CHAPTER 46

Anti-Inflammatory Herbs for Arthritis

J. Hall, R. Bravo-Clouzet
University of Arizona, Tucson, AZ, USA

LIST OF ABBREVIATIONS
ASTHO The Association of State and Territorial Health Officials
CDC Center for Disease Control and Prevention
COX Cyclooxygenase enzyme
CRP C-reactive protein
DMARDs Disease-modifying antirheumatic drugs
IL-1 Interleukin 1
IL-18 Interleukin 18
IL-6 Interleukin 6
MMP Matrix metalloproteinase expression
NF-kB Nuclear transcription factor kappa B
NO Nitric oxide
NSAIDs Nonsteroidal anti-inflammatory drugs
OA Osteoarthritis
PGE2 The naturally occurring prostaglandin E2
RA Rheumatoid arthritis
TNF Tumor necrosis factor
WOMAC The Western Ontario and McMaster Universities score

1. INTRODUCTION
According to the Center for Disease Control and Prevention (CDC) data, arthritis is a
serious public health concern in the United States, where an estimated 22.2% (49.9
million) of US adults reported doctor-diagnosed arthritis during 2007–2009. Hence,
approximately one in five adult Americans suffer from some form of arthritis and the dis-
ease affects more women (24.3%) than men (18.2%) when controlled for age. Almost two
thirds of people with arthritis are younger than 65 years. It affects members of all racial
and ethnic groups. Arthritis is also more common among adults who are obese than
among those who are normal weight or underweight. Moreover, arthritis is the most
common cause of physical disability with the associated cost of $128 billion annually.
Taking into account the aging US population and growing prevalence of obesity, the
prevalence of arthritis is expected to rise significantly by 2030 (CDC, 2010).
Considering the diminishing quality of life in people with rheumatic diseases as well as
a huge economic burden associated with it, a consortium of federal and not-for-profit

Bioactive Food as Dietary Interventions for Arthritis and Related Inflammatory Diseases # 2013 Elsevier Inc.
http://dx.doi.org/10.1016/B978-0-12-397156-2.00253-2 All rights reserved. 619
620 J. Hall and R. Bravo-Clouzet

organizations induced a large-scale effort called the National Arthritis Action Plan, which
has reduction of total lifetime disability as one of the leading health priorities in the
United States (A.F., ASTHO, CDC, 1999).

2. ARTHRITIS
Diseases of the musculoskeletal system are among the most common human affliction.
The term arthritis (from Greek arthro-, joint þ itis, inflammation) encompasses more
than 100 rheumatic diseases and conditions that affect joints in the body. The three most
common kinds of arthritides are osteoarthritis (OA), rheumatoid arthritis (RA), and gout.
Typically, rheumatic conditions are characterized by pain and stiffness in and around one
or more joints. This chapter will focus on OA and RA.

2.1 Osteoarthritis
OA is a whole joint disease including cartilage, synovial tissue, subchondral bone, liga-
ments, muscles, and tendons. Cartilage is the main target tissue of the disease. OA is the
most common form of inflammatory and degenerative disease of synovial joints, charac-
terized by articular cartilage loss. It is now generally accepted that OA is not only a con-
sequence of ‘wear and tear’ or injuries to the joint, but is also an active joint disease with a
pronounced inflammatory component (Henrotin et al., 2010).

2.2 Rheumatoid Arthritis

RA is a chronic autoimmune disease that affects 1% of the adult population worldwide. It
often leads to joint destruction, deformity, and functional decline. In addition, it signif-
icantly increases comorbidity in the neurologic, cardiovascular, and metabolic system
(Brennan and McInnes, 2008).

