Ten studies have found varying degrees of success in using devil’s claw to reduce pain and improve mobility in osteoarthritis, rheumatoid arthritis, and lower-back pain.
Until two years ago, herbalist Margaret Osgood was climbing mountains—pretty impressive at seventy-six years old. Then a fall down a flight of stairs at work changed everything for Osgood. She dislocated both hips, her pelvis, and one shoulder. Though now much improved, she still has chronic joint pain. Fortunately, she gets relief from herbs such as ginger, turmeric, boswellia, and devil’s claw. Acupuncture and massage therapy have further relieved her aches and pains.
Osgood’s condition, osteoarthritis, is the most common form of arthritis, in which the cartilage that cushions the joints breaks down faster than the body can replace it. Nearly 12 percent of Americans older than twenty-five have it. After age forty-five, nine out of ten Americans show signs of the disease on X-rays. That’s because osteoarthritis can result from either simple wear and tear on the joints or more serious trauma such as an injury like Osgood’s. Rheumatoid arthritis, another relatively common form, afflicts about 2.1 million Americans, mostly women. This form of arthritis is an autoimmune disorder in which the body’s immune system attacks the joints, but may damage other connective tissue as well.
A healthy lifestyle, including a good diet, weight control, and exercise, is known to have a huge effect on arthritis. A diet high in unsaturated fats, low in saturated fats, and rich in nonallergenic foods can improve rheumatoid arthritis symptoms. And a diet rich in antioxidants can retard the progression of osteoarthritis. In a recent study of obese people with osteoarthritis in the knee joints, a six-month program of diet and exercise led to an average weight loss of nineteen pounds and less knee pain and disability.
Conventional treatment of osteoarthritis usually includes relieving pain and inflammation with nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or naproxen, or one of the lesser-known NSAIDs such as indomethacin (Indocin), diclofenac (Voltaren), or piroxicam (Feldene). These drugs block the enzyme systems that produce chemicals called prostaglandins and leukotrienes. The problem is, not all prostaglandins and leukotrienes are pro-inflammatory, and some even have desirable effects, such as protecting the stomach lining. But NSAIDs block all these chemicals, so habitual users of them can experience side effects such as stomach irritation and ulcers. Newer medicines called COX-2 inhibitors, such as celecoxib (Celebrex) and rofecoxib (Vioxx), are more selective in their inhibition of inflammatory chemicals and hence have fewer side effects.
More natural, safer remedies, including herbs and other supplements, can also relieve arthritis aches and pains. Even though most of the herbs traditionally used to treat arthritis inhibit the same inflammatory chemicals as the NSAIDs, they do so with minimal to nonexistent side effects. Why? Researchers don’t know yet. It may be because, like the COX-2 inhibiting drugs, they selectively target the inflammatory chemicals that cause arthritis. At this stage, that’s only a guess.
Natural medicines for arthritis
Because arthritis is such a widespread malady, there has been quite a bit of research on herbs’ ability to ease joint pain. Here are the highlights.
Devil’s claw (Harpagophytum procumbens). This vine, a native of southwest Africa, has a long history as an arthritis remedy. Traditionally, the dried roots were made into tea. Modern consumers are more likely to take devil’s claw as a tincture, tablet, or capsule. Some products are standardized to the active component harpagoside.
Ten studies have found varying degrees of success in using devil’s claw to reduce pain and improve mobility in osteoarthritis, rheumatoid arthritis, and lower-back pain. In the most recent study, 122 osteoarthritis patients received either devil’s claw or the arthritis drug diacerhein for four months. The devil’s claw dosage was six 435-mg capsules of powdered extract standardized to 9.5 mg harpagoside and 14.5 mg of other iridoid glycosides. Devil’s claw worked as well as diacerhein but with far fewer side effects.
A typical recommended dosage of devil’s claw is up to six 400- to 500-mg capsules of standardized extract each day, or 1 to 4.5 g of encapsulated, powdered root. Devil’s claw is not recommended, however, for people with gallstones, stomach inflammation, or gastric or duodenal ulcers.
