Multi-Pronged Attack Against Arthritis
By Rosemary Stevens
Osteoarthritis is a joint disease caused by trauma, obesity, or most often a consequence of normal aging.
The most affected area in osteoarthritis is joint cartilage.
Cartilage consists of smooth tissue that covers the ends of bones in joints such as the knee, hip, and wrist. When cartilage is properly functioning, your bones effortlessly glide over each other with each movement. Cartilage also helps your joints absorb the impact of movement.
Osteoarthritis causes the top layer of cartilage to degrade. When this happens, bones under the cartilage start to grind together. The constant grinding of bone-on-bone creates swelling, pain, and loss of joint motion.
Over time, the joint may become dysfunctional to the point that surgical replacement with synthetic materials is required.
Drugs used to relieve osteoarthritis pain do little to protect joint cartilage and are laden with side effects.
In a search for safer alternatives, researchers have identified three herbal extracts that combat joint discomfort and stiffness associated with osteoarthritis better than leading arthritis drugs.
What separates these plants from drugs is their ability to also slow cartilage degradation.
This article describes remarkable human studies that compare these herbal extracts directly with popular arthritis drugs.
Improve Function of Aging Joints
A number of human studies have demonstrated beneficial effects of two herbal extracts—Scutellaria baicalensis, commonly called Chinese skullcap, and Acacia catechu, commonly known as cutch tree—for those suffering from arthritis.
One clinical study showed this herbal combination was better than placebo at reducing pain, stiffness, and functional impairment in people with osteoarthritis. This herbal extract combination compared favorably—and often proved superior—to the NSAID drug celecoxib (also known as Celebrex®).7
This particular study included 52 middle-aged adults (ages 40-75) who had osteoarthritis of the knee and/or hip with symptoms severe enough to require treatment. The subjects were randomly assigned to receive the herbal extract of Chinese skullcap and cutch tree (125 mg or 250 mg, twice daily), a placebo, or the drug celecoxib (100 mg twice daily).
At the beginning of the study, and after 30, 60, and 90 days of treatment, all subjects completed the arthritis-specific questionnaire called the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), which produces a score specific to arthritis pain and disability. This score is routinely used in both research and by doctors in the clinical management of patients with osteoarthritis.
As measured by the WOMAC score, results for pain were impressive. When all patient visits were analyzed together, the higher-dose herbal combination and celecoxib both significantly reduced the average pain score compared to baseline scores. However, the higher-dose herbal blend was significantly more effective than celecoxib at pain relief after 30 days.
The herbal combination of Chinese skullcap and cutch tree also outperformed the placebo and celecoxib in its effect on joint stiffness and at improving functional impairment when compared to baseline. Both supplement doses reduced the stiffness scores at every point in time measured compared to baseline, whereas celecoxib produced no significant changes in stiffness.
The participants also filled out a second questionnaire called the Medical Outcomes Study Short Form-36 to answer general questions that measure health-related quality of life. This form revealed that both herbal combination doses (125 mg or 250 mg, twice daily) and the NSAID celecoxib produced significant improvements in physical function score and in energy and mental health scores compared with a placebo. And, in a head-to-head comparison between the herbal combination and celecoxib, the herbal combination was found to be superior to celecoxib at improving function scores at 90 days.
In these studies comparing the herbal combination to celecoxib, all doses were well-tolerated, and none of the blood chemistry or hematology tests was altered in any of the treatment groups.7
A second study of the same two extracts demonstrated that these herbs, compared to baseline, were superior to the NSAID drug naproxen at improving pain and range of motion scores, and were equally effective at improving stiffness scores.8 Naproxen is available by prescription or at lower doses over the counter as Aleve®. This study was performed to evaluate the herbal extract combination on short-term relief of symptoms in 79 men and women (ages 40-90) who had osteoarthritis of the knee.8
In this randomized, double-blind study, the patients either received 500 mg/day of the dual herbal extract combination or 440 mg/day of naproxen. Both treatments were given for just one week, and the results were evaluated using the WOMAC questionnaire.
In this study, no significant reduction in pain scores or in range of motion was detected in the drug-treated group. But among subjects receiving the herbal extract combination, total pain scores fell by an approximate 20% after one week, and range of motion improved by 6%.
On stiffness scores, the herbal supplement group experienced an approximate 24% reduction, and the naproxen group experienced an approximate 27% reduction, indicating that both the herbal extract combination and the drug reduced stiffness to a similar extent.
Slowing Cartilage Breakdown
Based on clinical research, combining Chinese skullcap extracts with cutch tree is beneficial in relieving osteoarthritis pain, reducing joint stiffness, and improving function.
But when cutch tree is combined with another herb, Morus alba, also known as white mulberry, this combination provides an entirely different benefit—one that no known drug is able to do: it impedes the normal degenerative progression by slowing the cartilage breakdown process. This is a hallmark structural alteration of osteoarthritis.9
In a group of 135 adults (ages 35-75) who were suffering from knee pain, subjects either took 200 mg of the white mulberry/cutch tree herbal extract combination, a placebo, or a combination of glucosamine (750 mg) and chondroitin (600 mg), all twice daily for 12 weeks.
The researchers measured cartilage breakdown by determining levels in the urine of a biomarker called urinary type II collagen C-telopeptide (uCTX-II). The higher the uCTX-II levels in urine, the greater the degree of cartilage breakdown. This test is known to be a valid indicator of cartilage breakdown in humans.10,11
After 12 weeks, there was a statistically significant difference in the uCTX-II levels between the herbal extract combination andplacebo groups. Placebo recipients experienced an increase in excreted uCTX-II levels while those in the white mulberry/cutch tree herbal-extract combination experienced a decline in the uCTX-II. No significant changes were seen in uCTX-II levels in the glucosamine/chondroitin group.
