Efficacy of some Herbal Medicines in Osteoarthritis with a Focus on Topical Agents: A Systematic Review

Author(s): Sadra Ansaripour, Morteza Dehghan*

Journal Name: Current Pharmaceutical Design

Volume 26 , Issue 22 , 2020

Become EABM
Become Reviewer

Abstract:

Osteoarthritis (OA) is a leading cause of musculoskeletal disorders that mainly affects the elderly population. Some herbal medicines have the potential to alleviate the pain associated with OA and improve physical activity mostly through anti-inflammatory and anti-oxidative properties. The aim of this study was to investigate the effects of herbal medicines, especially topical types, on osteoarthritis.

In this systematic review, the keywords “osteoarthritis”, “herbal compounds”, “herbal medicine”, “topical drug”, “hydrogels”, “cream” and “treatment” were used to search publications published from 2010 to 2019 and indexed in databases including PubMed, SCOPUS, Web of Science and Google Scholar. After screening of titles and abstracts and detection of duplicate publications, 38 eligible articles were included in the main review. We also included herbal formulations in vivo.

Bioactive fractions of herbal medicines mostly worked on OA through suppression of interleukin-1β (IL-1β), inducing nuclear factor-κB (NF-κB) activation by inhibition of inhibitor of NF-κB (IκBα) phosphorylation, IκBα degradation, p65 phosphorylation, and p65 nuclear translocation, downregulation of NF-κB targets including COX-2 and MMPs, upregulation of collagen type II, cartilage-specific proteoglycans (CSPGs), β1-integrin, and expression of cartilage-specific transcription factor SOX-9 protein. Noticeably, herbal medicines do not produce desirable effects, thereby using their combinations with other therapeutic agents seem to exert substantial clinical outcomes.

Herbal gels have demonstrated robustly significant healing effects on knee pain, stiffness and mobility. It is worth considering that because OA is a chronic disease, longer duration of the studies/trials would even lead to obtaining more reliable judgments regarding topical treatment tolerability, safety and efficacy and clarify local or systemic adverse effects. Stability and standardization of a defined amount or concentrations of herbal gels would give promising effects on OA treatment and pain relief.

Keywords: Herbal medicine, topical drug, hydrogels, herbal cream, osteoarthritis, proteoglycans.

