A supplement to The Herb Companion from the American Botanical Council and the Herb Research Foundation.
Arthritis has plagued the human race since the beginning of history. Fourteen of the eighty-six Byzantine emperors (a.d. 324–1453) are known to have suffered from this joint disorder. Historians analyzing medical and government records of the empire concluded that heredity was a major factor in the disease but that overconsumption of alcohol and fatty foods also played a role. Whatever the cause, the disease was so prevalent in the Byzantine population that it contributed to political and military difficulties.
Today, arthritis, in its various forms, is America’s number one cause of disability. It may limit its victims’ ability to walk, dress, climb stairs, or even get out of bed in the morning. The economic impact on the American economy, including medical care and lost wages, exceeds $50 billion a year. More than forty million Americans, roughly one in seven, suffer from one form of arthritis or another.
Arthritis is not one condition, but a group of more than 100 ailments causing inflammation and tissue damage in the joints. The most common form, especially among older people, is osteoarthritis, or degenerative joint disease. One-half of all cases of arthritis are this form. Associated with aging and wear and tear on joints, it is characterized by pain and inflammation stemming from cartilage breakdown.
One of the most destructive forms is rheumatoid arthritis, which affects about 1 percent of Americans. It may occur at any age but typically affects people between the ages of twenty and fifty, women three times as frequently as men. It attacks a joint’s synovial lining, a membrane that secretes an egg-whitelike fluid that lubricates the joint. Inflammation of the membrane produces an overabundance of fluid, causing swelling, pain, and restriction of joint movement. Severe cases may result in permanent deformity.
The cause of rheumatoid arthritis is not known. Heredity may play a role, as well as the body’s own immune system. Infections have also been known to bring on its symptoms. A growing body of evidence suggests that food allergens entering the bloodstream can cause an inflammatory response in the joints. A diet high in saturated fats may also be a contributing factor.
The condition may begin with a low-grade fever, fatigue, joint stiffness, and pain. Bouts may be intermittent, coming and going within a few weeks. Pain and swelling may be limited to one or two joints or may affect several. Commonly affected joints include those of the hands and wrists, feet and ankles, and knees. They are often red, swollen, and warm to the touch. The best way to avoid joint degradation and deformity is early intervention; this is where herbs enter the picture.
Now more than ever, researchers are looking to herbs as alternatives to the nonsteroidal anti-inflammatories such as aspirin and the corticosteroids commonly used to combat arthritis. Dozens of plants have been used as folk remedies to treat arthritis, especially rheumatoid arthritis. Among them are feverfew (Tanacetum parthenium), devil’s-claw (Harpagophytum procumbens), and cayenne pepper (Capsicum annuum). Most of the traditional herbal remedies are believed to relieve pain and inflammation. The latter action has been extensively explored by researchers.
Best known for its efficacy in reducing the severity and duration of migraine headaches, feverfew has also found a receptive audience with arthritic patients. Researchers in the United Kingdom suggest that more people may self-medicate with feverfew to treat arthritis than to treat migraines. Unfortunately, very few studies have been conducted on feverfew’s use for this purpose.
In a double-blind, placebo-controlled, randomized study in 1989, forty-one women with symptomatic rheumatoid arthritis received 70 to 86 mg of dried, chopped feverfew leaf or a placebo daily for six weeks. Although the feverfew did not benefit anyone in the treatment group, all of whom had well-developed symptoms unresponsive to conventional treatments, the researchers urged further tests to determine whether it might be effective at the onset of symptoms or for treating osteoarthritis. Followup studies have yet to be conducted.
The most efficacious herbal derivative now used in the symptomatic treatment of arthritis is capsaicin, the highly pungent compound responsible for the hot bite of red peppers. The pure compound and its analogs are now approved by the Food and Drug Administration for over-the-counter topical creams to treat persistent pain at the site of a healed shingles infection, burning pain in the toes, feet, and legs of diabetic neuropathy, as well as the pain of rheumatoid and osteoarthritis. It is also approved for the treatment of shingles (herpes zoster), a painful viral infection resulting in inflammation and blisters along the path of a nerve.
Capsaicin is currently the subject of clinical studies for a wide range of topical applications, including arthritis pain, psoriasis, vitiligo (a disorder manifested by smooth white patches on the skin), intractable itching, phantom pain syndrome, postsurgical pain, and sciatica.
A single topical application of a capsaicin preparation initially activates pain, producing the familiar burning sensation along with inflammation and hypersensitivity. Repeated applications lead to desensitization, pain relief, and reduction of inflammation. Capsaicin works by blocking a protein called substance P, which normally relays pain messages from nerve endings to the brain.