The importance of this study lies not only with potential prevention of osteoarthritis progression, but also in what it implies for people with early or mild osteoarthritis. Early intervention with nutrients aimed at reducing bone and cartilage degradation, in addition to reducing inflammation (as shown with Chinese skullcap/cutch tree combination) may help to prevent subsequent joint damage.9
How it Works
It was long thought that most joint damage was caused purely by repeated physical stress, where cartilage takes the brunt of the impact as bones are pressed together or slide over one another. But inflammatory changes—once thought to be minimal in osteoarthritis—are now recognized as playing a substantial role.12
Inflammatory cells secrete damaging chemicals that degrade cartilage. Cartilage lacks blood vessels, which severely limits its ability to repair itself. Because of that, the physical damage and inflammation leads to the steady breakdown of this joint-cushioning tissue, resulting in progressively worsening pain and limitation of movement.
The herbal extracts described in this article have been shown to provide safe and effective relief of osteoarthritis symptoms by inhibiting inflammation, while at the same time uniquely slowing the breakdown of cartilage.
Herbal extract combinations of Chinese skullcap/cutch tree and white mulberry/cutch tree provide pain relief and reduced inflammation by inhibiting certain enzymes that produce pain- and inflammation-signaling molecules.9,13-16 These enzymes include 5-LOX and COX 1 and 2. Inhibiting these enzymes is the main property of prescription and over-the-counter NSAID drugs.
However, there is a key difference between NSAIDs and these natural herbal extracts. Most NSAIDs selectively block the COX-2 enzyme, but not 5-LOX nor much COX-1.17 This can result in an imbalance that can produce the side effects associated with these drugs.4 Studies show that these flavonoid-rich herbal extracts provide “dual inhibition” of both the COX and LOX enzymes, safely reducing their production of pro-inflammatory signaling molecules in a more balanced fashion.
Osteoarthritis has been defined as a life sentence of pain, limited motion, joint stiffness, and loss of general satisfaction with life.
Despite decades of effort, mainstream medicine has uncovered nothing better than NSAID drugs, which have little or no impact on the disease process itself.
Newly identified herbal nutrients, however, hold much more hope for osteoarthritis sufferers.
Three have recently demonstrated impressive results in human studies. Chinese skullcap (Scutellaria baicalensis), cutch tree (Acacia catechu), and white mulberry (Morus alba) extracts all inhibit the COX and 5-LOX enzymes responsible for producing the pain and inflammation that constitute daily life for those with osteoarthritis. This effect is credited with relieving pain, stiffness, and limited range of motion at least as well, and in some cases better than, NSAID drugs.
The herbal combination of white mulberry and cutch tree extracts has been found to slow the cartilage degradation process common to all osteoarthritis sufferers. No known drug has similar effects on cartilage stability, making this combination of unique interest in those who wish not only to control their pain but also to impede the disease’s natural progression.
People with mild osteoarthritis may gain sufficient relief from supplements such as glucosamine sulfate. New clinical data, however, demonstrate that this combination of three herbal extracts is ideally suited for osteoarthritis sufferers. This is particularly relevant for those whose pain is not fully controlled, or who wish to slow the progression of cartilage degradation.
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- Park KK, Choi CH, Ha CW, et al. The Effects of Adherence to Non-Steroidal Anti-Inflammatory Drugs and Factors Influencing Drug Adherence in Patients with Knee Osteoarthritis. J Korean Med Sci. 2016;31(5):795-800.
- Santilli F, Boccatonda A, Davi G, et al. The Coxib case: Are EP receptors really guilty? Atherosclerosis. 2016;249:164-73.
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- Arjmandi BH, Ormsbee LT, Elam ML, et al. A combination of Scutellaria baicalensis and Acacia catechu extracts for short-term symptomatic relief of joint discomfort associated with osteoarthritis of the knee. J Med Food. 2014;17(6):707-13.
- Unigen Inc. Amlexin: A New Approach to Joint Protection. Unpublished data.2015.
- Saberi Hosnijeh F, Siebuhr AS, Uitterlinden AG, et al. Association between biomarkers of tissue inflammation and progression of osteoarthritis: evidence from the Rotterdam study cohort. Arthritis Res Ther. 2015;18:81.
- Garnero P, Piperno M, Gineyts E, et al. Cross sectional evaluation of biochemical markers of bone, cartilage, and synovial tissue metabolism in patients with knee osteoarthritis: relations with disease activity and joint damage. Ann Rheum Dis. 2001;60(6):619-26.
- Sokolove J, Lepus CM. Role of inflammation in the pathogenesis of osteoarthritis: latest findings and interpretations. Ther Adv Musculoskelet Dis. 2013;5(2):77-94.
- Yimam M, Brownell L, Pantier M, et al. UP446, analgesic and anti-inflammatory botanical composition. Pharmacognosy Res. 2013;5(3):139-45.
- Tseng-Crank J, Sung S, Jia Q, et al. A medicinal plant extract of Scutellaria Baicalensis and Acacia catechu reduced LPS-stimulated gene expression in immune cells: a comprehensive genomic study using QPCR, ELISA, and microarray. J Diet Suppl. 2010;7(3):253-72.
- Morgan SL, Baggott JE, Moreland L, et al. The safety of flavocoxid, a medical food, in the dietary management of knee osteoarthritis. J Med Food. 2009;12(5):1143-8.
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