Oral enzyme therapy using trypsin-bromelain-rutoside combination to counter pain and swelling in orthopaedic conditions: a single-centre experience
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20222058Keywords:
Inflammation, Antioxidant, Arthralgia, FlavonoidAbstract
Background: Various orthopaedic conditions end up being painful, chronic and progressive, and are associated with persistent inflammation. The present study aimed to evaluate the efficacy and safety of an enzyme-bioflavonoid combination of trypsin-bromelain-rutoside in managing the chronic pain and swelling in out-patients with various orthopaedic conditions.
Methods: The study was a prospective, observational study, conducted in 100 patients attending the orthopaedics department at a multi-speciality hospital located in Nashik, Maharashtra, India. Verbal rating scales were used for grading the pain intensity and extent of swelling at baseline and on days 3 and 8, after being prescribed oral tablets of trypsin-bromelain-rutoside combination. Scores were analysed using paired t test. A 5-point Likert scale was used to evaluate patient- and investigator-reported global assessment of improvement in pain and swelling at days 3 and 8.
Results: At baseline, 68 patients reported moderate-severe pain, while 74 patients had moderate swelling. The mean scores for pain and swelling showed statistically significant reduction at both day 3 (p<0.0001) and day 8 (p<0001). By day 8, 98 patients reported good-excellent improvement and the investigator reported good-excellent improvement in 97 patients. No adverse event was reported by any patient.
Conclusions: The results indicate that this therapy led to significant improvement in the pain and swelling as early as day 3 and further improvement with continued therapy, and can, thus, provide a safe alternative in patients with various orthopaedic conditions and reduce the need for other analgesic and anti-inflammatory drugs.
References
Gallo J, Raska M, Kriegova E, Goodman S. Inflammation and its resolution and the musculoskeletal system. J Orthop Translat. 2017;10:52-67.
Conaghan P. A turbulent decade for NSAIDs: update on current concepts of classification, epidemiology, comparative efficacy, and toxicity. Rheumatol Int. 2011;32(6):1491-502.
Marcum Z, Hanlon J. Recognizing the risks of chronic nonsteroidal anti-inflammatory drug use in older adults. Ann Longterm Care. 2010;18(9):24-7.
Daftary G, Shah A, Divekar G, John J, Patil N, Khemnar B. Systemic therapy with bromelain-trypsin-rutoside combination in inflammation: A narrative review of the pharmacodynamics. Natl J Physiol Pharm Pharmacol. 2022;12(11):1.
Brien S, Lewith G, Walker A, Hicks S, Middleton D. Bromelain as a Treatment for Osteoarthritis: a Review of Clinical Studies. Evid Based Complement Alt Med. 2004;1(3):251-7.
Leipner J, Iten F, Saller R. Therapy with Proteolytic Enzymes in Rheumatic Disorders. Bio Drugs. 2001;15(12):779-89.
Singer F, Oberleitner H. Drug therapy of activated arthrosis. On the effectiveness of an enzyme mixture versus diclofenac. Wiener Medizinische Wochenschrift. 1996;146(3):55-8.
Tilwe G, Beria S, Turakhia N, Daftary G, Schiess W. Efficacy and tolerability of oral enzyme therapy as compared to diclofenac in active osteoarthrosis of knee joint: an open randomized controlled clinical trial. JAPI. 2001;49:617-21.
Acharya T, Trivedi M, Mehta D, Chhaiya S, Gandhi S. A comparative study of effect on reducing pain, inflammation and side effect of combination of enzymes (bacterial proteases, papain, bromelain, vitamin C and rutin) versus conventional non-steroidal anti-inflammatory drugs (diclofenac) in patients of closed fracture lower end radius coming at orthopaedic department of a tertiary care hospital. Int J Basic Clin Pharmacol. 2016;5(3):1017.
Ueberall M, Mueller-Schwefe G, Wigand R, Essner U. Efficacy, tolerability, and safety of an oral enzyme combination vs diclofenac in osteoarthritis of the knee: results of an individual patient-level pooled reanalysis of data from six randomized controlled trials. J Pain Res. 2016;9:941-61.
