Author(s): A Krishna Sailaja*, E Veena Rani and Swetha
The main aim of this article is to reduce the adverse effects associated with synthetic drugs which are used to reduce the inflammation in rheumatoid arthritis. Rheumatoid arthritis is defined as a chronic inflammatory disorders affecting many joints, including those in the hands and feet. It is an autoimmune disease in which the body’s immune system (which normally protects the health from foreign substances like bacteria and viruses will mistakenly attacks the joints). The greatest disadvantage of the presently available potent synthetic drugs lies in their toxic reactions and reappearance of symptoms after discontinuation.To overcome this effects herbs/herbal based preparation are used to treat rheumatoid arthritis. Herbal medicines will act as parcels to human inorder to combat disease from the dawn of civilization. Some of the natural herbs which shows anti-rheumatic action are-vatariguggul, terpenes, stem bark of ficusbengalensis, punarnava etc.,
Rheumatoid arthritis is a chronic inflammatory autoimmune disorder which mainly effects the joints, hand, feet. Autoimmune diseases in which the bodys immune system will mistakenly attacks the body’s own tissues reduces the defence activity and may be prone to several infections. The immune system mainly contains the cells and antibodies which play a major role in the destruction of the foreign invaders. Patients with autoimmune disorder have the cells and antibodies which will mainly target the tissues and is associated with the inflammation of the tissues around the joints [1, 2].
The characteristic features of the rheumatoid arthritis are that they can cause extra-articular inflammation and injury in other organs. Slowly the inflammation spreads to the multiple organs which is referred to as systemic illness [3, 4].
Figure 1: Normal and arthritic Joint
Rheumatoid arthritis symptoms depends upon the degree of inflammation and the type of body tissue involved in inflammation. Remissions may occur upon treating with certain drugs but sometimes there are chances of relapse of disease and toxic reactions may occur due to the synthetic drugs and its severity may differ among the affected individuals [5, 6].
The most notable symptoms are muscle and joint stiffness which is mostly experienced during morning times and is referred to as morning stiffness and post-sedentary stiffness.
Generally joint stiffness occurs due to the inflammation of the synovium the tissue that lines the joint and resulting in the excess production of the synovial fluid (synovitis).
If the inflammation is chronic it may even damage the body tissues, including cartilage and bone which in turn leads to the weakness of bones resulting in joint deformity, loss of range of motion, loss of function.
Even the small joints of both the hands and wrists are also involved, the arthritis which is associated with the hands creates the difficulty in performing simple tasks like opening jars and turning doors.
Not only the joints even the vocal cords are also effected due to rheumatoid arthritis which changes the tone of voice (leads to the inflammation of the cricoarytenoid joint which causes horseness of voice) [7, 8].
Rheumatoid arthritis is characterized by synovitis with thickening of the synovial lining and infiltration by inflammation cells . Generation of new synovial blood vessels is induced by angiogenic cytokines. The synovium proliferates and grows out over the surface of cartilage, producing a tumor like mass called pannus. Pannus destroys the articular cartilage and subchondral bone producing bony erosions.
The actual cause of RA is unknown. Some of the infectious agents like the bacteria, viruses, fungi have been also responsible to cause rheumatoid arthritis.
Some research proved that, there may be some genetic reasons associated with the rheumatoid arthritis. Immune cells called lymphocytes are activated and chemical messengers (cytokines, such as tumor necrosis factor (TNF), interleukin-1 and interleukin-6) are expressed in the inflamed areas [9, 10].
| S.no | Body part | Effect |
| 1. | Eyes | Corneal abrasion (eye dryness) |
| 2. | Mouth | Sjogren’s syndrome (dryness of mouth) |
| 3. | Lungs | Pleuritis (creates difficulty in breathing, coughing), nodules formation |
| 4. | Heart | Pericarditis -at an increased risk it leads to heart attack |
| 5. | Blood vessels | Decrease the RBC and WBC levels(felty’s syndrome is a condition occurs due to decreased concentration of WBC in the body) |
| 6. | Elbows and fingers | Carpal tunnel syndrome ( formation of lumps/firm bumps under the skin) |
| 7. | Kidneys | Amyloidosis causes the nephrotic syndrome and renal failure. |
Drugs used to treat rheumatoid arthritis: [13]
First-line drugs:(reduces pain and inflammation)
| S.no | Drug | Brand name | Side effects |
| 1 | Acetylsalicylate | Aspirin | Ulcers |
| 2 | Naproxen | Naprosyn | Abdominal pain |
| 3 | Ibuprofen | Advil, medipren, motrin | Gastrointestinal bleeding |
| 4 | Diclofenac | Voltaren | Stomach upset |
| 5 | Corticosteroids | - | Facial puffiness,weight gain, cataracts. |
Second line drugs (slow acting drugs-promotes disease remission and prevent progressive joint destruction):
| S.no | Drug | Brand name | Side effects |
| 1 | Hydroxychloroquine | Plaquenil | Skin rashes, muscle weakness |
| 2 | Sulfasalazine | Azulfidine | Stomach upset, rashes |
| 3 | Methotrexate | Rheumatrex, trexall, otrexup | Bone marrow depression, cirrhosis. |
| 4 | Gold thioglucose | Solganal | Mouth sores, skin rashes |
| 5 | Gold thiomalate | Myochrysine | Kidney damage |
Due the side effects associated with the synthetic drugs and a chance of relapse herbs are used to treat the rheumatoid arthritis.
