Introduction
Osteoarthritis is a health condition that affects the joints and muscles around the knees. It is characterized by breakdown of joint cartilage over a period of time. In normal circumstances, cartilage allows bones to slide over one another, but patients with this condition experience pain around joints because there is not enough lubrication to prevent the bones from gliding over one another without interference. Top layer of cartilage becomes worn out, causing wearing and breakdown of joint tissues. Over time the joint may lose its shape. The most affected joint areas are fingers, knees, feet, hips, lower back and both joints become affected. Normal aging process is also a contributing factor for osteoarthritis development as well as obesity, muscle weakness, joint injury and stress caused by genetic factors. Patients view contemporary medicines (CAM) also known as herbal drugs to be more effective in treatment of osteoarthritis because they are less toxic and have fewer side effects as compared to prescription drugs. These drugs are either combined with conventional medicine or used alone for effective results. However, adverse effects in a few cases may be reported such as bleeding, nausea and diarrhea but go away within days.
Cat’s claws are plant products extracted from the Amazon Peruvian rainforest and used for treating arthritis and fibromyalgia. The plant contains antioxidants called pycnogenol known be free radical scavenger. Cat’s claws bark is known for its ethnomedical use for treating inflammation. Species for cat’s claws include Uncaria tomentosa and Uncaria guianensis. Vincaria consists of Uncaria guianensis species known for anti-inflammatory agents best for the treatment of osteoarthritis. Vincaria contains oxindole alkaloids found in the Uncaria tomenstosa known for water extraction and helps enhance the immune system and therefore relieve symptoms of osteoarthritis (Miller, Mehta & Kunte 2005).
Serrasil® is a natural herbal extract known for its mineral source to treat joint pain. This mineral product is derived from the Sierra Mountains in the USA and demonstrated by various studies to determine its effectiveness in the treatment of osteoarthritis. A study conducted on human cartilage joints revealed that sierrasil extracts helped in the reduction of cartilage reproduction when used along with IL-1β and nitric oxide. When chondrocyte production of nitric oxide is increased, catabolic activities are stimulated therefore inhibiting the production of inflammation in the joints. It’s known for its ability to crush IL-1β to interject events in human cartilage. Herbal extracts of cat’s claw (Uncaria guianensis, Vincaria) and sierrasil are clinically proven to provide inhibiting enzymes of NF-ĸB and tumor necrosis inhibitors for treatment of osteoarthritis of the knee according to placebo. From the evaluated results we see that sierrasil can limit cartilage degradation when induced with IL-1β in vitro however further research is needed to support this evidence to determine its effectiveness. Further research on sierrasil on treatment of osteoarthritis based on the acute vitro observation revealed that sierrasil was beneficial to osteoarthritis patients in the sense that it offered protection of the cartilage, helped in minimizing inflammatory events and was proven to be safe. Patients were required to be put on this medication for two months to observe any benefits (Miller, Mehta & Kunte 2005).
Boswell is a clinically tested anti-inflammatory agent used for treating osteoarthritis. This plant helps reduce inflammation and promote blood circulation around the joints. With increased blood circulation, pressure is taken off the joints and blood around the areas flow more freely. Celadrin is a natural ingredient composed of herbs. It’s mostly used for pain reduction and decreased inflammations in the joints. A constant supply of chondroitin sulphate in the diet helps lubricate the joints and the body as a whole. These lubrications reduce pain brought about by osteoarthritis. Lubricants released from chondroitin sulphate lubricate the joints and prevent further damage to the bone caused by rubbing. These reduce the pain suffered and prevent the further spread of the disease. Evening Primrose Herb not only treats osteoarthritis but also all other inflammatory problems. This herbal product contains gamma-linolenic acid; oil extracts that help reduce inflammation and works as effective as other pharmaceutical drugs (Articles Base 2009).
Willow bark is an anti-inflammatory agent containing flavonoids, salicylates and tannins ingredients similar to those found in aspirin for relieving pain. Willow bark takes longer to metabolize and be absorbed in the system as compared to salicylate (aspirin). A dosage of 120-240mg of salicin extracted from willow bark taken daily reduces back pain. For quicker results, patients are recommended to use a high dosage of 240 mg which is equivalent to 50mg of aspirin. People who are sensitive to aspirin are advice not to use this drug and also diabetic, hemophilia, kidney and liver diseases, asthmas, peptic ulcers, gout and hypoproteinemia disease. Capsaicin is an ingredient found in chili peppers known for its effects on pain-sensitive nerves. Analgesic studies reveal that the use of capsaicin on osteoarthritis patients help in the treatment of joint pains. The benefits of using ginger as an Osteoarthritis treatment is that provides anti-inflammatory extracts that improve symptoms of this disease, reduce pain and swelling improve movement and mobility. The only side effects associated with the use of it is bad breath and belching, which are no adverse side effects however, scent-free ginger tables are also available (Articles Base 2009).
