical or pharmaconutrition or nutrient*).tw,kw. 176,748
12. (herb* or plant).tw,kw. 510,626
13. Phytotherapy/ or exp Plant Extracts/ or "Plants, Medicinal"/ or exp Zingiberaceae/ 244,523
14. (curcumin or demethoxycurcumin or didemethoxycurcumin or bisdemethoxycurcumin or turmeric).tw,kw. 19,027
15. (fish oil* or omega 3 or n-3 fatty acid* or PUFA or Green-lipped mussel or Perna canaliculus).tw,kw. 37,140
16. ((rose adj (hip or heb)) or rosehip or roseheb or rosehaw).tw,kw. 200
17. collagen/ or collagen.tw,kw. 227,055
18. Harpagophytum.tw,kw. 190
19. Hyaluronic Acid/ or hyaluronic acid.tw,kw. 32,727
20. vitamins/ or vitamin*.tw,kw. 246,642
21. minerals/ or minerals.tw,kw. 46,356
22. (Methylsulfonylmethane or methyl sulfonmethane or methyl sulfone or dimethyl sulfone).tw,kw. 411
23. or/5–22 1,490,134
Study types: Systematic reviews
24. (Systematic Review or Meta-Analysis).pt. or Cochrane Database Syst Rev.ja. or ((systematic adj3 review) or "meta analys*" or metaanalys*).ti,ab. 374,538
Combined sets
25. 4 and 23 11,259
26. 25 and 24 564
Limits
27 limit 26 to yr="2011 -Current" 459
Final result
  27 459

Scopus via Elsevier 10 February 2022

Title: Dietary supplements for treating osteoarthritis
The final search result, usually found at the end of the documentation, forms the list of abstracts.

TITLE-ABS-KEY = Title or abstract or keywords; ALL = All fields; PRE/n = "precedes by". The first term in the search must precede the second by a specified number of terms (n).; W/n = "Within". The terms in the search must be within a specified number of terms (n) in any order.; * = Truncation; “ “ = Citation Marks; searches for an exact phrase; LIMIT-TO (SRCTYPE, "j" = Limit to source type journal; LIMIT-TO (DOCTYPE, "ar" = Limit to document type article; LIMIT-TO (DOCTYPE, "re" = Limit to document type review
Search termsItems found
Population: Osteoarthritis
1. TITLE-ABS-KEY ( ( osteoarthritis OR gonarthrosis OR coxarthrosis OR arthrosis OR osteoarthrosis OR osteo-arthritis ) OR ( degenerative W/2 arthritis ) ) 148,774
Intervention: Dietary supplements
2. TITLE-ABS-KEY ( glucosamine OR acetylglucosamine OR "n-acetylglucosamine" OR "n-acetyl-d-glucosamine" OR chondroitin OR nutraceutical* OR pharmaconutraceutical OR pharmaconutrition OR nutrient* OR curcumin OR demethoxycurcumin OR didemethoxycurcumin OR bisdemethoxycurcumin OR turmeric OR zingibera* OR; "diet* supplement*" OR "functional food*" OR phytotherap* OR herb* OR plant OR collagen OR harpagophytum OR "hyaluronic acid" OR vitamin* OR mineral OR "fish oil*" OR "omega 3" OR "n-3 fatty acid*" OR pufa OR "Green-lipped mussel" OR "Perna canaliculus" OR ( rose W/1 ( hip OR heb ) ) OR rosehip OR roseheb OR rosehaw OR methylsulfonylmethane OR "methyl sulfonmethane" OR "methyl sulfone" OR "dimethyl sulfone" ) 4,895,882
Study types: Systematic reviews
3. TITLE-ABS-KEY ( ( systematic W/2 review ) OR "meta analys*" OR metaanalys* ) OR ( SRCTITLE ( cochrane ) AND DOCTYPE ( re ) )  
Combined sets
4. 1 AND 2 21,314
5. 4 AND 3 1,308
Limits
6. From 2011 -  
Final result
  5 AND 6 980
Page published