Efficacy and Safety of Phyllanthus Amarus Cream Treatment in Knee Osteoarthritis

Decha Pinkaew1, *, Kanokwan Kiattisin2, Khanittha Wonglangka1, Pisittawoot Awoot3
1 Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
2 Department of Pharmaceutical Sciences, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
3 Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

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© 2020 Pinkaew et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, 110 Intharawor Road, Sri Phum Sub-district, Chiang Mai, Thailand; Tel: 8846873443; E-mail:



Knee osteoarthritis (OA) is a chronic degenerative joint disease and inflammatory pain which decreases daily activities.


The aim of the present investigation was to examine skin permeation and skin irritation test of Phyllanthus Amarus (PA) cream including the effects of four weeks of treatment with PA cream in patients with osteoarthritis (OA) of the knee.


The permeation study of PA cream was determined by Franz diffusion cells using a stillborn piglet skin. The primary irritation test was evaluated in rabbits and human volunteers following the Draize test. The study included sixty respondents diagnosed with symptomatic knee OA (12 males, 48 females). All the respondents volunteered to participate and randomly allocated into 3 groups including (n =20 in each group), followed by the placebo group and Phyllanthus Amarus (PA) cream group and NSAIDs cream group. They used a cream twice per day for four weeks. The patients were tested on 3 occasions; before two weeks and four weeks for the treatment period. The respondents were completely assessed for pain and function assessment by the visual analog scale (VAS) and the Western Ontario and McMaster Universities O-osteoarthritis Index questionnaire (WOMAC), respectively.


The PA cream showed good skin permeation after 10 hours. It had a high accumulative amount in the dermis and the receiving chamber more than the stratum corneum. Therefore, it could help to relieve pain and prolong the effect. The PA cream did not irritate the skin of rabbits and human volunteers. It is safe to be used in clinical treatment. The VAS and total WOMAC scores significantly decreased after 2 weeks (P < 0.001) and 4 weeks (P < 0.001) of intervention compared with before treatment in both the PA cream and NSAIDs groups in OA knee. However, the VAS and total WOMAC score of PA cream were not significantly compared with the NSAIDs groups.


The Phyllanthus amarus cream is a new choice, and effective method for OA of the knee treatment. These data indicate that the treatment through Phyllanthus amarus cream improves pain relief and function.

Keywords: Knee osteoarthritis, Phyllanthus Amarus, Visual analog scale, The Western Ontario and McMaster Universities O-osteoarthritis Index questionnaire, Permeation, Irritation.