2.3 Risk Factors for OA and RA

There are multiple risk factors for OA and RA.
It is established that being overweight antedates the development of knee OA
(Manninen et al., 1996). Moreover, majority of studies suggest that the relationship of
obesity to knee OA is stronger in women than in men (Felson et al., 1997).
The fact that a high incidence of OA in women is observed just after menopause is
indicative of a protective effect of estrogen. Tanamas (2011) provided the first systematic
review (27 studies) examining the evidence for a relationship between sex hormones (ex-
ogenous and endogenous) and polymorphisms and structural changes in OA. Previous
reviews focused mainly on studies of exogenous estrogen use and hormone replacement
therapy. The available evidence supports an effect of endogenous and exogenous estro-
gen as well as estrogen receptor polymorphisms on joint health.
 Anti-Inflammatory Herbs for Arthritis 621

Furthermore, studies are suggesting that nutritional factors affect RA incidence. The
cohort study from Finland was indicative of a protective effect of high serum selenium
levels against RA incidence (Knekt et al., 2000).
Two epidemiological studies showed that current smokers, ex-smokers, and ever-
smokers of both sexes had an increased risk for RA (for ever-smokers the odds ratio
was 1.7, 1.2–2.3 for women, and 1.9 for men) (Stolt, 2003).
Stress is known to change immune and neuroendocrine responses with activation of
the hypothalamic–pituitary–adrenal axis and the sympathetic nervous system (Agarwal
and Marshall, 2001). Numerous psychoneuroimmunological studies indicate that stress
increases the release and production of inflammatory biomarkers interleukin 1 (IL-1),
interleukin 6 (IL-6), and tumor necrosis factor (TNF), which contributes to altered
health and health-related outcomes (Steptoe et al., 2007).

3. INFLAMMATION
Although inflammation is an essential component of the host defense against infections,
an excessive inflammatory response can nonetheless lead to detrimental outcomes, such
as arthritis, cancer, and other autoimmune diseases.
Inflammation is a key contributory factor in the pathogenesis of RA and OA. It is
well established that various cytokines are involved in RA and OA pathology. TNF-a,
IL-1b, and interferon-g (IFN-g), produced by macrophages, dendritic cells, and T cells
are the most important cytokines stimulating matrix metalloproteinase expression
(MMP) and synovial inflammation under inflammatory conditions. These pro-
inflammatory cytokines are responsible for joint swelling and the cartilage and bone
erosion through osteoclast formation (Ritchilin, 2000). Therefore, blockade of these
cytokines and their downstream effectors is a suitable therapeutic strategy for RA
and OA.

4. CURRENT PHARMACOLOGICAL THERAPY FOR ARTHRITIS

Current pharmacological therapy for arthritis is nonsteroidal anti-inflammatory drugs
(NSAIDs), corticosteroids, and disease-modifying antirheumatic drugs (DMARDs).
NSAIDs are drugs with analgesic and antipyretic effects, and in higher doses have
anti-inflammatory effects. Not only are most NSAIDs nonselective inhibitors of the
enzyme cyclooxygenase (COX), but they also inhibit the repair of cartilage. Moreover,
NSAIDs have various side effects including 50% higher risk of heart attack and stroke.
Corticosteroid medications reduce inflammation and pain, and slow joint damage by
inhibiting prostaglandins and leukotriens. But that comes with a price. Side effects
include bleeding, osteopenia, cataracts, weight gain, and diabetes.
622 J. Hall and R. Bravo-Clouzet

DMARDs produce similar outcomes as corticosteroids but are more suitable for pro-
longed use as they are needed in chronic conditions. Side effects vary, and may include
liver damage, bone marrow suppression, and severe lung infections (Young, 2009).

5. ANTI-INFLAMMATORY HERBS
Given the modest results of current pharmacological therapy for OA/RA and adverse
side effects associated with their continued use as well as their monetary burden,
there has been growing interest in the use of non-synthetic, natural drugs derived from
plant/herbal sources to alleviate OA and RA symptoms (Berenbaum, 2008; Clutterbuck
et al., 2009). The most studied botanical constituent for its anti-inflammatory properties
is curcumin. Less studied herbs, but traditionally used in different cultures for their
anti-inflammatory properties are boswellia, stinging nettle, cat’s claw, devil’s claw,
willow bark, and others. This chapter will describe anti-inflammatory properties of
curcumin, boswellia, and stinging nettle as natural plant-derived remedies for arthritis
treatment.