[1]
Hunter DJ. Pharmacologic therapy for osteoarthritis--the era of disease modification. Nat Rev Rheumatol 2011; 7(1): 13-22.
[http://dx.doi.org/10.1038/nrrheum.2010.178] [PMID: 21079644]
[2]
Hunter DJ, Schofield D, Callander E. The individual and socioeconomic impact of osteoarthritis. Nat Rev Rheumatol 2014; 10(7): 437-41.
[http://dx.doi.org/10.1038/nrrheum.2014.44] [PMID: 24662640]
[3]
Wluka AE, Lombard CB, Cicuttini FM. Tackling obesity in knee osteoarthritis. Nat Rev Rheumatol 2013; 9(4): 225-35.
[http://dx.doi.org/10.1038/nrrheum.2012.224] [PMID: 23247649]
[4]
Dehghan M, Asgharian S, Khalesi E, Ahmadi A, Lorigooini Z. Comparative study of the effect of Thymus daenensis gel 5% and diclofenac in patients with knee osteoarthritis. Biomedicine (Taipei) 2019; 9(2): 9.
[http://dx.doi.org/10.1051/bmdcn/2019090209] [PMID: 31124455]
[5]
Lugo JP, Saiyed ZM, Lane NE. Efficacy and tolerability of an undenatured type II collagen supplement in modulating knee osteoarthritis symptoms: a multicenter randomized, double-blind, placebo-controlled study. Nutr J 2016; 15(1): 14.
[http://dx.doi.org/10.1186/s12937-016-0130-8] [PMID: 26822714]
[6]
Kabiri F, Hassanpour-Dehkordi A, Dris F. Effects of massage therapy and aromatherapy on fatigue in patients with knee osteoarthritis. J Herbmed Pharmacol 2018; 7(3): 141-7.
[http://dx.doi.org/10.15171/jhp.2018.24]
[7]
Kravchenko I, Eberle L, Nesterkina M, Kobernik A. Anti-inflammatory and analgesic activity of ointment based on dense ginger extract (Zingiber officinale). J Herbmed Pharmacol 2019; 8(2): 126-32.
[http://dx.doi.org/10.15171/jhp.2019.20]
[8]
Dehghan M, Karimi Shervedani E. Comparison of the effect of topical application of Eugenia caryophylata extract and topical diclofenac in primary knee osteoarthritis: a clinical trial study. Advanced Herbal Medicine 2016; 2(2): 28-34.
[9]
Malekmohammad K, Sewell RDE, Rafieian-Kopaei M. Antioxidants and atherosclerosis: mechanistic aspects. Biomolecules 2019; 9(8): 301.
[http://dx.doi.org/10.3390/biom9080301] [PMID: 31349600]
[10]
Gupta A, Chaphalkar SR. Anti-inflammatory and immunosuppressive activities of flavonoids from medicinal plants. J HerbMed Pharmacol 2016; 5(3): 120-4.
[11]
Rouamba A, Compaoré M, Kiendrebeogo M. Molecular targets of honey bee’s products in cancer prevention and treatment. J Herbmed Pharmacol 2019; 8(4): 261-8.
[http://dx.doi.org/10.15171/jhp.2019.38]
[12]
Bagheri N, Safaei N, Aleebrahim-Dehkordy E, Khaledi M, Madmoli M, Ansaripour S. In vitro antibacterial activity of Bunium persicum and Rheum ribes on Acinetobacter baumanii. Int J Ayurvedic Med 2019; 10(1): 47-51.
[13]
Ekalu A, Ayo RG-O, Habila JD, Hamisu I. A mini-review on the phytochemistry and biological activities of selected Apocynaceae plants. World Health 2019; 5: 6.
[http://dx.doi.org/10.15171/jhp.2019.39]
[14]
Dehghan M, Abdoli-Tafti A, Ganji F, Ghaedi R. Comparison the effects of ginger (Zingiber officinale) jelly and piroxicam jelly on pain of knee osteoarthritis. Majallah-i Ilmi-i Danishgah-i Ulum-i Pizishki-i Kurdistan 2018; 23(1): 8-17.
[15]
Moradi-Podeh B, Kheirollah A, Ahmmadpour F, Lamuchi-Deli N, Payami S-A, Mohammadzadeh G. Effects of Zingiber officinale hydro-alcoholic extract on HMG-COA reductase level in the testis of streptozotocininduced diabetic rats. J Herbmed Pharmacol 2018; 7(2): 94-9.
[http://dx.doi.org/10.15171/jhp.2018.16]
[16]