Devil’s Claws is used as a herbal remedy used for treating arthritis. The benefits of using the devil’s claws are that it reduces pain and symptoms associated with the disease. Anecdotal evidence suggests the effectiveness of using Devil’s claws for treating arthritis, however; the treatment has not been involved in clinical trials (Globinmed 2007)
Herbs contain essential nutrients whose deficiency has given rise to osteoarthritis. These herbs have enzymes that stimulate the body for normal functioning such as releasing lubrication of the affected joint. Most of the herbs we have seen above contain anti-inflammatory substances that reduce pain. Commercial preparations of herbal medicines are cheaper and readily available in the market compared to pharmaceutical drugs. Herbal medicines do not have side effects on the body, and patients would use them without any professional advice. It is cheaper to use herbal remedies for treating osteoarthritis compared to contemporary medicine. Many experts offer advice for using herbal medicines that do not require a scheduled appointment. These medicines offer long term relief from symptoms of osteoarthritis, may also heal the condition completely. These medicines can be used along with other treatments, may choose two treatments to obtain the best results. Commercial preparations of these medicines are available everywhere in the world, therefore readily available (Home remedies 2008).
Background
There are some traditional methods and treatments used by communities worldwide for relieving and reducing inflammation of osteoarthritis symptoms. Natural treatments and herbs effectively treat this condition with little or no side effects as compared to pharmaceutical medicines. Examples of herbal remedies include; Boswellia Tree Extract, Celadrin, Chondondoitin Sulphate, Devil’s Claws, Cat’s Claws, Evening Primose Herb and Ginger. G. Nutraceuticals in the management of osteoarthritis
The use of nutritional supplements as pharmaceutical agents has been used over the years to help in osteoarthritis management. Quite some diseases are caused by dietary deficiencies and the center of their pathogenesis can be well treated by correcting the insufficiencies. There is no clinical evidence that suggests that pathogenesis of osteoarthritis is caused by nutritional abnormalities but dietary supplements can be used as a secondary role in its management. Hyaline cartilage lies in the synovial joints and consists of chondrocytes which produce type II collagen fibers, water and proteoglycans. This type II collagen fiber provides tensile in the joints that provide strength and rigidity of the cartilage and proteoglycans provides lubrication of the interstices. Nearly 70 percent of the population aged more than 65 years have osteoarthritis. Osteoarthritis starts when proteoglycan gradually get finished resulting in loss of compressibility of the joint and reducing chances of shock absorption. It’s due to the stress of the cartilage that leads to osteophyte formation. Anti-inflammatory drugs are mostly used to relieve symptoms temporarily, has any clinical report proved the effectiveness of herbal medicines ?. These agents provide relief by inhibiting the synthesis of prostaglandins (Clayton 2007).
Boswellia is a herbal tree found in the hilly area of India. This tree provides good anti-inflammatory agents for treatment of osteoarthritis. It is the gum resin traditionally known as Guggulu that is extracted from this plant responsible for producing anti-inflammatory agents, anti-arthritis and analgesic benefits. A double-blind study carried out in 2003 on elderly patients of 333mg three times a day observed tremendous results when patients on medication reported decreased severity of pain and swelling on the joints and also resumed to the normal movement functions of the joint. Mild drug reactions included nausea, diarrhea, and epigastric pain. Boswellia was also found to inhibit leukocyte electase that helps in the management of autoimmune disorders, rheumatoid arthritis for instance. The use of Boswellia decreases the glycosaminoglycan depletion, therefore keeping articular cartilage in good condition. When articular cartilage is well lubricated, patients with osteoarthritis recover quickly and stop further spreading of the disease (Clayton 2007).
Vitro studies carried out on the effects of avocado and soybean oil extracts revealed that the combination of one-third of avocado and two-thirds of soybean oil inhibited the depletion of glycosaminoglycan on joint structures. Oral dosage is also available with a dosage of 300mg daily and is reported to have beneficial to patients who have hip or knee osteoarthritis. With the use of these natural products, patients reported decreased use of nonsteroidal anti-inflammatory drugs (NSAIDS) and pain scores and joint movement improved significantly. The use of natural medication has reduced the over-reliance on NSAID drugs, has prolonged life, reduced chances of developing disability and modified the indications for joint surgery, thereby saving medical costs (Clayton 2007).
Chondroitin herbal substance for the treatment of osteoarthritis is widely available in sulphated form. The oral dosage of chondroitin required for a patient with osteoarthritis is 1200mg taken daily. Chondroitin is a substance contained in glycosaminoglycan that is found in the proteoglycans responsible for making articular cartilage a supplement that slows the process of osteoarthritis by increasing the production of synthesis of proteoglycan in the articular cartilage. The supplements provided by chondroitin inhibit proteolytic enzymes, stimulate collagen and glycosaminoglycan synthesis and contributes to cartilage matrix deposition. Glucosamine and chondroitin work together to stimulate glycosaminoglycan synthesis in chondrocytes with its anti-inflammatory effects in influencing cellular metabolism. Adverse effects reported with the use of chondroitin include asthma and atopy and when it interacts with anticoagulants; heparin and warfarin for example it leads to excessive bleeding. Chondroitin Sulphate (CS) oral medications are easily absorbed therefore obtaining quicker results in improvement of the knee or hip symptoms (Clayton 2007).
