Efficacy of Topical Oleoresin of Pistacia Atlantica L. Subspecies Kurdica for Symptomatic Relief of Knee Osteoarthritis: A Randomized Double-Blinded Controlled Trial

Introduction: Data suggest that topical use of the oleoresin of Pistacia atlantica subspecies could relieve joint pain. Therefore, the efficacy and safety of topical cream of oleoresin of P. atlantica subspecies kurdica (OPAK) were evaluated for the symptomatic treatment of the Kellgren-Lawrence grade 1 or 2 knee osteoarthritis.Methods: Fifty patients applied topical OPAK and 50 other patients applied placebo on the knees every 8 h for 1 month. Outcome measures were WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) pain, stiffness, function and total scores; 12-Item Short-Form Health Survey (SF-12) and Health Assessment Questionnaire-Disability Index (HAQ-DI) scores; number of 500 mg acetaminophen tablets taken per day during the trial; and hematological and kidney and liver function tests.Results: Decrease of pain and stiffness and improvement of function in the OPAK group were statistically more than the placebo group (p < 0.001, p = 0.006, p < 0.001 respectively). The OPAK group used significantly fewer acetaminophen tablets during the trial compared with the placebo group (p < 0.001). The increase of SF-12 score and decrease of HAQ-DI score in the OPAK group were significantly more than in the placebo group (p < 0.001 for both parameters). OPAK had no significant effects on the other parameters compared with the placebo and no local and systemic side effects were observed in the patients.Conclusions: Topical OPAK is safe and reduces joint pain, stiffness and dysfunction and analgesic dose, and improves quality of life in the knee osteoarthritis patients.