Madhu K, Chanda K, Saji MJ. Safety and efficacy of Curcuma longa extract in the treatment of painful knee osteoarthritis: a randomized placebo-controlled trial. Inflammopharmacology 2013; 21(2): 129-36.
[http://dx.doi.org/10.1007/s10787-012-0163-3] [PMID: 23242572]
[17]
Sadraei H, Ghanadian SM, Asghari G, Gavahian A. Bronchodilator effect of apigenin and luteolin, two components of Dracocephalum kotschyi on isolated rabbit trachea. J Herbmed Pharmacol 2019; 8(4): 281-6.
[http://dx.doi.org/10.15171/jhp.2019.41]
[18]
Sanders M, Grundmann O. The use of glucosamine, devil’s claw (Harpagophytum procumbens), and acupuncture as complementary and alternative treatments for osteoarthritis. Altern Med Rev 2011; 16(3): 228-38.
[PMID: 21951024]
[19]
Boroumand N, Samarghandian S, Hashemy SI. Immunomodulatory, anti-inflammatory, and antioxidant effects of curcumin. J Herbmed Pharmacol 2018; 7(4): 211-9.
[http://dx.doi.org/10.15171/jhp.2018.33]
[20]
Cameron M, Chrubasik S. Topical herbal therapies for treating osteoarthritis. Cochrane Database Syst Rev 2013; (5): CD010538
[PMID: 23728701]
[21]
Cheng C-C, Chen Y-H, Chang W-L, et al. Phytoestrogen bavachin mediates anti-inflammation targeting Ikappa B kinase-I kappaB α-NF-kappaB signaling pathway in chondrocytes in vitro. Eur J Pharmacol 2010; 636(1-3): 181-8.
[http://dx.doi.org/10.1016/j.ejphar.2010.03.031] [PMID: 20361957]
[22]
Mobasheri A. Intersection of inflammation and herbal medicine in the treatment of osteoarthritis. Curr Rheumatol Rep 2012; 14(6): 604-16.
[http://dx.doi.org/10.1007/s11926-012-0288-9] [PMID: 22987043]
[23]
Yoo W-H, Yoo H-G, Park S-H, et al. Efficacy and safety of PG201 (Layla(®)) and celecoxib in the treatment of symptomatic knee osteoarthritis: a double-blinded, randomized, multi-center, active drug comparative, parallel-group, non-inferiority, phase III study. Rheumatol Int 2014; 34(10): 1369-78.
[http://dx.doi.org/10.1007/s00296-014-2964-8] [PMID: 24531687]
[24]
Majima T, Inoue M, Kasahara Y, Onodera T, Takahashi D, Minami A. Effect of the Japanese herbal medicine, Boiogito, on the osteoarthritis of the knee with joint effusion. Sports Med Arthrosc Rehabil Ther Technol 2012; 4(1): 3.
[http://dx.doi.org/10.1186/1758-2555-4-3] [PMID: 22230247]
[25]
Wang X, Cao Y, Pang J, et al. Traditional chinese herbal patch for short-term management of knee osteoarthritis: a randomized, double-blind, placebo-controlled trial. Evid Based Complement Alternat Med 2012; 2012 171706
[http://dx.doi.org/10.1155/2012/171706] [PMID: 22454655]
[26]
Jabbari M, Hashempur MH, Razavi SZE, Shahraki HR, Kamalinejad M, Emtiazy M. Efficacy and short-term safety of topical Dwarf Elder (Sambucus ebulus L.) versus diclofenac for knee osteoarthritis: A randomized, double-blind, active-controlled trial. J Ethnopharmacol 2016; 188: 80-6.
[http://dx.doi.org/10.1016/j.jep.2016.04.035] [PMID: 27125590]
[27]
Coulson S, Vecchio P, Gramotnev H, Vitetta L. Green-lipped mussel (Perna canaliculus) extract efficacy in knee osteoarthritis and improvement in gastrointestinal dysfunction: a pilot study. Inflammopharmacology 2012; 20(2): 71-6.
[http://dx.doi.org/10.1007/s10787-012-0128-6] [PMID: 22366869]
[28]
Smith DB, Jacobson BH. Effect of a blend of comfrey root extract (Symphytum officinale L.) and tannic acid creams in the treatment of osteoarthritis of the knee: randomized, placebo-controlled, double-blind, multiclinical trials. J Chiropr Med 2011; 10(3): 147-56.
