Effect of topical <i>Cichorium intybus</i> gel on knee osteoarthritis: A randomized, double-blind, placebo-controlled trial

Background and aims: The existing evidence indicates the adverse effects of oral non-steroidal anti-inflammatory drugs (NSAIDs) on reducing pain associated with knee osteoarthritis (OA). This study aimed to investigate the effect of the herbal drug Cichorium intybus gel and diclofenac gel on pain reduction, morning stiffness, and physical function in knee OA patients. Methods: In a randomized, double-blind clinical trial, 150 patients with moderate to severe knee OA without comorbidity were randomized to one of three groups (A, B, and C). Then, patients were treated with one fingertip unit per 25 cm2 of the skin of 3% hydroalcoholic C. intybus extract gel, diclofenac gel, and placebo gel three times a day for six days. The therapeutic response was evaluated using standard measures. Results: C. intybus gel and diclofenac gel could significantly reduce the visual analogue scale score and Western Ontario and McMaster Universities Arthritis Index score, including total pain, physical function, and morning stiffness (P&lt;0.001) in comparison with the control group. The effect of C. intybus gel and diclofenac gel was not significantly different (P&gt;0.05). No serious adverse effects were observed based on the findings. Conclusion: C. intybus extract gel as an alternative herbal remedy can be further investigated given its efficacy, which is better than placebos and similar to diclofenac.