Herbal Medicines for Arthritis Not Backed by Evidence

WEDNESDAY, Jan. 11 (HealthDay News) — There is little evidence
to support the widespread use of herbal medicines to relieve the symptoms
of osteoarthritis, according to a review of these products.

Osteoarthritis is a painful condition that involves damage to cartilage
and other structures in and around the joints, particularly the fingers,
knees and hips. It differs from rheumatoid arthritis, which is an
immune-based disorder.

Devil’s claw, cat’s claw, ginger, nettle, rosehip, turmeric, willow
bark, Indian frankincense and vegetable extracts of avocado or soybean
oils are all among the herbal medicines traditionally used to treat
osteoarthritis.

“Unfortunately, a large number of people suffer from osteoarthritis
pain,” said one expert, Dr. Robert Graham, an internist at Lenox Hill
Hospital in New York City.

“Current pharmacological management is largely focused upon reduction
of pain and of inflammation with the use of NSAIDs [painkillers] and
Tylenol, offering only temporary pain relief at the expense of known
adverse effects associated with NSAID use,” he added. “Patients have and
will continue to use herbal and dietary supplements with hopes of finding
the ‘cure’ for osteoarthritis pain, many times without sharing this with
a conventional medical professional.”

However, few studies on the use of herbal medicines for osteoarthritis
have been conducted, according to the authors of the review in the January
issue of the journal Drug and Therapeutics Bulletin. Many of the
studies that have been carried out had design flaws and limitations,
included too few patients, or weren’t long enough, according to a journal
news release.

The available clinical trial evidence suggests that the vegetable
extracts, Indian frankincense and rosehip may be effective and produce few
unwanted side effects, but more “robust data are needed,” according to the
journal.

Evidence in favor of the use of other herbal medicine is at best
equivocal or unconvincing, the review found.

“Use of herbal supplements comes up a lot in the treatment of joint
pain,” said Dr. Victor Khabie, chief of surgery and sports medicine at
Northern Westchester Hospital Center, in Mount Kisco, N.Y. “I have never
seen a study that has convinced me that its use is beneficial.”

The journal also warned that herbal medicines can interfere with other
medicinal products and prescription drugs. For example, extensive use of
nettle can interfere with drugs used to treat diabetes, lower blood
pressure and depress the central nervous system. Willow bark can cause
digestive and kidney problems.

“Herbal medicines have traditionally been used for the relief of
osteoarthritis symptoms. However, there is a lack of licensed herbal
medicinal products on the market for such symptoms, and none specifically
licensed for osteoarthritis,” the journal concluded.

“Also the efficacy and safety of such products is generally under-
researched and information on potentially significant herb-drug
interactions is limited,” the release added.

For his part, Graham said that some patients do seem to be helped by
herbal remedies.

“In some cases patients may be able to lower or stop the use of NSAIDs
and to avoid the adverse effects of NSAIDs,” he said. “Unfortunately, the
[review] authors did not review the popular dietary supplements
glucosamine and chondroitin sulfate alone or in combination, which has
been shown to be effective in a subgroup of patients with
moderate-to-severe pain.

“Although prospective studies are needed, I do believe that their use
should be discussed with [patients’] physicians and physicians should
consider integrating some of the more promising and/or safest herbals and
dietary supplements into their standard of practice — their patients are
already doing it,” Graham said.

Khabie agreed that certain herbals might seem to work for some
patients, although the reasons remain uncertain. “I do have patients who
tell me that various supplements have relieved their joint pain, and it is
unclear whether they are responding to a placebo effect,” he said. “Some
herbal supplements can act as blood thinners, which could complicate
upcoming surgery, so I usually ask my patients to discontinue their use
two weeks prior to their procedure.”

Doctors treating patients with osteoarthritis should routinely ask them
if they are taking any herbal products, the journal suggested.

More information

The U.S. National Institute of Arthritis and Musculoskeletal and Skin
Diseases has more about osteoarthritis.

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