[http://dx.doi.org/10.1016/j.jcm.2011.01.003] [PMID: 22014903]
[29]
Panahi Y, Rahimnia AR, Sharafi M, Alishiri G, Saburi A, Sahebkar A. Curcuminoid treatment for knee osteoarthritis: a randomized double-blind placebo-controlled trial. Phytother Res 2014; 28(11): 1625-31.
[http://dx.doi.org/10.1002/ptr.5174] [PMID: 24853120]
[30]
Street RA, Sidana J, Prinsloo G. Cichorium intybus: Traditional uses, phytochemistry, pharmacology, and toxicology. Evidence Based Complementary and Alternative Medicine 2013; 2013 579319
[31]
Sharma S, Ganju E, Upmanyu N, Jain P. Therapeutic microemulsion of curcumin for the management of osteoarthritis. J Drug Deliv Ther 2018; 8(5-s): 341-7.
[http://dx.doi.org/10.22270/jddt.v8i5-s.1989]
[32]
Razavi ZE, Karimi M, Khamessi M. Effects of galbanum oil on patients with knee osteoarthritis: A randomized controlled clinical trial. Ann Phys Rehabil Med 2018; 61 e535
[http://dx.doi.org/10.1016/j.rehab.2018.05.1245]
[33]
Yang J, Liu Y, He L, et al. Icariin conjugated hyaluronic acid/collagen hydrogel for osteochondral interface restoration. Acta Biomater 2018; 74: 156-67.
[http://dx.doi.org/10.1016/j.actbio.2018.05.005] [PMID: 29734010]
[34]
González-Rodríguez M, Fernandez-Romero A, Rabasco A. Towards the antioxidant therapy in Osteoarthritis: Contribution of nanotechnology. J Drug Deliv Sci Technol 2017; 42: 94-106.
[http://dx.doi.org/10.1016/j.jddst.2017.04.032]
[35]
Amorndoljai P, Taneepanichskul S, Niempoog S, Nimmannit U. A comparative of ginger extract in nanostructure lipid carrier (NLC) and 1% diclofenac gel for treatment of knee osteoarthritis (OA). J Med Assoc Thai 2017; 100(4): 447-56.
[PMID: 29911849]
[36]
Bae K-J, Jeong J-W, Choi C-H, et al. Antiosteoarthritic effects of ChondroT in a rat model of monosodium Iodoacetate-induced osteoarthritis. Evidence Based Complementary and Alternative Medicine 2018; 2018 8565132
[http://dx.doi.org/10.1155/2018/8565132]
[37]
Bai Z, Guo X-H, Tang C, Yue S-T, Shi L, Qiang B. Effects of artesunate on the expressions of insulin-like growth factor-1, osteopontin and C-telopeptides of type II collagen in a rat model of osteoarthritis. Pharmacology 2018; 101(1-2): 1-8.
[http://dx.doi.org/10.1159/000479160] [PMID: 28898893]
[38]
Ma Z, Piao T, Wang Y, Liu J. Astragalin inhibits IL-1β-induced inflammatory mediators production in human osteoarthritis chondrocyte by inhibiting NF-κB and MAPK activation. Int Immunopharmacol 2015; 25(1): 83-7.
[http://dx.doi.org/10.1016/j.intimp.2015.01.018] [PMID: 25637445]
[39]
Lai Y-L, Lin Y-Y, Sadhasivam S, et al. Efficacy of Bletilla striata polysaccharide on hydrogen peroxide-induced apoptosis of osteoarthritic chondrocytes. J Polym Res 2018; 25(2): 49.
[http://dx.doi.org/10.1007/s10965-018-1448-z]
[40]
Razavi SZE, Karimi M, Kamalinejad M. The efficacy of topical oliban oil (Boswellia carterii B.) in relieving the symptoms of knee osteoarthritis. Physical Medicine, Rehabilitation, and Electrodiagnosis 2019; 1(1): 7-13.
[41]
Xu X, Lv H, Li X, Su H, Zhang X, Yang J. Danshen attenuates osteoarthritis-related cartilage degeneration through inhibition of NF-κB signaling pathway in vivo and in vitro. Biochem Cell Biol 2017; 95(6): 644-51.
[http://dx.doi.org/10.1139/bcb-2017-0025] [PMID: 28662337]
[42]
Shoara R, Hashempur MH, Ashraf A, Salehi A, Dehshahri S, Habibagahi Z. Efficacy and safety of topical Matricaria chamomilla L. (chamomile) oil for knee osteoarthritis: A randomized controlled clinical trial. Complement Ther Clin Pract 2015; 21(3): 181-7.
