Home' Australian Pharmacist : Australian Pharmacist March 2013 Contents Australian Pharmacist March 2013 I © Pharmaceutical Society of Australia Ltd.
1. Which ONE of the following
statements about arthritis is
a) All forms of arthritis are characterised
by pain, swelling and inflammation.
b) Treatment of the underlying
inflammation will effect a cure.
c) Most forms of arthritis are incurable.
d) Herbal medicines present the only
effective curative treatment of arthritis.
2. Which ONE of the following
statements is CORRECT?
a) Many anti-arthritic herbs can be taken
as dietary supplements, by addition to
b) Low doses only of herbal medicines
are required for treatment.
c) The advantage of using herbal
medicines is that they are short term
d) Taking a herbal medicine as a food
supplement is an inadvisable practice,
due to problems of dose calculation.
3. Which ONE of the following
statements is CORRECT? Given a
choice of herbal medicines to treat
a) thunder god vine is the best candidate
due to its wide margin of safety.
b) cat’s claw use is not recommended
due to lack of information of its
c) high doses of evening primrose oil
(up to 28 g daily) can be taken to treat
d) stinging nettle can only be used by
direct application of fresh leaf to the
4. Which of the following statements is
MOST TRUE with regard to turmeric?
a) Its important constituent, curcumin,
is an effective antioxidant, Cox-2
inhibitor and anti-inflammatory.
b) It is best used in combination with an
c) It has been the subject of large scale
RCTs that have established its efficacy.
d) It has little discernable taste and odour
and therefore encourages patient
THE COMPLEMENTARY APPROACH
times a day). Although it was found to
improve joint pain and movement in
RA (fresh ginger, 5–50 g or powdered
ginger, 0.1–1.0 g daily).28 Inhibition of COX
and LO pathways were the suggested
mechanisms of action.28 Ginger may be
used as a supplement to diet.
Thunder god vine, Trypterygium
wilfordii, while demonstrating beneficial
effects on RA symptoms, could not be
recommended because of its serious
There is a need for large scale RCTs to
determine the efficacy, dosage and safety
considerations of herbal medicines used
by many in the treatment of arthritis.
In the meantime, there are a number of
remedies, such as the use of turmeric and
stinging nettle, which seem to have merit.
The list of herbal remedies claimed to be
effective in treating arthritis is extensive,
but often anecdotal and historically
based, without the foundation of good
1. Eustice C. How does a rheumatologist explain arthritis? At:
2. A snapshot of arthritis in Australia 2010 (AIHW). At: www.aihw.
3. Kidd BL, Urban LA. Mechanisms of inflammatory pain. Br J
4. Bondeson J. The mechanisms of action of disease-modifying
antirheumatic drugs: a review with emphasis on macropharge
signal induction and the induction of proinflammatory
cytokines. Gen Pharmacol. 1997 Aug;29(2):127–50; At: www.
5. Rofecoxib – Wikipedia, the free encyclopaedia. At: http://
6. Macfarlane Gj, Paudyal P, Doherty M, et al. A systematic
review of evidence for the effectiveness of practitioner-based
complementary and alternative therapies in the management
of rheumatic diseases: rheumatoid arthritis. Rheumatology.
7. Waller RD, Williamson L. Complementary medicine
use in RA. At: http:// rheumatology.oxfordjournals.org/
8. Cameron M, Gagnier JJ, Chrubasik S. Herbal therapy for treating
rheumatoid arthritis. Cochrane Database of Syst Rev Feb 16
2011. At: www.ncbi.nlm.nih.gov/pubmed/21328257.
9. Duke JA. The Green Pharmacy Guide to Healing Foods.2008.
Rodale Inc. Page 6.
10. Higden J. Curcumin. Linus Pauling Institute, Oregon State
University. 2005; At: http://lipi.oregonstate.edu/infocenter/
11. Deodhar SD, Sethi R, Srimal RC. Preliminary study on
antirheumatic activity of curcumin (diferuloyl methane). Indian
J Med Res. 1980;71:632–4 .
12. Chandran B, Goel A. A randomized, pilot study to assess
the efficacy and safety of curcumin in patients with active
rheumatoid arthritis. Phytother Res. Nov 2012;26(11):1719–25.
13. Braun L, Cohen M. Herbs & Natural Supplements - an evidence-
based guide. Marrickville, NSW 2005;Elsevier Mosby;365.
14. Reference 9; 28–9 .
15. Barnes J, Anderson LA, Phillipson JD. Herbal Medicines, 3
edition. London 2007. The Pharmaceutical Press; 429–35, and
references contained therein.
16. Reference 13;343–9 .
17. Reference 15; 452–5, and references contained therein.
18. Nettle. Memorial Sloan-Kettering Cancer Institute; At: www.
mskcc.org/print/cancer-care/herb/nettle and references
19. Randall C, Randall H, Dobbs F, et al. Randomized controlled trial
of nettle sting for treatment of base-of-thumb pain. J Roy Soc
Med. Jun 2000;93(6):305–09 .
20. Reference 15; 132–5, and references contained therein.
21. van Wyk B-E, Wink M. Medicinal Plants of the World.Pretoria,
South Africa 2004. Briza Publications;330.
22. Rojas-Duran R, Gonzalez-Aspajo G, Ruiz-Martel C et al. Anti-
inflammatory activity of mitraphylline isolated from Uncaria
tomentosa bark. J Ethnopharmacol.m oct11 2012;143(3):801–
23. 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 Apr 2002;29(4):678–81.
24. Cameron M, Gagnier JJ, Chrubasik S. Herbal therapy for
treating rheumatoid arthritis. Cochrane Summaries; At: http://
25. Reference 16; 160.
26. Shalby AB, Hamza AH, Ahmed HH. New insights on anti-
inflammatory effect of some Egyptian Plants against renal
dysfunction induced by cyclosporine. Eur Rev Med Pharmaco.
27. Singh R, Akhtar N, Haqqi TM. Green tea polyphenol
epigallocatechin-3 -O-gallate: Inflammation and arthritis. Life
Sci. Jun 2010;86(25-26):907–18.
28. Reference 15;293–8, and references contained therein.
29. Canter PH, Le HS. Ernst E. A systematic review of randomised
clinical trials of Trypterygium wilfordii for rheumatoid arthritis.
Phyto med. May 2006;13(5):371–7 .
Key learning points
• There are many forms of arthritis,
the majority of which cannot be
• Symptomatic treatment of pain,
inflammation and swelling using
herbal remedies may be of interest
to some sufferers who wish to avoid
• Turmeric herb or its extract, stinging
nettle and cat’s claw have some
merit in the treatment of arthritis.
• GLA-containing fixed oils, such as in
evening primrose, borage seed and
blackcurrant seed oils do improve
pain and disability
• A patient’s consultation with their
physician is advisable to minimise
the risk of drug interaction or
adverse event of any herbal remedy
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