Herbal anti-inflammatories (Part 2)

A range of herbs available in oral supplements may be useful in helping to control inflammation associated with RA. It is important to note that herbal supplements are not a replacement for proven disease-modifying anti-rheumatic drugs (DMARDs), including both conventional DMARDs and newer biologics that have been shown to slow or prevent the progression of joint damage in RA. Herbal supplements may be useful as adjunctive treatments (this means secondary treatments used in conjunction with a primary treatment).

As with all supplements, whether vitamins, minerals, herbal or chemical products, consult with your doctor before you start taking an herbal supplement. There may be health risks associated with use of any supplement, including interactions with medications that you are taking and negative effects associated with health conditions you may have. Your doctor is also in the best position to determine the proper and safe dosage for any supplement.

 

Dong quai

Dong quai (also known as angelica, Chinese angelica, or female ginseng) is a member of the family of plants called Apiaceae, which includes parsley, celery, anise, caraway, and carrots. It has been used for thousands of years in China, Japan, and Korea. Medicinal uses of dong quai include menstruation pain, cardiovascular conditions, and inflammation. It has been used traditionally to treat arthritis. However, there is little data supporting its benefits in either osteoarthritis or RA.1

Dong quai may increase the risk of bleeding and should be used with caution in patients with bleeding disorders. Patients taking dong quai should limited exposure to the sunlight or ultraviolet light. Also, it should be used with caution in patients with diabetes or in those with hormone-sensitive conditions, including breast, uterine, and ovarian cancers. Dong quai should be avoided by women who are pregnant or breastfeeding.2

Devil’s claw

 

Devil’s claw is made from roots of the plant Harpagophytum procumbens, which grows in savannah and desert regions of Southern Africa. Devil’s claw is mainly used as an anti-inflammatory and pain medication and there is a growing body of evidence suggesting that it is as effective as non-steroidal anti-inflammatory drugs (NSAIDs) (Advil, Motrin) for short-term relief of pain associated with osteoarthritis. However, many existing studies have been small and limited in design. It has not been studied in RA.3

Devil’s claw should be used with caution in patients with stomach ulcers, bleeding disorders, diabetes, heart disease, a history of stroke, gout. It should be stopped at least 2 weeks before and after surgery or other procedures where there is increased risk for bleeding. Devil’s claw should be avoided by women who are pregnant or breastfeeding.2

Sarsapareilla

 

A vine plant grown in Mexico, Central and South America, and India, sarsapareilla has been used in Chinese medicine for centuries as a treatment for various inflammatory conditions. It has anti-bacterial, anti-inflammatory, and antioxidant properties. There have been no studies of the use of sarsapareilla as a treatment for RA. However, there is a theoretical basis for the use of the plant in arthritis. Sarsapareilla contains a flavanoid called astibin which has been shown to suppress lymphocyte functions in animals with possible benefits in some forms of arthritis.4

Bromelain

 

Bromelain is a digestive enzyme extracted from the stem and fruit of pineapple and other plants in the same family. It assists in digestion and has anti-inflammatory properties. There is some evidence showing that bromelain is as effective as the prescription NSAID diclofenac in relieving knee pain associated with osteoarthritis. There has been one small study of bromelain in patients with RA. In the study, bromelain resulted in reduced swelling in a majority of patients. Other evidence for the effectiveness of bromelain in RA comes from several case reports.5

Bromelain should be used with caution in patients with stomach ulcers, bleeding disorders, heart disease, or liver or kidney disease. It should be stopped at least 2 weeks before and after surgery or other procedures where there is increased risk for bleeding.  Bromelain should be avoided by women who are pregnant or breastfeeding.2

Curcumin

 

Curcumin is a key component of the popular Indian spice turmeric, which is a member of the ginger family. It has been used in Asian medicine to treat inflammation and arthritic pain for centuries. There is preliminary evidence that curcumin may be effective in improving symptoms associated with RA.6

Curcumin should be used with caution in patients with bleeding disorders, immune system disorders, liver disease, diabetes, or gallstones. It should be used with caution in patients receiving anticoagulant treatments, such as warfarin (Coumadin). Curcumin should be stopped before surgery and should be avoided by women who are pregnant or breastfeeding.2

Evening primrose oil

 

Evening primrose is a yellow-flowered plant that produces seeds from which a medicinal oil is made. It contains the omega-6 fatty acid gamma-linolenic acid (GLA) and has anti-inflammatory and antioxidant properties. At present, there is high quality evidence to support its use in atopic dermatitis. Several small clinical trials of evening primrose oil have been conducted in patients with RA. While some of these trials have reported benefits, including patient-reported improvement in symptoms and decreased NSAID use, findings from these studies have been inconsistent and there is currently insufficient evidence to make definitive conclusions concerning the benefits of evening primrose oil in RA.7

Evening primrose oil should be avoided by patients with seizure disorders and used cautiously in patients who are receiving drugs to treat psychiatric illness. It should be stopped 2 weeks before surgery and should not be used by women who are pregnant or nursing.2

Go back to Part 1.

Written by: Jonathan Simmons | Last reviewed: September 2013.
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