S-Adenosylmethionine (SAMe) is a natural treatment of arthritis, depression, migraine headaches, liver diseases and fibromyalgia. SAMe is found in living cells of the brain and liver and it gets involved in biochemical pathways. SAMe contains sulphur that is synthesized from amino-acid L-methionine and andesine triphosphate. Overall, SAMe helps in the synthesis of proteoglycans in chondrocytes cultures that derive from the articular cartilage in osteoarthritis patients. According to research done on effect of SAMe on osteoarthritis patients, symptoms have been reported to reduce on patients put on SAMe medication for two weeks, however, the action of the medication appeared to be slower than that of non-steroidal anti-inflammatory drugs (NSAIDs). This treatment was also reported to be more effective than placebo treatment. Mild side effects associated with the use of SAMe treatment were heartburn and nausea and was also reported to have caused adverse effects on patients with bipolar disorder such as agitation and mania reactions and therefore discouraged to use the treatment. Other clinical trials have been done to test the effectiveness of SAMe as a treatment of osteoarthritis confirm that SAMe works indirectly on the joints to decrease perception of pain through elevating depression, therefore, relieving the symptoms. Long term use of SAMe diminish osteoarthritis with time (Clayton 2007).
Collagen Hydrolysate is a hydrolyzed gelatin product used in foodstuffs and pharmaceutical products and is known for its beneficial factors in alleviating symptoms of osteoarthritis. Collagen Hydrolysate is used to manufacture hydrolysis of pharmaceutical-grade gelatin, an agent used for osteoarthritis treatment. Hydrolyzed collagen contains amino acids that help in the synthesis of collagen, a protein component of the cartilage matrix. When chondrocytes are stimulated to synthesize collagen matrix, the symptoms of osteoarthritis improve significantly. Clinical trials have also revealed that 10g of collagen hydrolysate taken daily decreases pain of the knee or hip in osteoarthritis patients and also double up efficacy for collagen hydrolysate as compared to patients on placebo observed to adverse symptoms (Clayton 2007).
It’s founded on vitro studies that diacerein’s metabolite rhein helps in inhibiting the activity of interleukin-1 responsible for increasing collagenase production in the articular cartilage. Diacerine also helps stop superoxide anion production, neutrophils and macrophages which are phagocyte properties and chemotactic production. Patients with osteoarthritis put on a dosage of 50mg of oral diacerein medication twice daily reported decreased pain, improvement in joint functions and reduction in joint space narrowing. Patients also reported improved quality of life with the use of diacerein and reduction in the use of NSAID and analgesic drugs. As compared to NSAIDs treatments, diacerein does not interfere with the normal activities of renal and platelet cyclooxygenase, therefore, may work well on patients with renal impairment (Clayton 2007).
Oxaceprol contains amino acid L-proline that inhibits leukocytes adhesion and migration, therefore, hindering inflammatory process. Oxaceprol is clinically tested for its beneficial characteristics of analgesic properties and is known to be tolerant to patients with osteoarthritis of knee or hip better than diclofenac use. It also does not impair the gastrointestinal system as compared to the use of NSAIDs. Clinical administration of oral oxeceprol requires 200mg to 400 mg three times a week was taken daily and no adverse effects are attributed to it (Clayton 2007).
For normal metabolic functions of the cartilage matrix to take place, inorganic sulphate is required to synthesise glycosaminoglycans for the healthy functioning of the cartilage matrix. Extracellular sulphate is required in a constant supply of dietary sulfur to reduce symptoms of osteoarthritis. Sulfur in our diets derives from sulfur amino acids such as cysteine and methionine responsible for healthy cartilage. Osteoarthritis causes progressive depletion of sulfate storage and with the use of sulfur amino acids, glycosaminoglycan is synthesized to enhance the cartilage and replace sulfate storage, therefore, helping in the progression of osteoarthritis. Most of the nutraceuticals used in the management of osteoarthritis such as SAMe, chondroitin sulphate, and glucosamine sulphate contain sulfur. It is for this sulfate composition that compensates for suboptimal sulfur amino acids for healthy articular cartilage. Increasing consumption of foodstuffs containing high quantities of inorganic sulfates such as dietary protein and mineral water improve osteoarthritis symptoms over a period of time (Clayton 2007).
