One of the most supportive botanical medicines for the patient with RA may well be cur-cumin or turmeric (Curcuma longa). Notable for its ability to act as an antioxidant and antiinflammatory,59-61 curcumin seems well suited for treating this condition. More recent research suggests that curcumin is a potent inhibitor of the signaling pathway utilized by a specific type of IL-6, called oncostatin M.62 Specifically, curcumin decreases the proinflammatory pathways induced by oncostatin M. If not inhibited via this pathway, oncostatin M signaling results in the transcription=translation of metalloproteinases and their inhibitors. An imbalance between metalloproteinases and their inhibitors may represent one of the mechanisms of joint damage in RA. To be able to slow down metalloproteinase expression may represent one of the many recently discovered mechanisms of efficacy of an ancient herb.
A second botanical option recently reported in the botanical literature is the Ayurvedic herbal combination Maharasnadhi Quathar (MQR). In a three-month study that involved 45 patients with RA treated with this herbal combination and a second group of RA patients treated with another traditional preparation, the patients in the MQR-treated group demonstrated significant increases in the activity of the antioxidant enzymes superoxide dis-mutase, catalase, and glutathione peroxidase, which is important as reactive oxygen species are believed to be one of the mediators of inflammation and responsible for the pathogenesis of tissue destruction in RA.63 Another finding of the study was that lipid peroxidation was reduced by 34% in the MQR-treated group. MQR is a combination of 26 herbs, with the bulk (70%) of its composition accounted for by alpinia galangal (Alpinia calcarata), but also including a variety of other plants, such as ginger (Zingiber officinale), tropical almond (Ter-minalia chebula), tribulus (Tribulus terrestris), ashwagandha (Withania somnifera), and cor-iador also called Chinese parsley (Coriandrum sativum).
Oleoresin gum extracts of boswellia (Boswellia serrata), with 37.5%-65% boswellic acid, exert potent anti-inflammatory actions via inhibition of inflammatory mediators such as leu-kotrienes. The recommended boswellia dose is 150mg three times per day.64 Bromelain, a commonly used proteolytic enzyme, has direct clinical application for treating RA, as do other enzymes. Select results have yielded upward of 73% positive results, ranging from good to excellent.65 Ginger (Zingiber officinale) extracts have demonstrated benefit as well, with good pain relief in preliminary studies.66 Ginger suppresses prostaglandin synthesis through inhibition of cyclooxygenase-1 and cyclooxygenase-2 and leukotriene biosynthesis by inhibiting 5-lipoxygenase.67 These herbs and numerous others show promise for alleviating symptoms and potentially modulating pathophysiologic changes.
Other select herbs that have been used in the treatment of RA include the following:
Oleoresin gum extracts of boswellia, with 37.5%-65% boswellic acid, exert potent anti-inflammatory actions via inhibition of proinflammatories such as leukotrienes.
Cayenne (Capsicum frutescens)
Topical cayenne application acts specifically by depleting stores of substance P from sensory neurons. In a placebo-controlled study, arthritis patients were instructed to apply 0.025% capsaicin cream to painful joints. After four weeks of capsaicin treatment, the mean reductions in pain in the RA patients were 57% and 33% in OA patients. The global evaluations showed that 80% of the capsaicin-treated patients experienced a reduction in pain after two weeks of treatment.68 In vitro analysis has also shown that high doses of capsaicin also works on the cellular levels as it has been shown to decrease the synthesis of collagenase and prostaglandin E2.69
Thunder God Vine (Tripterygium wilfordi)
In a prospective, double-blind, placebo-controlled study in patients with long-standing RA in whom conventional therapy had failed, low-dose (180mg per day) or high-dose (360mg per day) extract of thunder god vine was supplemented for 20 weeks, followed by an open-label extension period. The results indicated that more than half of the patients who completed the trial showed therapeutic benefit in the treatment group.70 In another study, 6 of 10 patients treated with 180 mg per day of ethyl acetate extract of Tripterygium wilfordi (EA) extract showed disease improvement, and 8 of the 9 patients who received EA extract at doses greater than 360 mg per day experienced improvement in both clinical manifestations and laboratory findings. One patient met American College of Rheumatology criteria for remission.71 Research has elucidated that Tripterygium wilfordii Hook f suppresses immune responses by inhibiting transcription of cytokine genes, including interleukin-2 and gamma interferon.72 In addition, the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is currently conducting a phase II trial to evaluate the safety and effectiveness of thunder god vine for rheumatoid arthritis.73
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