Nettles (Urtica dioica). This weed packs a therapeutic sting. In one study, twenty-seven patients with osteoarthritis in hand joints applied either a placebo of white deadnettle leaf (Lamium album) or stinging nettle leaf daily for one week. The nettle patients experienced a significant reduction in arthritis symptoms.
If the idea of applying a stinging plant’s leaves to an arthritic knee makes you wince, consider taking nettles orally. When forty osteoarthritis patients took either 200 mg of the drug diclofenac (Voltaren) or 50 mg of diclofenac plus 50 g of stewed fresh nettle leaf, both treatments improved symptoms by about 70 percent. In other words, nettle enhanced the drug’s effects, allowing people to reduce their dosage by 75 percent. How does this plant work? Like the active compounds in NSAIDs, nettles inhibit the chemical pathways involved in inflammation and the production of chemicals that stimulate cartilage inflammation and destruction.
If you can’t get fresh nettle leaves where you live, you can try taking them in a variety of forms. A typical recommended dosage is up to 1 teaspoon of leaf tincture three times a day, up to six 300-mg capsules a day, or two to three cups of tea a day. To make nettle tea, steep 2 teaspoons of dried leaves in 1 cup boiled water for 10 minutes.
Willow bark (Salix spp.). This herbal remedy—along with aspen bark (Populus tremuloides), meadowsweet (Filipendula ulmaria), licorice (Glycyrrhiza glabra), and other herbs—contains salicin, which the intestinal tract converts to salicylic acid, a chemical relative of the active ingredient in aspirin, acetylsalicylic acid.
In a recent study, 210 men and women with lower-back pain took either a placebo or one of two doses of willow bark. The higher dose provided 240 mg of salicin each day, and the lower dose 120 mg. After four weeks, willow-extract users were more likely to be pain-free and less likely to rely on the drug tramadol to control pain. The higher dose was significantly more effective than the lower dose. The authors noted that 240 mg of salicin is equivalent to a mere 50 mg of aspirin (less than one-sixth of a 325-mg tablet), suggesting that other constituents in willow bark may be contributing to pain relief.
Preliminary research suggests that willow bark may also ease osteoarthritis and rheumatoid arthritis. In the most recent study, a willow-bark extract that supplied 240 mg of salicin per day was significantly more effective than a placebo and overall, moderately effective in treating osteoarthritis.
A proprietary herbal formula called Reumalex combining willow bark with guaiac (Guaiacum officinale), black cohosh (Cimicifuga racemosa), sarsaparilla (Smilax spp.), and poplar (Populus spp.) has also been shown to reduce osteoarthritis pain. The study’s authors concluded that the formula has a mild pain-relieving effect that’s appropriate for self-medication.
A second study on a proprietary formula containing a standardized extract of aspen bark and other herbs also showed good results. Phytodolor combines aspen bark with ash (Fraxinus excelsior) and goldenrod (Solidago virgaurea). The formula has undergone ten trials comparing it to either a placebo or an arthritis drug (diclofenac, piroxicam, or indomethacin). Patients in the studies had a variety of joint diseases, including osteoarthritis, rheumatoid arthritis, and back pain. On the whole, the formula worked significantly better than a placebo and as well as the drugs, but without side effects. The dosage used was 30 to 40 drops taken three times per day.
If you’re taking a standardized, plain willow-bark product, a typical recommended dosage would deliver 240 mg of salicin a day. If your product is unstandardized, take up to six 400-mg capsules a day. Although studies have relied on standardized willow bark, Deborah Wiancek, N.D., author of The Natural Healing Companion (Rodale, 2000), says that in her experience, unstandardized, whole-plant extracts are effective as well.
While Wiancek has seen willow bark provide relief in as soon as one day, some individuals—especially those with chronic arthritis—may need to take it for two to four weeks to see results.
Because of the remote risk of Reye’s syndrome, do not give willow bark to children with viral infections.