Glucosamine is an amino monosaccharide sugar and an original component in the synthesis of glycosamine responsible for the formation of hyaluronic acid in articular cartilage and proteoglycans. Glycosamine helps in relieving osteoarthritis symptoms by stimulating synthesis of glycosaminoglycans and inhibiting the depletion of proteoglycans in vitro. This process stimulates the restoration of cartilage in vivo therefore normal joint functioning. Glucosamine helps in stimulating the production of protein and chondrocytes aggrecan mRNA, constrains the production and depletion of matrix enzymes in vitro. It also stops the synthesis of pro-inflammatory mediators that generate degrading enzyme synthesis and also blocks chondrocyte proliferation. Clinical studies demonstrated on 1500mg daily for patients with joint space narrowing affiliated with articular cartilage degeneration demonstrated that glucosamine effectively prevented the progression of osteoarthritis. Meta-analysis results calculated the mean difference in joint space narrowing of 0.27mm in three years. Glucosamine decreases joint space narrowing, therefore, improving joint functions and mobility. When measured by Lequesne’s indices, functions of joint space narrowing improve moderate to large degrees. About 125 osteoarthritis patients who were on glucosamine reported gastrointestinal tract reaction but the conditions were mild. The symptoms were diarrhea, abdominal discomfort, dyspepsia but resolved with time. The combination of glucosamine and chondroitin sulfate on patients with asthma was reported to increase respiratory tract secretion, therefore, worsening the condition (Clayton 2007). Other community intervention programs include:
Acupuncture
Acupuncture is a natural method developed in China for the treatment of osteoarthritis. Needs are placed in different locations of the body that enables the flow of energy in the system. The concept behind pricking needles in the body is that it releases blocked energy, therefore, causing the disease. Acupuncture involves the stimulation of endorphins production since the process was reduced by naloxone. Meta-analysis of acupuncture trials including 393 patients was performed to see its effectiveness in the treatment of osteoarthritis. Acupuncture was seen to be very effective in relieving pain according to trials done on 393 patients, however, data provided does not indicate whether the use of acupuncture as a method of treatment of osteoarthritis is efficacy to other treatments of the knee. The procedures involved in acupuncture are; needle placement in five local locations, four in distal joints and nine needs in each affected leg. Participants who were involved in the experiment reported having been experiencing energy in the local sensational of heaviness, numbness, soreness in the places that the needles were placed. Electrical stimulation was applied on the knee points for 20 minutes in conjunction with needle insertion to promote blood stimulation. This experiment included two control groups; sham acupuncture and education group. In sham acupuncture group, needles were inserted into the sham abdominal points and taped to the surface where pain was experienced and no electrical stimulation. The educational group on the other hand enrolled 570 participants with radiographic knee osteoarthritis, one with osteophyte with moderate to severe pain. Participants who were in the true and sham acupuncture received 25 sessions each. Reports revealed that pain levels were reduced in participants in true acupuncture group compared to the sham group. The true acupuncture group reported improved functions as compared to sham group (Ronald, Moskowitz, Goldberg et al 309).
Yoga
Yoga is practiced in Indian communities for treatment of different ailments. This practice includes meditation that attempts to harmonize the spirit and body, requires physical postures and breathing attentions. Yoga postures help in the treatment of osteoarthritis in the sense that it relaxes the mind and improve physical condition of the affected joint thereby alleviating the symptoms of osteoarthritis. A comparative analysis was carried out on patients on treatment and those without on an 8-week yoga program to determine the effectiveness of its effectiveness on osteoarthritis patients. Results revealed that those on the program reported a reduction in amounts of pain during activities, finger motions and joint tenderness. Pilot studies also reported improved stiffness on osteoarthritis patients following completion of yoga intervention (Ronald, Moskowitz, Goldberg et al 309).
Tai Chi
Tai Chi is a health promotion exercise commonly practiced in Chinese culture. The exercise stimulates cognitive, cardiovascular and responses of the musculoskeletal responsible for producing psychological and physiological changes. This practice includes gentle flowing movement that promotes mobility and flexibility activities necessary for the improvement of fitness and strengthens joints, therefore, reducing falls in the elderly. A study was conducted on 33 elderly patients to see the effectiveness of tai chi in improvement of osteoarthritis symptoms. Two participants were involved in the trial and were put on 1-hour tai chi classes for 12 weeks. With the use of the Arthritis Self-Efficacy scale, results revealed that participants on the trial improved in the osteoarthritis symptoms, level of tension dropped, improvement in total arthritis self-efficacy and significant change in their health condition (Ronald, Moskowitz, Goldberg et al 309).
Research design and methods
Cat’s claw and sierassil
Research used in determining the effectiveness of sierrasil in the treatment of osteoarthritis used randomized, placebo-controlled multi-centre trial and double-blind study by Somaiya Medical College & Hospital in India.
Research hypothesis and objective
Cat’s Claw
The purpose of this study using a cat’s claws was to determine whether natural mineral supplements, sierrasil would effectively relieve osteoarthritis symptoms of mild to moderate pain of the keep safely.
Devil’s claw
The objective of this study is to determine the effectiveness of devil’s claws in the treatment of osteoarthritis.
Type of experimental design
Experimental design used here was to determine the effectiveness of herbal medicine on osteoarthritis patients.
