Top 5 Herbal Supplements for RA

  • Plants as medicine

    For thousands of years, plants have been used for their healing properties.  Modern day supplements derived from various herbs and plants are increasingly available at your local grocery or health food stores.  Several supplements, touted for their pain-relieving or anti-inflammatory benefits, are commonly used in Ayruvedic and Chinese medicine.  A number of these are popular in people living with rheumatoid arthritis or other inflammatory diseases.  

    At times, it can become difficult to distinguish between the marketing claims of supplement manufacturers and the proven tract records of select herbs.  Fortunately, researchers have been putting select herbs to the test and science backs up their use.  Here are five of the top herbal supplements known to benefit people with RA.

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    Boswellia serrata (Indian Frankincense, Boswellin, Salai Guggal)
    Frankincense, or boswellia serrata, is derived from the bark of the Boswellia tree native to Arabia and India.  Boswellia serrata extracts are used in Ayurvedic for their anti-inflammatory and analgesic properties.  Studies in OA have found that patients taking boswellia reported less knee pain, better mobility, and an ability to walk longer distances.  It has also been shown to slow cartilage damage.  A British review (Ernst 2008) found boswellia extracts to be safe and effective for both OA and RA, however results of studies in RA were not statistically significant.  Typical dose of boswellia is 400 mg - 800 mg taken three times daily.

    Cat’s Claw (Uncaria tomentosa)
    Uncaria tomentosa, known as Cat’s Claw, comes from a woody vine that grows in parts of South and Central America.  It has been shown to have an anti-inflammatory effect against tumor necrosis factor (TNF)-alpha, the same inflammatory target as a number biological drugs for RA.  One study found that people with RA who took cat’s claw in conjunction with sulfasalazine or hydroxychloroquine experienced a 53% reduction in painful joints compared to 24% reduction with placebo (Mur 2002).  Cat’s claw is believed to stimulate the immune system, so theoretically it may interfere with immunosuppressant medications such as azathioprine, cyclosporine, prednisone, and other corticosteroids (Natural Medicines Comprehensive Database).  

    Typical dose for cat’s claw extract is 20 mg taken three times daily.  As several plants are called “cat’s claw,” look for products that contain uncaria tomentosa but are free of tetracyclic oxindole alkaloids (TOAs).  Cat’s claw can cause headache, dizziness and vomiting, and can lower blood pressure, so don’t use it if taking an anti-hypertensive medication or blood thinner.

    Curcumin (Turmeric, Curcuma longa, Curcuma domestica)

    Turmeric, the yellow-colored spice used in Indian curries, is derived from the root of the Turmeric plant native to India and Indonesia which is related to the ginger plant.  Curcumin, a component of tumeric, has anti-inflammatory and analgesic properties that can reduce the pain, inflammation, and stiffness associated with RA.  It has been shown to regulate inflammatory cytokines such as IL-6, IL-12, TNF-alpha and IFN-gamma and associated JAK-STAT pathways in immune cells (Bright 2007), as well as certain enzymes including cyclooxygenase-2 (COX-2) (Bengmark 2006), the target of the pain medication Celebrex. In a small pilot study, a curcumin product called BCM-95 reduced joint pain and swelling in patients with active RA better than the NSAID diclofenac sodium (50 mg) (Chandran 2012).  


  • Typical dose for turmeric extract is 450 mg standardized to 95% curcuminoids taken three times daily.  High doses or long-term use of turmeric may cause indigestion, nausea, or diarrhea.  Avoid turmeric if you take blood thinners, are pregnant, or have gallbladder disease.

    Ginger (Zingiber officinale)
    Ginger (Zingiber officinale) is derived from the dried or fresh root of the ginger plant native to China, South East Asia, West Africa, and the Caribbean.  It is commonly used in Chinese and Ayurvedic medicine for its anti-inflammatory and analgesic properties, however studies in RA are lacking.  Trials in OA comparing the pain-reducing effectiveness of ginger extracts with ibuprofen and placebo have shown mixed results.  In one clinical trial, the ginger extract Zintona EC (250 mg taken four times daily) significantly reduced pain after 3 months of treatment compared to placebo in patients with osteoarthritis of the knee.  Ginger root suppresses prostaglandin synthesis through inhibition of COX-1 and COX-2.  In another study in patients with OA, a different ginger extract (Eurovita Extract 77, 255 mg taken twice daily for 6 weeks) significantly reduced pain upon standing, pain after walking, and stiffness compared to placebo.  