Ginger (Zingiber officinale). This spicy root is antioxidant, analgesic, and inhibits the body’s synthesis of prostaglandins and leukotrienes. Ginger oil and eugenol (components present in clove, ginger, and in lesser concentrations in basil, holy basil, turmeric, and carrots) have been shown to reduce swelling in animals with arthritis.
In a study of fifty-six patients (twenty-eight with rheumatoid arthritis, eighteen with osteoarthritis, and ten with muscle discomfort), powdered ginger alleviated pain and swelling in three-quarters of the arthritis patients and produced some degree of relief for all of the patients with muscle pain. The recommended dosage for patients in the study was 500 to 1,000 mg per day, but many people took three to four times this amount with the result of faster and greater relief.
Turmeric (Curcuma longa). This spice has long been prized as an anti-inflammatory, antioxidant, and anti-cancer herb. In lab experiments, the active constituent curcumin proved as effective as the potent anti-inflammatory agents hydrocortisone and phenylbutazone in reducing inflammation—but without side effects. When compared to a placebo, a formula containing turmeric, zinc, and the Ayurvedic herbs ashwaganda (Withania somnifera) and boswellia (Boswellia serrata) has been shown to significantly reduce pain and disability in osteoarthritis patients.
A typical suggested dosage of turmeric is one 450-mg capsule of standardized extract three times per day, or up to 2 g per day of whole turmeric. (There’s no real consensus on whether a standardized extract is better, however.) Don’t use turmeric if you have stomach ulcers or excess stomach acid, gallstones, bile duct obstruction, or if you are pregnant.
Cayenne (Capsicum annuum). This red pepper contains capsaicin, which inhibits prostaglandins and leukotrienes in test-tube studies and lowers inflammation in arthritic rats. Capsaicin also blocks substance P, a transmitter of nerve pain. When applied to the skin, capsaicin initially activates pain nerves. Then, with repeated use, it renders them unresponsive, creating local pain relief. Studies have found that repeated application of capsaicin ointments effectively reduces conditions involving nerve pain. Diana Dummer, director of Front Range Herbal Institute in Denver and a holistic health consultant, finds topical cayenne useful in managing arthritis pain, too.
To use cayenne topically, apply an ointment to the pain site four to five times per day; it may take two weeks of use for benefits to be noticeable. To use it internally, take one 400- to 500-mg capsule or 5 to 10 drops of tincture up to three times a day.
Pain-fighting fats. The seeds of evening primrose (Oenothera biennis), borage (Borago officinalis), and black currant (Ribes nigrum) contain essential fatty acids that suppress inflammation. Several studies have shown that the oils from all three plants may help relieve symptoms of rheumatoid arthritis.
Most of the studies on these oils used a daily dose of about 1.5 g of gamma-linolenic acid (the omega-6 fatty acid found in all three oils). Check the bottle for the percentage of this acid in the oil. You’ll probably need to take enough capsules to yield a dosage of about 7 g of oil per day.
Boswellia (Boswellia serrata). This tree native to India, Northern Africa, and the Middle East yields a gummy resin used in Ayurvedic medicine to treat arthritis. Test-tube studies show that boswellic acids inhibit production of leukotrienes. A standardized extract of ashwaganda, boswellia, ginger, and curcumin reduced joint swelling in 182 patients with rheumatoid arthritis. Due to an unusually strong response to the placebo, though, improvements in other symptoms such as pain were not significant.
A 1996 analysis of eleven German studies, however, concluded that boswellia was more effective than a placebo and in some cases allowed patients to lower their intake of NSAIDs. Yet a 1998 study failed to find benefits of boswellia compared to the placebo. The usual dosage is 400 mg of standardized extract two to three times a day.
Linda B. White, M.D. has written numerous magazine articles on natural health. She is the coauthor of Kids, Herbs, & Health (Interweave Press, 1998) and The Herbal Drugstore (Rodale, 2000).
The reference list for this article is extensive. If you would like a copy, please send a self-addressed, stamped envelope to “Arthritis,” Herbs for Health, 243 E. Fourth St., Loveland, Colorado 80537-5655, or e-mail us at HerbsforHealth@HCPress.com.