Rationale behind the research
Clinical studies done on devil’s claws as a herbal treatment of osteoarthritis reveal conflicting data about efficacy of the root/tuber as an anti-inflammatory and analgesic reliever. It is thought that iridoid glycosides are responsible for producing anti-inflammatory agents responsible for lubricating the joints, but what’s conflicting about the herb is that it becomes inactive when separated from the whole root extract. The basis of the root chemical components of the drug components is unknown, one might not tell the right dosage or risks associated with it. No adverse effects have been reported from the use of herbal roots, only temporary mild effects such as burping, bad breath for ginger, diarrhea and bradycardia.
When glucosamine is used for treating osteoarthritis, some complications may arise if the product is issued along with herbs and dietary supplements. Herbs that may lower blood sugar levels may decrease effectiveness if the patient is already on glucosamine treatment and may cause severe bleeding. Devil’s claws increase gastric acid secretions effective for producing lubricants that will prevent joint pains, however, the acid secretions may interfere with natural body activities of anti-acids and histamine -2 blockers. Cardiac and anti-arrhythmic drugs may cause increased activity in the body caused by anticoagulants (Pubmed 2003). (Medicine Plus 2009).
Study population
Participants were recruited from two private arthritis clinics and others from Somaiya Medical College. The population pattern used were adult patients of both sexes, age more than 20 years and ambulatory participants. Participants of mild to moderate symptoms of arthritis were grouped in classes II or III according to radiological and ARA functional class. Knee pain osteoarthritis was further subdivided into grade II or III by Kellgren Lawrence classification, an 100mm Visual Analog Scale used for assessing baseline functional of the overall pain of 50mm. Randomized procedure was done in groups of four assigned with a pre-specified probability formulated. The groups represented number of treatment groups with a total probability of 24. Investigators held treatment codes sealed in a manner they could only understand in case they observed any serious adverse effects on any participants. According to Miller, Mehta & Kunte (2005), participants were assigned according to the algorithm until subjects of 96 and the procedure were repeated in cycles. Investigators stood by throughout the study to monitor adverse vents, blindness and keep an eye on trial supplies. Research coordinators were kept out of the trial to avoid bias related activities. The subjects groups studied in sierrasil trial include:
- Group A-High dose sierrasil
- Group B-Low dose sierrasil
- Group C-Low dose sierrasil cat’s claw extract
- Group D-Placebo
Recruitment strategy
Ginger as a treatment of osteoarthritis selected subjects on diagnostic criteria based on identification of prognostic factors which may predict responsiveness depending on the patients‘ population to the therapeutic intervention being tested, herbal products and dietary supplements for this case. Participants were required to perform validated experiments for the classifications of symptoms of osteoarthritis such as WOMAC, and placebo clinical trials. Trails of symptoms on herbal agents such as ginger and devil’s claw should include patients whose osteoarthritis condition is likely to respond to treatments. These categories classify patients with low to moderate pain intensities to examine how each one of them responded to clinical trials. Trials structure modifying agents included patients who were not at the last stages of their disease and also those that had high risks of structural progression, for example, middle-aged women. However, the studies did not mention overweight women with osteoarthritis of unilateral knee or patients who increased consumption of bone scintigraphy in the juxta-articular bone as a control group for osteoarthritis patients (Altman & Marcusses 2536-2538).
Methods and procedure for data collection
Cat’s claw
107 subjects were recruited and grouped into 25 different subjects per group making a total of 100 subjects. Investigators used the estimation method in recruiting participants based on the efficacy of cat’s claw extract used alone in the treatment of osteoarthritis as we have seen in the trial results above. Before the treatment was administered, assessment of vital signs was contacted, radiological of the affected knee and laboratory test done one week before the baseline. Serum, urine pregnancy tests, blood count, SGPT, serum creatinine and erythrocyte were among the laboratory tests done before the recruitment process was done. In the baseline assessment, vital signs were recorded in WOMAC scores of groups A, B, C and VAS. After initiation of the first treatment, the trials were repeated in cycles at weeks 1, 2, 4, 6 and 8 and constant monitoring of compliance along with observing adverse effects in these participants. After the study of group was completed, laboratory tests were done all over again (Miller, Mehta & Kunte 2005).
Protocol deviation was characterized by dropouts from the study of more than 4 days and failure to take the medication within the fifth day of scheduled visit. These deviations included activities such as skipping medication, consuming other medication without getting permission from the investigator, not attending the scheduled visits for more than one day and not coming long with study medication bottles in the scheduled visits. Patients on this study trial were not allowed to consume calcium and cartilage supplements, steroids, analgesics, NSAIDs or any other form of medication that would alter the outcomes of the study. Rescue medications were the only combination medicines allowed (Miller, Mehta & Kunte 2005).
