Bromelain for Osteoarthritis
Verdict: Counter-Evidence
Across 4 PubMed studies, the evidence for Bromelain in Osteoarthritis grades Tier D — counter-evidence. High-quality evidence indicates it is not effective (or is harmful) for this use.
D 🔴 D Counter-Evidence Counter-Evidence
Why this grade7-layer evidence engine
⚖️
Scoring transparency
All scores computed by a 7-layer evidence engine — fully auditableRaw score 0.47
D
C
B
A
S
← counter-evidence / ineffectiveeffective / strong evidence →
Final grade
D · Counter-Evidence
Confidence
77%
Broadly consistent
Evidence level
E3
Single high-quality meta-analysis
▸View the full decision path (audit trail)
- compute_raw_score — 加權公式: L2×0.30 + L3×0.25 + L5×0.25 + L11×0.10 + L1×0.10 = 0.465
- tier_from_score — 依分數區間映射至 tier letter
- apply_hec_rules — 高品質 SR/MA 顯示 positive (1 篇 > 0 negative)
- tier_strict_requirement_check — Tier 條件達標，未降階
- detect_disputes — 偵測到 0 個 hard + 0 個 soft dispute
- decide_status — 依 tier + dispute 結果決定 status
PubMed studies (4)L2 · primary research & systematic reviews
Bromelain as an adjunctive treatment for moderate-to-severe osteoarthritis of the knee: a randomized placebo-controlled pilot study
Finding: No statistically significant difference between bromelain and placebo for the primary outcome (total WOMAC, p=0.27). Only 31 of 47 enrolled completed; both groups improved only on the WOMAC disability subscale. Authors concluded bromelain is not efficacious as an adjunctive treatment for moderate-to-severe knee OA.
View on PubMed Improved WOMAC score following 16-week treatment with bromelain for knee osteoarthritis
Finding: At 4 weeks no significant difference between bromelain and diclofenac groups (both improved; 2 diclofenac patients withdrew for adverse effects). Within-group improvement at 16 weeks of bromelain: total WOMAC 12.2 vs 25.5 baseline, pain 2.4 vs 5.6, stiffness 0.8 vs 2.0, function 9.1 vs 17.9; SF-36 physical component and oxidative-stress markers also improved.
View on PubMed Bromelain as a Treatment for Osteoarthritis: a Review of Clinical Studies
Finding: Reviewed 12 clinical studies (10 knee, 2 shoulder), mostly uncontrolled case series or comparisons against diclofenac. Bromelain looked promising and was comparable to diclofenac in some trials, but the evidence base was deemed inconclusive: short treatment periods, inadequate power, weak or absent follow-up, several unpublished studies, unclear optimal dose. Authors called for phase II trials before definitive efficacy testing.
View on PubMed Efficacy and safety of bromelain: A systematic review and meta-analysis
Finding: 54 articles reviewed qualitatively, 39 meta-analyzed across many indications. Oral bromelain showed a small but significant pain reduction (mean difference about -0.27 on pain scales). Moderate-quality studies indicated potential for oral bromelain in pain control; no major health risks reported. OA was only one of several indications and was not analyzed as an isolated pooled estimate.
View on PubMed Regulatory & authoritative positionsL4/L5 · FDA / EMA / NIH ODS / Cochrane / Mayo …
L4a US FDA
Neutral
Bromelain (CAS Reg. No. 9001-00-7) ... ENZYME, FLAVOR ENHANCER, FLAVORING AGENT OR ADJUVANT, PROCESSING AID, TEXTURIZER; GRAS, 21 CFR 184.1024 source↗
L4b EU EFSA
Against
L4d TW TFDA / 衛福部
Neutral
酵素製劑屬食品添加物第（十七）類「其他」，可於各類食品中視實際需要適量使用，限於食品製造或加工必須時使用。 source↗
L5a NIH Office of Dietary Supplements
Cautious
L5c Cleveland Clinic
Neutral
L5e Specialty Society (condition-mapped)
Not addressed