A Systematic Review on Panchakarma-Based Ayurveda Treatment in Janu Sandhigata Vata

Abstract

Janu Sandhigata Vata or knee osteoarthritis (KOA) causes chronic pain, stiffness, immobility and affects daily life. Panchakarma-based Ayurvedic treatment is popular in arthritis. The present study has done a systematic review on effectiveness and safety of panchakarma-based treatment in chronic KOA. The study searched for double-arm randomized comparative trials (RCoTs) with human subjects (age ≥ 18 years) explicitly diagnosed with KOA in fourteen electronic databases including MEDLINE, PubMed Central, Cochrane, Ayush Research Portal for indexed research and clinical trials published till September 30, 2022. At least one patient-centred primary outcome, namely pain, physical function, global improvement according to OMERACT III were eligible. Risk-of-bias analysis was done independently by the two authors using the revised Cochrane risk-of-bias tool for randomized trials. Effect size as standardized mean differences between treatments were estimated for pain and stiffness. The inclusion criteria screened 10 RCoTs. The RCoT which used manual therapies in a multimodal ayurvedic care against conventional care had overall low risk of bias. Remaining 9 RCoTs compared the treatment outcomes of different panchakarma-based treatment with and without pharmacological interventions. In 3 RCoTs, effect size on pain and stiffness were medium to large and significant (P<0.01). Only 3 RCTs reported safety concerns and no serious adverse outcomes related to intervention were noted. Sudation techniques and enema therapy used as standalone or in multimodal ayurvedic care showed benefit in KOA. Future studies on the long-term efficacy and safety goals aligned to psychosomatic record of patients are required for personalized Ayurveda multimodal care.