[http://dx.doi.org/10.1016/j.ctcp.2015.06.003] [PMID: 26256137]
[43]
Park YJ, Cho YR, Oh JS, Ahn EK. Effects of Tribulus terrestris on monosodium iodoacetate‑induced osteoarthritis pain in rats. Mol Med Rep 2017; 16(4): 5303-11.
[http://dx.doi.org/10.3892/mmr.2017.7296] [PMID: 28849084]
[44]
Lee SA, Moon S-M, Han SH, et al. Chondroprotective effects of aqueous extract of Anthriscus sylvestris leaves on osteoarthritis in vitro and in vivo through MAPKs and NF-κB signaling inhibition. Biomed Pharmacother 2018; 103: 1202-11.
[http://dx.doi.org/10.1016/j.biopha.2018.04.183] [PMID: 29864899]
[45]
Maksimović Z, Samardžić S. Herbal medicinal products in the treatment of osteoarthritis Osteoarthritis biomarkers and treatments. Intech Open 2018.
[46]
Taylor N. Nonsurgical management of osteoarthritis knee pain in the older adult: an update. Rheum Dis Clin North Am 2018; 44(3): 513-24.
[http://dx.doi.org/10.1016/j.rdc.2018.03.009] [PMID: 30001790]
[47]
Chakradhar NS, Kanaka MB, Sangeetha S, Damodharan N. Herbal medicines and formulation approaches for the treatment of arthritis. Drug Invention Today 2018; 10(9): 1617-25.
[48]
Amorndoljai P, Taneepanichskul S, Niempoog S, Nimmannit U. A clinical study phase II of ginger extract in nanostructured lipid carrier for pain relief in knee osteoarthritis patients. Isan J Pharm Sci 2015; 10: 121-32.
[49]
Baraf HS, Gloth FM, Barthel HR, Gold MS, Altman RD. Safety and efficacy of topical diclofenac sodium gel for knee osteoarthritis in elderly and younger patients: pooled data from three randomized, double-blind, parallel-group, placebo-controlled, multicentre trials. Drugs Aging 2011; 28(1): 27-40.
[http://dx.doi.org/10.2165/11584880-000000000-00000] [PMID: 21174485]
[50]
Bagheri S, Ebadi N, Taghipour Z, Toliyat T, Mirabzadeh Ardakani M. Persian medicine herbal therapies for osteoarthritis: a review of clinical trials. Research Journal of Pharmacognosy 2018; 5(4): 75-81.
[51]
Cameron M, Chrubasik S. Oral herbal therapies for treating osteoarthritis. Cochrane Database of Systematic Reviews 2014; 5(5)CD002947
[http://dx.doi.org/10.1002/14651858.CD002947.pub2]
[52]
Ross SM. Natural health strategies for pain care, Part I: A phytomedicine compendium. Holist Nurs Pract 2019; 33(1): 60-5.
[http://dx.doi.org/10.1097/HNP.0000000000000308] [PMID: 30422926]
[53]
Laslett LL, Jin X, Jones G. Efficacy and safety of plant-derived products for the treatment of osteoarthritis. Botanics 2015; 5: 1-20.
[54]
Shafiei M, Ghasemian A, Mostafavi SK, Teimouri M, Vardanjani HR, Mirforughi SA. Gold nanoparticle-based colorimetric platform technology as rapid and efficient bacterial pathogens detection method from various sources. Rev Med Microbiol 2019; 30(2): 128-32.
[http://dx.doi.org/10.1097/MRM.0000000000000160]
[55]
Garbus M, Melo M. Are topical NSAIDs an effective treatment of knee and hand osteoarthritis in adults? Evidence-Based Practice 2019; 22(1): 9-10.
[56]
Poorgheysar A, Sajjadi M, Shareinia H, Mohammdzadeh MH, Nouroozi A. The effect of hot intermittent cupping on pain, stiffness and disability of patients with knee osteoarthritis. Traditional Medicine Research 2019; 4(1): 25-32.


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 26
ISSUE: 22
Year: 2020
Page: [2676 - 2681]
Pages: 6
DOI: 10.2174/1381612826666200429013728
Price: $65

Article Metrics

PDF: 25
HTML: 2