Another study was carried out to compare ginger extracts to placebo and ibuprofen in treatment of osteoarthritis in patients experiencing hip or knee problems. The study controlled was in a controlled, cross-study (with a washout period of one week, followed by three treatment periods), double-blind and double-dummy study. The study used Acetaminophen medication as rescue medication throughout the experiment. The three treatment periods of placebo, ibuprofen and ginger extracts reported different ranking efficacy when using visual analog scale of pain of (Friedman test: 24.65, P<0.00001) and Lequesne-index of (Friedman test: 20.76, P<0.00005). With the use of cross-study method, no difference in patients on placebo and ginger extracts were examined (Siegel-Castellan test). Another test on combination of ibuprofen and ginger extracts on patients with osteoarthritis showed positive results than that of placebo (chi-square, P<0.05). No serious side effects were reported during this period with patients with active medication (Bliddal 9-12).
The patients were put on this trial for two weeks with 2 capsules taken orally twice a day with meals. The rescue medications used were paracetamol (acetaminophen) of 500mg tablet not exceeding 4 tablets a day. Serrasil is a botanical plant composed of silicate minerals such as calcium, potassium, aluminum, magnesium and many more. The compositions of these minerals are in percentages of; 5.9% iron, 1.3% calcium, 9.5% aluminum, 45% of silica (SiO2) and other trace elements. Sierrasil was used in the two group trials, one with a high dosage of 3g/day and the other with a 2g/day low dose. A separate experiment was also done in combination with low dosage of 2g/day of sierrasil combined with cat’s claws extracts (Uncaria guianensis) at 100mg/day dosage.
Data analysis procedure
Efficacy of osteoarthritis of the knee or hip using ginger extracts.
In 2001, studies were conducted to examine the effects of ginger extracts on knee pain for patients with osteoarthritis (OA). 261 patients were randomly picked with moderate to severe knee pains and enrolled in a 6 week, double-blind, placebo-controlled, parallel, and multi-center group study. Patients were washed out and put on ginger extract twice a day combined with acetaminophen, as a rescue medication. The primary efficacy was used as a variable to the proportion of respondents that used ginger extracts and experienced pain reduction in knees while standing; the method used intent to treat analysis. This analysis classified respondents who reported reduced knee pain by 15mm on a visual analog scale. Reports revealed that out of the 261 evaluated patients that experienced knee pain while standing, 247 of them reported reduced knee pain on standing with the use of ginger medication compared to the control group (63% versus 50%; p=0.048). When analyzing mean values, secondary efficacy variables reported greater response to the group that used ginger extract as compared to the control group (Altman & Marcusses 2536-2538).
Reduction in knee pain on standing with mean values of (24.5mm versus 16.4mm; p=0.005), pain reduction after walking 50 feet (15.1 mm vs. 8.7mm; P=0.0016) and Mcmaster and Western Ontario Universities (WOMAC) reported a reduction of osteoarthritis composite index with mean values of (12.9mm vs. 9.0mm; P=0.087). Reports also indicated that rescue medications were less used by patients who were on ginger medication and the change of quality of life was the same in the two groups. Patients who were on ginger extracts reported gastrointestinal discomforts as compared to the placebo group (59 patients vs. 21 patients), however, the effects were mild and brought the study to the conclusion that ginger moderately relived pain in the knee in patients with osteoarthritis (Altman & Marcusses 2536-2538).
Plant extracts from Devil’s claw (Harpagophytum procumbens) are used to treat patients with rheumatic diseases, arthrosis and low back pain for this case. Aqueous extracts have been tested on their efficacy and long term safety effects on use of this substance. The dosage is measured in (Doloteffin; 2400mg daily, corresponding to 50mg harpogoside). These products have been tested successfully with patients with arthritis experiencing back pain. The study was conducted for a period of 12 weeks and carried out on 75 patients. Western Ontario and Manchester University carried out the experiments to standardize the assessment of treatment effects of Devil’s craw herbal products on osteoarthritis patients using an index of (10 point scale) and a VAS pain scale of10cm (PubMed 11665-1172).
There was remarkable reduction in pain and symptoms by patients suffering from osteoarthritis who used Devil’s craw as a form of treatment. Each subscale used by McMaster and Western Ontario Universities reported improvements with a total index of 23.8% for pain subscale, 22.2% stiffness subscale and physical subscale reported 23.1%. Western Ontario and MacMaster universities reported a 22.9% reduction in the overall scores, 25.8% reduction in Vas pain scores for actual pain, 25.2% average pain, 22.6 % for work pain and the total score in reduction of pain was 24.5%. Clinical findings on physicians recorded continuous improvements in pain on palpation by 45.5%, 35% on mobility limitations and joint crepitus improved by 25.4%. These clinical results suggested that Devil’s claw plant extract was of beneficial effects in treatment of patients with osteoarthritis of the hip or knee and minimal side effects connected to the use. However, there were cases of drug reactions such as dyspeptic complaints and sensational fullness but tremendous benefits were observed with the use of the product (PubMed 11665-1172).
