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Morinda Citrifolia L. (Noni) Improves the Quality of Life in Adults with Osteoarthritis

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Morinda Citrifolia L. (Noni) Improves the Quality of Life in Adults with Osteoarthritis Portland State University PDXScholar Community Health Faculty Publications and Presentations School of Community Health 2011 Morinda Citrifolia L. (noni) Improves the Quality of Life in Adults with Osteoarthritis Mian-Ying Wang University of Illinois College of Medicine at Rockford M. Nawal Lutfiyya Essentia Institute of Rural Health Vicki Weidenbacher-Hoper Essentia Institute of Rural Health Lin Peng University of Illinois College of Medicine at Rockford Martin S. Lipsky Portland State University See next page for additional authors Follow this and additional works at: https://pdxscholar.library.pdx.edu/commhealth_fac Part of the Alternative and Complementary Medicine Commons, and the Natural Products Chemistry and Pharmacognosy Commons Let us know how access to this document benefits ou.y Citation Details Wang, M. Y., Lutfiyya, M. N., Weidenbacher-Hoper, V., Peng, L., Lipsky, M. S., & Anderson, G. (2011). Morinda citrifolia L.(noni) improves the Quality of Life in adults with Osteoarthritis. Functional Foods in Health and Disease, 1(2), 75-90. This Article is brought to you for free and open access. It has been accepted for inclusion in Community Health Faculty Publications and Presentations by an authorized administrator of PDXScholar. Please contact us if we can make this document more accessible: [email protected]. Authors Mian-Ying Wang, M. Nawal Lutfiyya, Vicki Weidenbacher-Hoper, Lin Peng, Martin S. Lipsky, and Gary Anderson This article is available at PDXScholar: https://pdxscholar.library.pdx.edu/commhealth_fac/80 Functional Foods in Health and Disease 2011, 1(2):75-90 Page 75 of 90 Research Open Access Morinda citrifolia L. (noni) improves the Quality of Life in adults with Osteoarthritis 1Mian-Ying Wang, 3M. Nawal Lutfiyya, 2Vicki Weidenbacher-Hoper, 1Lin Peng, 2Martin S. Lipsky, and 1Gary Anderson 1Department of Pathology and 2Department of Family and Community Medicine, University of Illinois College of Medicine at Rockford, 1601 Parkview Avenue, Rockford, IL 61107, USA. 3 Essentia Institute of Rural Health, 502 East 2nd Street, Duluth, MN 55805, USA Running title: Noni improves the QoL of adults with osteoarthritis Corresponding Author: Mian-Ying Wang, MD, Department of Pathology, University of Illinois College of Medicine at Rockford 1601 Parkview Ave, Rockford, IL 61107, USA Submission date: 24 January 2011, Acceptance date: 20 February 2011, Publication date: 20 February 2011 Abstract Background: Morinda citrifolia Linn (noni), as a “pain killer”, has been used as a traditional medicine by Polynesians for over 2000 years. It was reported to have a broad range of therapeutic effects including analgesic and anti-inflammation. The in-vitro and in vivo anti- inflammatory and analgesic properties of noni juice (NJ) suggest that NJ may be a useful adjunctive treatment for osteoarthritis (OA). In this pilot study we explored whether NJ improves the symptoms and Quality of Life (QoL) for adults with OA. We also sought to evaluate the tolerability and safety of NJ for patients with OA in a primary care setting. Methods: This was an open label three-month intervention pilot study. Data were collected by pre/post intervention survey and laboratory testing. Inclusion criteria were: adults of both sexes aged 40 to 75, with a diagnosis of OA on the hip or knee by x-ray examination provided by their primary care physician, not on prescription medicine for OA, and who were willing to drink 3 oz of NJ a day for 90 days. Functional Foods in Health and Disease, 2: 75-90 Page 76 of 90 Results: Of the 64 questions measuring different aspects of QoL asked on the pre/post survey, 49 (77%) had significant pre/post mean scale differences as measured by independent t-test. The OA patients reported being significantly more satisfied with their current health conditions including mobility, walking and bending, hand, finger, and arm functions, household tasks, social activity, arthritis pain, work ability, level of tension, and mood. The study participants were also more positive about their future health and reported taking less over-the-counter (OTC) pain relievers. Pre/post laboratory testing including: lipid panel, liver and kidney functions were in the normal ranges. High Sensitive C Reactive Protein (hsCRP), an inflammatory biomarker, was reduced by 10% after the intervention. Conclusion: As a nutritional supplement, NJ demonstrated a potential therapeutic effect and improved the symptoms and the QoL for adults with OA. A larger, double blinded, and placebo controlled clinical trial study is needed to confirm these benefits. NJ has the potential to become an adjunctive therapy for OA patients. Clinical trial registration number: NCT01070264. Key words: Morinda citrifolia (noni), Noni juice (NJ), Osteoarthritis, Quality of life (QoL), pain scales Background Approximately 10% of people in the U.S. have OA, making it the most common form of arthritis and one of the most prevalent