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    A recent in vitro study of synovial cell cultures from RA, OA, and healthy controls, researchers found that Eurovita Extract 77, a combination of ginger and Alpinia galanga extracts, was more effective than betamethasone, a potent glucocorticoid steroid, in reducing inflammatory reactions in RA synovial cells (Ribel-Madsen 2012).  Ginger also reduces nausea and vomiting and is a proven treatment for motion sickness and chemotherapy-induced nausea.

    With different ginger extracts available, dosing varies depending upon the product.  In studies for arthritis, products tested include 255 mg of Eurovita Extract 77 taken twice daily, 170 mg of Eurovita Extract 33 taken three times daily, and 250 mg of Zintona EC taken four times daily.  Ginger is generally safe for most people but may cause mild side effects including heartburn, diarrhea, and general stomach discomfort.  Ginger may increase your risk of bleeding and should not be taken with medications used to slow blood clotting.  Avoid ginger if you are pregnant, have gallbladder disease, or take medications for high blood pressure.

    Thunder God vine (Tripterygium wilfordii)
    Thunder god vine is a perennial vine native to China, Japan, and Korea that is used in Chinese medicine for conditions involving inflammation or overactivity of the immune system.   Results from a recent Chinese open-label, randomized controlled trial in 207 patients with active RA showed that monotherapy with thunder god vine (20 mg three times a day) was not inferior to monotherapy with methotrexate (12.5 mg per week).  Dual treatment with both both thunder god vine and methothrexate was most effective in controlling disease activity in patients with active RA (Qian-wen Lv 2014).  A previous study in 121 patients with active RA (only 51% completed the 24 week study) found that those who took thunder god vine (60 mg three times a day) had greater reduction in disease activity than those who took sulfasalazine (1 g twice a day) (Goldbach-Mansky 2009).  


  • Typical dose of Thunder God vine extract is up to 60 mg taken three times daily.  Thunder god vine can cause severe side effects, including headache, stomach upset, skin reactions, hair loss, menstrual changes, and temporary infertility in men, and be poisonous if it is not carefully extracted from the skinned root.  It should not be used if you are taking immunosuppressive drugs, like prednisone.


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    SOURCES:

    "Supplement and Herb Guide." Arthritis Foundation. Accessed June 7, 2014 at
    http://www.arthritistoday.org/arthritis-treatment/natural-and-alternative-treatments/supplements-and-herbs/supplement-guide/

     

    Bengmark S. Curcumin, an atoxic antioxidant and natural NFkappaB, cyclooxygenase-2, lipooxygenase, and inducible nitric oxide synthase inhibitor: a shield against acute and chronic diseases. JPEN J Parenter Enteral Nutr. 2006 Jan-Feb;30(1):45-51.

    Bright JJ. Curcumin and autoimmune disease. Adv Exp Med Biology. 2007; 595:425–451. Review.

    Chandran B, Goel A. A randomized, pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis. Phytother Res. 2012 Nov;26(11):1719-25. doi: 10.1002/ptr.4639. Epub 2012 Mar 9.

    Ernst E. Frankincense: systematic review. BMJ. 2008;337:a2813. doi:10.1136/bmj.a2813

    Goldbach-Mansky R, Wilson M, Fleischmann R, et al. Comparison of Tripterygium wilfordii Hook F versus sulfasalazine in the treatment of rheumatoid arthritis: a randomized trial. Ann Intern Med. 2009 Aug 18;151(4):229-40, W49-51.

    Mur E, Hartig F, Eibl G, Schirmer M. Randomized double blind trial of an extract from the pentacyclic alkaloid-chemotype of uncaria tomentosa for the treatment of rheumatoid arthritis. J Rheumatol. 2002 Apr;29(4):678-81.

    Qian-wen Lv, Wen Zhang, Qun Shi, et al. Comparison of Tripterygium wilfordii Hook F with methotrexate in the treatment of active rheumatoid arthritis (TRIFRA): a randomised, controlled clinical trial. Ann Rheum Dis. doi:10.1136/annrheumdis-2013-204807. Epub 14 April 2014.

    Ribel-Madsen S, Bartels EM, Stockmarr A, et al.  A Synoviocyte Model for Osteoarthritis and Rheumatoid Arthritis: Response to Ibuprofen, Betamethasone, and Ginger Extract—A Cross-Sectional In Vitro Study.  Arthritis, vol. 2012, Article ID 505842, 9 pages, 2012. doi:10.1155/2012/505842

    Rosenbaum CC, O’Mathúna DP, Chavez M, Shields K. Antioxidants and antiinflammatory dietary supplements for osteoarthritis and rheumatoid arthritis. Altern Ther Health Med. 2010 Mar-Apr;16(2):32-40.

    Lisa Emrich is author of the blog Brass and Ivory: Life with MS and RA and founder of the Carnival of MS Bloggers.

     

Published On: June 09, 2014