Discussion and anticipated problems
These natural pain relief treatments are relatively safe and have no adverse side effects. One of the disadvantages of using them is bad breath and burping linked to ginger medication. Herbal remedies have been used for many years now and medical labs and doctors are reporting benefits associated with them. Herbal medicines used to treat knee arthritis may be slower compared to medical drugs but in the long run, the results are tremendous since they heal the condition naturally. Herbal supplements include capsules, tablets, sprays, oral pills and suspensions. Most of these supplements do not come with the right proportions and when used wrongly, negative effects may be realized. Throughout the research, I have used randomized trials of herbal medicines for osteoarthritis treatment and compared them to placebo to achieve clinical results.
The use of natural products in elderly people suffering from chronic ailments has gained popularity over the years. Osteoarthritis for instance has used some herbal plants to relieve symptoms and treat the disease completely. Herbal medicines use various parts of plants such as leaves, roots, tubers and barks for medicinal purposes. Most indigenous cultures all over the world have used plants on one occasion or the other to promote health and alleviate pain. Western medicines are also using Ayurvedic traditional Indian medicine and traditional Chinese medicine in the treatment of common ailments, osteoarthritis for example. Research in herbal medicines is still in its early phases and many clinical trials are trying to provide evidence on the process involved in the treatment of osteoarthritis using herbal extracts. Various control trials such as placebo have only reported on preliminary findings without concrete evidence to back these natural products as the basis for treatment of osteoarthritis. Some clinical evidences on herbal and dietary medicines have established efficacy for clinical conditions combined with other pharmaceutical drugs or used alone in the improvement of osteoarthritis symptoms. Most people use herbal products because the therapies are gentler and produce fewer effects as compared to pharmaceutical drugs. Clinical studies also reported adverse effects on asthma and pregnant women as these drugs are mixed with foods or combination with other drugs may cause adverse effects. Although herbal drugs are readily available in our markets, a patient needs to seek professional advice before use. Quite some herbal agents have been established as anti-inflammatory drugs such as and pain relievers and should only be used according to the dosage requirement. Community intervention programs have also stepped in the management of osteoarthritides such as yoga, Tai chi and Acupuncture.
Cat’s claws study on treatment of mild to moderate osteoarthritis of the knee was designed to determine its natural mineral supplements used alone, with Uncaria guianensis extracted from cat’s claws, sierrasil and vincaria. Osteoarthritis continues to affect millions especially the middle-aged population over 65 years worldwide. Researchers are using therapeutic options to try and relieve osteoarthritis symptoms but the options are not optimal. Pharmaceuticals have been using non-steroidal anti-inflammatory classes (NSAIDs) that block cyclo-oxygenase (COX) for the management and treatment of the disease. The use of NSAIDs provide temporary relief of osteoarthritis symptoms but does not heal the disease. Therapy has been seen to be beneficial by COX-2 class since it reduces unwanted renal and gastrointestinal side effects caused by herbal products as well as pharmaceutical drugs. Recent studies have revealed adverse side effects such as cardiovascular risks in association with COX-2 when used along with NSAIDs. Alternative therapeutic approaches have also been used to traditionally manage and pain and discomfort in osteoarthritis patients such as Tai chi, yoga, acupuncture and nutraceuticals. Various forms of physical therapies have also been used as they offer non-pharmacological benefits that are cheaper, readily available and have fewer side effects.
The use of nutraceuticals is widely practiced by different communities worldwide and is known for its beneficial factors in relieving and healing osteoarthritis symptoms. Examples of nutraceuticals include glucosamine either used alone or in combination with chondroitin in the management of osteoarthritis. These two nutraceuticals contain structural elements composed in the cartilage and matrix of the joints. Therapeutic research on these nutraceuticals reveals that ingestions of large amounts of matrix elements such as mineral water would correct the elements lost in the process of catabolic caused by inflammation of the cartilage and articular muscles. Recent studies reveal that daily consumption of oral glucosamine would not effectively stimulate chondroitin production necessary for cartilage disposition. Evidences on effectiveness of glucosamine on osteoarthritis patients are not sufficient enough to prove its anti-inflammatory effects on this disease. Glucosamine does not directly influence the disease process but maintains cartilage balance in the process of catabolic pathways. Patients with this medication have to wait for months before any change can be experienced. Efficacy on glucosamine and chondroitin studies show varying results on the benefits of each one of them with limited limitations.
The amino monosaccharide sugar is an enzyme responsible for glycosamine synthesis, therefore, enables the formation of hyaluronic acid in articular cartilage and proteoglycans for healthy cartilage. Glycosamine helps in relieving osteoarthritis symptoms by stimulating synthesis of glycosaminoglycans and inhibiting the depletion of proteoglycans in vitro. Another botanical-based product is green tea catechins and contains epigallocatechin gallate (EGCG) used for treating chronic inflammation osteoarthritis. Green tea catechins known for their epigallocatechin gallate components help slow down degradation of cartilage in vitro and also maintain joint architecture. The anti-inflammation activity is brought about as a result of inhibition of reproduction of inflammatory events, therefore, preventing NF-ĸB stimulation caused by cytokines and oxidants. NF-ĸB is widely used by therapies and pharmaceuticals because of its reproduction inhibiting factors in chronic inflammation known to regulate numerous genes responsible for causing inflammation. NF-ĸB regulates the production of matrix metalloprotease (MMPs) in joints by the use of chondrocytes. When the joint is injured or becomes inflamed, chondrocytes release matrix metalloproteases which in turn break down cartilage matrix releasing glucosamine and thereafter glucosamine. Studies have demonstrated the benefits of EGCG in the prevention of matrix metalloproteases formation and reproduction of cartilage in joints of human cartilage stimulated by the pro-inflammatory cytokine and IL-1β and used by therapists as herbal remedy for treatment of osteoarthritis.