List of the herbs: [14]
| S.no | Biological name | Family | Part of theherb | Target | Uses |
| 1 | Boswelliaserrata | Burseraceae | Gum of theboswelliatrees | COX-2, LOX-5 | This herb is thought to work by blocking substances that attack healthy joints. |
| 2 | Allium cepa | Amaryllidaceae | Onions | COX-2, TNF-Alpha, LOX-5 | Antioxidant and anti-inflammatory action |
| 3 | Aloe barbadensis | Aloeaceae | Leaves | TNF-a,IL-6 | Anti-arthritic activity |
| 4 | Azadiractaindica | Meliaceae | Leaf | NF-KB signaling pathway | Anti-inflammatory, anti-ulcer. |
| 5 | Argemonemexicana | Papaveraceae | Whole plant latex | IL-2,IFNgammainhibition,IL-10 | Cough, asthma, pertussis, rheumatalgia |
| 6 | Capparisdeciduas | Capparaceae | Roots | TNF-a | Fruit powder, sugar is prescribed in rheumatism, gout. |
| 7 | Green -lipped mussel(pemacanaliculus) | Mytilidae | Boiled mussel | Dual inhibitor ofarachidonic acidoxygenation by both the COX and LOX pathways | Reduces the inflammation associated with arthritis |
| 8 | Rehmanniaglutinosa | Orobanchaceae | Root | COX-1 and COX-2 | Treats RA, effective in reducing joint pain and swelling |
| 9 | Thunder god (tripterygium) | Celartraceae | Root | Inhibiting transcription ofcytokines genes,including IL2,gamma interferon | Treats rheumatoid arthritis |
| 10 | Borage oil (boragoofficinalis) | Boraginaceae | Seeds | Suppress theinflammationmediators | Helps to treat RA by reducinginflammation |
| 11 | Black adusa(justiciagendarussa) | Acanthaceae | Leaves | Inhibits INOS, COX 2 expression viaNF-KB pathway | Anti -arthritic activity |
| 12 | Chaste tree (vitexagnus ) | Lamiaceae | Roots | Inhibits inflammation mediators | Treats rheumatic disorder |
| 13 | Tinosporagulancha(tinosporacordiofollia) | Menispermaceae | Leaves | IL-1B, TNF-a | Anti-inflammatory, used in thetreatment of RA |
| 14 | Anantamulindia sarsaparilla (hemidusmus) | Apocyanceae | Leaf | NF-KB | Used in the treatment of RA |
| 15 | Bastard guilder(premnacorymbosa) | Verbenaceae | Leaves | COX-1, COX-2 | Suppresses the development of chronic arthritis |
| 16 | Black pepper(piper nigrum) | Piperaceae | Seeds | COX-pathway, IL-6 | Reduces arthritic symptoms |
| 17 | Turmeric root(curcuma longa) | Zingiberaceae | Rhizome | NF-KB pathway | Inhibits joint inflammation in both acute and chronic phases of arthritis |
| 18 | Clearing nut(strychnospotatorum) | Loganiaceae | Seeds | NF-KB pathway | Anti -arthritic |
| 19 | Hygrophilaauriculata | Acanthaceae | Roots, leaves | TNF-a | In the treatment of jaundice, hepatic obstruction, rheumatism |
| 20 | Vatteriaindica | Dipterocarpaceace | Oil | InhibitsLipooxygenase | Treats respiratory disorders like chronic bronchitis, diarrhea and rheumatism |
| 21 | Cat’s claw(uncariatomentosa) | Rubiaceae | Root bark | TNF | Anti-inflammatory properties, may stimulate the immune system |
| 22 | Burdock root(arctiumlappa) | Asteraceae | Root | Suppress theinflammatorymediators | Anti-inflammatory, reduces congestion |
| 23 | Devil’s claw(harpagophytumprocumbens) | Pedialaceae | Dry fruit | COX-2 | Used for rheumatic pain, backache, muscle and joint pain |
| 24 | Arnica | Asteraceae | Flowers,leaves | Inhibits the production ofan inflammatorysubstance known as NF-KB | Regulates the immune system, anti inflammatory, relieves muscle and joint pain |
| 25 | Eucommiaulmoides | Eucommiaceae | Bark | IL-1B expression, TNF-a | Reduces hip and joint pains |
| 26 | Nettles (urticadioica) | Urticacaea | Leaves, stem | COX-1, COX-2,prostaglandin D2 synthase | Treats all types of arthritis, gout, anti inflammatory action. |
| 27 | Punarnava (boerhaviadiffusa) | Nyctaginaceae | Leaves | Inhibits PLA2enzyme | Anti-spasmodic, antiinflammatoryaction, reduces joint pains. |
| 28 | Berberine | Berberidaceae | Flowers and leaves | NF-KB, COX2,TNF-a | Reduces joint pains |
| 29 | Piper betel | Piperaceae | Whole plant | IL-1B | Reduces the inflammation in arthritis |
| 30 | Pongamapinnata | Fabaceae | Leaves | NF-KB p65 nuclear translocation | Leprous sores, painful rheumatic joints |
| 31 | Solanumnigrum | Solanaceae | Whole plant | TNF-a, IL-1 | Treats pain, fever, inflammation |
Rheumatoid arthritis is an auto immune disorder. It cannot be cured completely but the symptoms can be treated effectively. In this article a detailed discussion was made on the progression of disease, Various herbs and the formulations used for the treatment of arthritis.