chronic diseases in western countries. For people older than 75 the estimated prevalence of OA rises to between 70 - 90% [1]. While the etiology of OA is multi-factorial, the condition results from the gradual degeneration of joint cartilage. Joint cartilage normally cushions the bones in a joint and if damaged causes bone overgrowth and fragmentation of the cartilage which can lead to inflammation, pain and functional impairment. As a result it is not surprising that OA is a leading cause of disability and that between 10 to 30 % of those affected with OA suffer from significant pain and disability [2-6]. Disease modifying treatments that halt the progression of OA remain elusive and as a result current management focuses on reducing symptoms [7]. These include interventions such as weight loss, exercise, analgesics, steroid joint injections, joint replacement and medications [8]. Non-steroid anti-inflammatory drugs [NSAIDs] are one type of medication though widely used for symptoms, have a significant side effect profile that compromises their benefits. While selective cyclooxygenase (Cox-2) inhibitors provide symptom relief with reduced GI side effects, an associated increase in the risk of cardiovascular disease led to several of these drugs being withdrawn from the market [9]. Due to a favorable safety profile many consider Functional Foods in Health and Disease, 2: 75-90 Page 77 of 90 acetaminophen as drug of choice for OA; however, acetaminophen predominately affects pain and may have only a modest benefit on improving function and relieving stiffness [10]. Faced with these challenges, many patients and health providers turn to alternative methods [11]. One viable alternative may be the complementary therapy of NJ made from Morinda citrifolia (noni) fruits [12]. Several research studies support the rationale for the traditional use of NJ for treating inflammatory and analgesic disorders [11, 13]. For decades, Polynesians have used noni for pain and to reduce inflammation [14]. The specie Morinda citrifolia L. [noni] belongs to the genus Morinda and the family Rubiaceae. Morinda includes about 80 species, of which noni is considered the “queen” [15]. Studies examining noni reported that the noni fruit possesses analgesic and tranquilizing activities [16]. An alcohol extract of noni fruit puree showed an analgesic and anti-inflammatory effect by inhibiting MMP-9 release from human monocytes after stimulation with lipopolysaccharides (LPS) and this effect was comparable to hydro- cortisone. The authors claimed that preparations of noni fruits are effective in decreasing pain and joint destruction caused by arthritis (17). Younis and his colleagues tested the analgesic and sedative effects of noni extract and found “a significant, dose-related, central analgesic activity in mice” and that “the analgesic efficacy of the noni extract was about 75% as strong as morphine, yet non-addictive and side effect free [18]”. Research comparing the analgesic effect of NJ to aspirin using hot-plate and twist assays in mice also supports NJ as a potentially effective treatment for OA [19]. Additionally, an anti-inflammatory effect of NJ was observed in acute liver injury models induced by CCl4 in female SD rats [20]. Other research revealed anti-oxidative activity that scavenges reactive oxygen species (ROS) and quenches lipid peroxides (LPO) in smokers [21]. Of particular interest in terms of NJ’s potential as a therapeutic natural product for OA, is the finding the NJ is a partial Cox-2 inhibitor in vitro with an inhibitory effect about 40% of the effect of celexcoxib [22]. These research findings coupled with its traditional use as a treatment for pain suggest that NJ might be an effective therapeutic nutritional supplement for OA patients. The goal of this study was to conduct a preliminary exploration of NJ’s impact on the symptoms and QoL of OA patients and at the same time to examine its tolerability and safety as a complimentary therapeutic nutritional agent for OA. Methods and Materials This study was a 12-week open label pilot intervention study for individuals with OA to explore the potential benefit of NJ for symptoms associated with OA. Research participants were recruited consecutively and enrolled into the study until a targeted sample size of approximately 100 was reached. Pre/post intervention assessment was used to examine efficacy. The inclusion criteria entailed: adults aged 40 to 75 of both sexes with X-ray diagnosis of OA of the hip or knee who were not taking prescription medicine for arthritis and were willing to drink 3 oz of NJ Functional Foods in Health and Disease, 2: 75-90 Page 78 of 90 daily for 90 days. The diagnostic criteria were deliberately set to mimic the real life clinical setting in which NJ would most likely be used---a primary care physician diagnosis of OA for those experiencing symptoms of OA proved by x-ray examination. Adults appearing to meet the study’s eligibility criteria were interviewed by an experienced clinical coordinator to confirm eligibility and to ensure that potential study participants were willing to complete all of the study measures including blood draws.
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