If you have an arthritic condition, see your physician or pharmacist before using a capsaicin product for external use. These professionals can advise you which product and concentration is best for you. Nonprescription topical products contain 0.025 percent or 0.075 percent capsaicin. Pain relief usually occurs within fourteen days of beginning applications but may take as long as six weeks. Ointments with higher concentrations of capsaicin must be prescribed by a physician. There is no evidence that cayenne capsules taken internally provide any relief from arthritis pain.
Devil’s-claw is a perennial creeping herb native to red sand steppes in southern Africa, especially in the Kalahari Desert, Namibia, and Madagascar. Although the jury is still out on whether devil’s-claw has any clinically verifiable benefit for arthritis sufferers, treating the condition is probably the most common use for the herb.
In Africa, the large secondary tubers of devil’s-claw have been used internally as a folk remedy for arthritis, indigestion, blood disorders, and fevers, and externally for sores. Today, the popularity of devil’s-claw as a medicine has put it at risk of extinction. When only traditional practitioners collected herbs, enough plants were left to replace those that were harvested. In 1984, however, commercial collectors harvested 66 percent of the known wild devil’s-claw plants in Botswana—a rate that is obviously not sustainable. Devil’s-claw is not cultivated, so all supplies come from southern Africa. Without managed growth and harvests, there may soon be nothing to harvest.
Early in the twentieth century, the tuber was introduced into German phytomedicinal practice, where it is primarily valued for reducing inflammation and pain from rheumatism and arthritis. It also is an ingredient in products to treat gastrointestinal symptoms and to relieve joint pain. In the United States, devil’s-claw products are sold as dietary supplements.
Studies of the anti-inflammatory properties of the plant have shown mixed results. Although oral doses of a water extract of the tuber did not significantly reduce inflammation in laboratory animals, later studies showed that intravenous administration of a water extract reduced acute inflammation.
A compound in the tuber called harpagoside has been considered the primary active component; however, a recent study found that while an extract of the whole tuber significantly reduced inflammation, pure harpagoside had no effect. This outcome suggests that a compound other than harpagoside, or perhaps a combination of several components, may be responsible for anti-inflammatory activity in devil’s-claw.
In another study, a water extract of the tuber relieved pain in chemically stimulated laboratory animals. The researchers suspect that a compound other than harpagoside may be responsible for the analgesic activity.
Whether you are considering herbal treatments or not, it is important to have a suspected arthritic condition diagnosed by a health-care provider so that treatment can begin early to avoid long-term complications.
Two other herbs have not been used traditionally for arthritis but have been the subject of preliminary investigations: ginkgo (Ginkgo biloba) and evening primrose (Oenothera biennis). Researchers speculate that an extract of ginkgo leaf may help arthritis by improving microcirculation of blood to the extremities as well as by providing antioxidants that could protect joints from inflammation. The essential oil of evening primrose has been used to treat deficiencies of essential fatty acids, chemical building blocks, ordinarily obtained through the diet, that aid in the production of normal levels of anti-inflammatory prostaglandin hormones.
For more information on arthritis, contact the Arthritis Foundation, 1330 W. Peachtree St., Atlanta, GA 30309; (800) 283-7800. The foundation offers brochures on different forms of arthritis and publishes a bimonthly magazine called Arthritis Today. Local and state chapters are located throughout the country. Check your local phone book or call or write the Arthritis Foundation for more information.
You can also direct questions on arthritic conditions to specialists at the foundation’s Web site, http:// www.arthritis.org/
Blumenthal, M. ed., S. Klein, trans. German Bundesgesundheitsamt Commission E Therapeutic Monographs on Medicinal Products for Human Use. Austin, Texas: American Botanical Council, in press.
Brown, D. Herbal Prescriptions for Better Health. Rocklin, California: Prima, 1996.
Foster, S. Feverfew (Tanacetum parthenium) Botanical Series, No. 310. 2nd ed. Austin, Texas: American Botanical Council, 1996.
Lascaratos, J. “Arthritis in Byzantium (a.d. 324–1453): Unknown Information from Non-Medical Literary Sources”. Annals of Rheumatic Disease 1995, 54(12):951–957.
Leung, A. Y., and S. Foster. Encyclopedia of Common Natural Ingredients Used in Foods Drugs and Cosmetics. 2nd ed. New York: Wiley, 1996.
Pattrick, M., S. Heptinstall, and M. Doherty. “Feverfew in Rheumatoid Arthritis: A Double-Blind Placebo-Controlled Study”. Annals of the Rheumatic Diseases 1989, 48:547–549.
“Herbs for Health” is offered bimonthly by the American Botanical Council and the Herb Research Foundation as a supplement to The Herb Companion.
Editor, Steven Foster
American Botanical Council
PO Box 201660 Austin, TX 78720
Herb Reaseach Foundation
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“Herbs for Health” is intended as an educational service, not a source of medical advice or a guide for self-medication. Please consult a qualified health-care professional for treatment of any serious health problems. For further information on any of the topics in “Herbs for Health”, write the American Botanical Council or the Herb Research Foundation.
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