The antioxidant vitamins A, C, E and selenium in the treatment of arthritis: a systematic review of randomized clinical trials

• Published in: Rheumatology 2007-08, Vol.46 (8), p.1223-1233
• Main Authors: Canter, P. H., Wider, B., Ernst, E.
• Format: Article
• Language: English
• Subjects: Antioxidants - therapeutic use; Arthritis; Arthritis - drug therapy; Ascorbic Acid - therapeutic use; Biological and medical sciences; Diseases of the osteoarticular system; Evidence-Based Medicine; Humans; Inflammatory arthritis; Inflammatory joint diseases; Medical sciences; Miscellaneous. Osteoarticular involvement in other diseases; Osteoarthritis; Randomized Controlled Trials as Topic; Rheumatoid arthritis; Selenium; Selenium - therapeutic use; Systematic review; Treatment Outcome; Vitamin A - therapeutic use; Vitamin E - therapeutic use; Vitamins; Vitamins - therapeutic use
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/kem116

Objective. To systematically review the evidence from randomized clinical trials (RCTs) for the effectiveness of the antioxidant vitamins A, C, E or selenium or their combination in the treatment of arthritis. Methods. A systematic search of computerized databases from inception to September 2006 for relevant RCTs, application of pre-defined inclusion/exclusion criteria and independent data extraction by two authors. Methodological quality was assessed using the Jadad scale. Results. The searches identified 20 unique RCTs meeting the inclusion criteria: 11 in inflammatory arthritis and 9 in osteoarthritis (OA). The studies included are generally of poor quality. They fall into three main clusters: selenium for rheumatoid arthritis (n = 5); vitamin E for inflammatory arthritis (n = 5) and vitamin E for OA (n = 7). One RCT suggests superiority of vitamin E over placebo and three RCTs suggest equivalence between vitamin E and diclofenac in the treatment of inflammatory arthritis. In OA, four RCTs compared vitamin E with placebo. Two shorter-term studies were positive and two longer-term studies were negative. Two further RCTs suggest equivalence between vitamin E and diclofenac in the treatment of OA. Findings for selenium, vitamin A and a combination product in inflammatory arthritis and for vitamin A, and a combination product in OA were negative. An isolated positive result for vitamin C in OA is of doubtful clinical significance. Conclusions. Clinical trials testing the efficacy of vitamin E in the treatment of OA and inflammatory arthritis have been methodologically weak and have produced contradictory findings. There is presently no convincing evidence that selenium, vitamin A, vitamin C or the combination product selenium ACE is effective in the treatment of any type of arthritis.