Potential effects of Pomegranate (Punica granatum) on Osteoarthritis: A systematic review

Background: Considering limitations of the established osteoarthritis (OA) medications, the use of adjuvant and complementary treatments has increased in OA individuals. Recent studies have demonstrated advantages of pomegranate in OA and indicate that pomegranate may be a therapeutic option; nevertheless, there is no systematic review regarding pomegranate and OA. Therefore, we systematically studied accessible papers about the effects of pomegranate on OA in human, animal, and in vitro models and likely mechanisms. Methods: Present systematic review study was registered on the international prospective register of systematic reviews database. Electronic databases (PubMed, Scopus, WOS, Embase, ProQuest) and search engine Google Scholar were searched until February 2021. Search alert services were turned on to recognize papers published following the primary search. Two investigators independently searched using MESH and non-MESH words in title, abstract, and keywords. Inclusion criteria were related clinical, animal, and in vitro studies published in any language as a full text. Exclusion criteria were reviews, book chapters, conference abstracts, and articles regarding pomegranate in health problems other than OA. Hand searching was used to check the references or citations of eligible papers and grey literature (theses and etc.) to find potential researches. Results: Twenty-three papers were included in our systematic review. Human, animal, and in vitro studies demonstrated favorable effects of pomegranate in improving clinical features and reducing inflammatory, oxidative stress, and apoptosis markers in OA. Conclusion: Present paper provides convincing evidence about the efficacy of pomegranate in OA and gives a justification for the importance of additional clinical studies.