High-dose vitamin E supplements may be effective in relieving pain in OA and RA, according to several double-blind studies, with some studies finding the effects are as strong as with diclofenac.
Osteoarthritis According to an early crossover study (Machtey & Ouaknine 1978), 52% of OA patients experienced less pain when treated with vitamin E (600 mg/day) compared with placebo. Several years later, a double-blind randomised study of 50 volunteers with OA confirmed these findings and showed that vitamin E (400 lU/day) was significantly superior to placebo in relieving pain, increasing mobility and reducing analgesic requirements (Blankenhorn 1986). Symptoms of pain at rest, during movement or with applied pressure all responded to treatment with vitamin E.
Vitamin E supplementation (500 lU/day) did not alter the loss of cartilage volume in knee OA according to a 2-year, double-blind, randomised placebo-controlled study of 138 patients (American College of Rheumatology clinical and radiographic criteria) © 2007 Elsevier Australia
(Wluka et al 2002). Additionally, symptoms did not improve. Vitamin E also failed to alleviate symptoms in a shorter, 6-month double-blind study using the same dose (Brand et al 2001) and symptoms of pain, stiffness and function did not change at the 1, 3 or 6 month assessments.
Comparisons with diclofenac Scherak et al (1990) found that high-dose vitamin E (1200 mg/day) was as effective as diclofenac (1 50 mg/day) in improving swelling, walking ability and range of motion in patients with knee or hip OA under doubleblind test conditions. Some 77% of patients experienced reduced or abolished pain with vitamin E, 67% had reduced pain on pressure and 62% had reduced pain on movement, which was considered as effective as diclofenac. Vitamin E was much better tolerated, with only 7.7% of patients reporting side-effects compared with 25.9% with diclofenac.
Rheumatoid arthritis According to several double-blind studies, a dose of 1200 mg/day vitamin E significantly reduces pain symptoms in people with RA but not always morning stiffness.
A double-blind study of 42 RA patients who received vitamin E (600 mg twice/day) over 12 weeks showed that pain parameters were significantly decreased with active treatment compared with placebo (Edmonds et al 1997). The same study also found no change in the Ritchie Articular Index, duration of morning stiffness, swollen joint count, or laboratory parameters with vitamin E supplementation compared with placebo. A further study using the same dose detected a significant inverse correlation between vitamin E levels and pain score whereas morning stiffness and sedimentation rate were not affected (Scherak & Kolarz 1991).
More recently, a combination of standard treatment (intramuscular methotrexate, oral sulfasalazine and indomethacin suppository at night) and vitamin E (400 mg three times daily) was compared with standard treatment and a combination of antioxidants or standard treatment alone (Helmy et al 2001). Standard treatment started to produce tangible improvements after 2 months, whereas additional treatment with either vitamin E or antioxidants improved symptoms more quickly, after 1 month.
Comparisons with pharmaceutical medication After 3 weeks' treatment with either high-dose vitamin E (400 mg RRR-alpha-tocopherol acetate three times daily) or diclofenac sodium, a significant improvement in all assessed clinical parameters was observed in hospitalised patients with established chronic RA (n = 85) according to a randomised, double-blind parallel group trial (Wittenborg et al 1998). Duration of morning stiffness, grip strength and the degree of pain, assessed by a 10 cm VAS,
reduced significantly with vitamin E as well as with diclofenac. Both treatments were considered equally effective by patients and physicians.
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