The researcher used two doses of mineral supplements together with anecdotal clinical experience and the use of herbal extracts, cat’s claw (Vincaria) for this case. The experiments we have seen above shows that a cat’s claw effectively treats symptoms of osteoarthritis. The study used mineral supplements in double-blind placebo-controlled multi-center design and randomized methods and proved the minerals to be safe. Compared to baseline conditions, cat’s claws treatment proved to be efficacious but there were some circumstances where the study could not determine the disassociation of baseline conditions from that of placebo. Evidence from first and second week of sierrasil treatment reveal faster results as compared to the participants on placebo treatment which lasted 6 weeks before the results could be evident. From the clinical trials, we see that sierrasil provides early relief of symptoms of osteoarthritis but the studies do not adequately us the significant difference in each one of the trials, such as differentiating the randomized trials to placebo therefore difficult for other researchers to interpret. There were also unexpected improvements on participants in the placebo group between weeks 6 to 8. When the study used in the initial trials pre-determined results to be attained between those weeks, so we are not sure if the patients responded positively to the medication or the researchers wanted to prove their study. Participants may have had high expectations that sierrasil treatment in the randomized group would heal the condition, so this might have reflected on the results of the placebo response. If placebo response were continuous then the results provided would be more reliable as opposed to an exaggerated response as reported in the 6 to 8 weeks study.
In the clinical trials, sierrasil used rescue medications to mask the benefits attributed to ingestion of this herbal medication. Placebo and low dose sierrasil groups used rescue medications more as compared to other groups that might have covered up the differences between negative effects and positive benefits in relation to the treatment and placebo. The study also reported total rescue medication consumed by both groups and it is this that makes it impossible to link changes in rescue medication to that of disease activity on weekly or monthly basis. Sierrasil test groups reported a significant reduction in the baseline values as early as 1 week with steady improvements whereas placebo subjects did not report significant benefits from baseline until weeks six to eight. The early results obtained from this study are not inconstant with that of the vitro studies that corroborated the protection of human cartilage breakdown by generation by IL-1β reported to prevent osteoarthritis by exposure to sierrasil. Other studies of human cartilage joints evidenced that the actuation of nitric oxide production which is a catabolic pathway was weakened by sierrasil. These studies will present their clinical findings but do not directly assess whether the benefits provided by sierrasil would protect against cartilage degradation associated with therapies or either if the botanical extract would provide a change in the joint architecture within the stipulated time frame.
Vincaria, an Uncarian guianensis extract was used as a chondroprotective in the Vitro studies and reported rapid response on benefits of the treatment osteoarthritis as evidenced by placebo and controlled group studies. Cat’s claw botanical extracts have also reported their effectiveness in providing inhibiting factors of transcription through NF-κB and tumor necrosis inhibitor. We have also seen that vincaria and sierrasil as herbal extracts can act as modifying in patients with osteoarthritis and are proven to be safe as evidenced by clinical studies. Minerals supplements are known for their safety and efficacy benefits 2-month study based on clinical and laboratory findings did not record any changes in the safety of this treatment. The study administered a mineral supplement dosage of 2g/day versus 3g/day, this combination reflects anecdotal clinical experiments with concluded that patients on higher dosage required more vigorous assessment than those on lower dosage. These two groups’ differences were brought out in the week one and two and better results were reported by participants on high dosage. These botanical extracts do not have standard measurements for the dosage requirement required to treat osteoarthritis within a specific period. The mechanism by which botanical herbs and natural mineral supplements achieve these actions and benefits are unclear, however, there was only one occasion where community intervention such as yoga tried to explain the magic behind the treatment. The study of human explants indicates that reduced production of nitric oxide in response to IL-1β would affect the natural transcription of events and some years back nitric oxide isoform was evidenced to promote chronic inflammation. Due to these conflicting reports, it is g hard for us to completely rely on botanical extracts for osteoarthritis treatment.
Clinical studies done on the anti-inflammatory activities of devil’s claws offer to contradict reports on benefits and use of this herbal medicine for treating osteoarthritis by itself without combination of other treatments. From these reports, we see that this plant root may not be used as a single agent for treating and preventing symptoms of osteoarthritis. Further research is needed to standardize iridoid glycosides to test efficacy so that everyone would use them would worrying about the adverse effects attributed to them.
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