Phytotherapeutic Interventions in the Management of Knee Osteoarthritis: A Systematic Review of Randomized Controlled Trials on Clinical Efficacy and Safety

This systematic review aims to synthesize and evaluate the clinical efficacy, safety, and disease-modifying potential of standardized botanical interventions—specifically Curcuma longa, Boswellia serrata, Zingiber officinale, Harpagophytum procumbens, and Avocado Soybean Unsaponifiables (ASU)—in the management of knee osteoarthritis (KOA). By analyzing 14 randomized controlled trials (RCTs) involving a total of N=1,276 participants published between 2019 and 2025, the research investigates whether these phytochemicals can serve as viable adjunctive or alternative therapies to conventional NSAIDs. The study focuses on both subjective patient-reported outcomes (VAS and WOMAC scales) and objective structural evidence, including MRI-confirmed cartilage protection and modulation of biochemical markers such as TNF−α and IL−6. Expected outcomes include: Establishment of a clinical hierarchy of effectiveness for the analyzed botanical extracts. Identification of rapid-onset analgesic effects (specifically within a 5-day window for standardized Boswellia). Evidence-based validation of high-bioavailability delivery systems (e.g., nanomicelles, SLBSP) in improving patient compliance and reducing gastrointestinal toxicity. A proposed framework for integrating these "analgesic-sparing" agents into personalized orthopedic care to mitigate the global polypharmacy burden.