5.1 Turmeric
5.1.1 Description
Turmeric (Curcuma longa) is a perennial herb and member of the Zingiberaceae family and
is cultivated extensively in Asia, India, China, and countries with a tropical climate. It
grows to a height of 3–5 ft and has large oblong leaves and funnel-shaped yellow or white
flowers (Review of Natural Products, 2011a).
The rhizome has a long history of culinary and medicinal use. Descriptions of tur-
meric use could be found as early as 650 BC in writings by Assyrians who used turmeric
as a spice and coloring dye. The Chinese and Ayurvedic (Indian) systems of medicine list
turmeric as an ingredients used to treat various illnesses such as rheumatism, bodyache,
skin diseases, intestinal worms, diarrhea, intermittent fevers, hepatic disorders, bilious-
ness, urinary discharges, dyspepsia, inflammations, constipation, leukoderma, amenor-
rhea, and colic (Pari et al., 2008).

5.1.2 Chemistry
The active constituents of turmeric are the phenolic compounds known as the curcumi-
noids. Three major curcuminoids isolated from turmeric are curcumin (diferuloy-
methane), demethoxycurcumin, and bisdemethoxycurcumin. Vogel and Pelletier
were the first to isolate curcumin in 1815. Curcumin makes up approximately 09% of
the curcuminoid content in turmeric. Besides flavonoids, turmeric has various volatile
oils, including turmerone, atlantone, and zingiberone, as well as fat, proteins, minerals,
and carbohydrates. The most researched active constituent is curcumin, which comprises
0.3–5.4% of raw turmeric. There are almost 3000 preclinical investigations about
 Anti-Inflammatory Herbs for Arthritis 623

turmeric in biomedical literature. These studies reported the antioxidant, anti-

inflammatory, antiviral, and antifungal properties of curcuminoids (Belcaro et al.,
2010b; Pari et al., 2008).

5.1.3 Absorption of curcumin

Due to its hydrophobic nature and rapid plasma clearance as well as conjugation, curcu-
min has reduced absorption rates and bioavailability in clinical applications (Anand et al.,
2007; Jurenka, 2009). Plasma concentration barely reaches 50 ng/ml of phase II metab-
olites (glucuronides and sulfates) after oral administration of dosages as high as 12 g/day.
Distribution in various body tissues has also shown to be limited. According to Sharma
(2004) as stated in Anand et al. (2007), oral curcumin administered to healthy volunteers
in doses of 2 g demonstrated low curcumin concentration in plasma (<10 ng/ml) 1 h
after the dose.

5.1.4 Evidence of anti-inflammatory activity

Numerous in vitro and animal studies demonstrated that curcumin has a role of a master
switch of inflammation by modulating several important molecular targets, including
pro-inflammatory enzymes (COX and lipoxygenases (LOX)), transcription factors
(e.g., Nuclear transcription factor kappa B (NF-kB), AP-1), cytokines (e.g., TNF,
IL-1, IL-6, IL-18, and chemokines), kinases (Janus kinases), and other enzymes
(Jurenka, 2009; Moon et al., 2010; Park et al., 2007 ).

5.1.4.1 In vitro studies/animal studies

• Kurien et al. (2010) demonstrated a heat-mediated 12-fold increase in curcumin’s
aqueous solubility and also heat-solubilized ability of curcumin to bind to proteins.
This study showed that heat-solubilized curcumin significantly decreased binding
of autoantibodies from Sjorgen’s syndrome and systemic lupus patients (up to 43/
70% and up to 52/70% respectively). Therefore, authors suggest that heat-solubilized
curcumin can amend autoimmune disorders.
• Park et al. (2007) reported the antiproliferative role of curcumin on the synovial
fibroblast cells obtained from patients with RA. This study demonstrated that the
synovial fibroblasts’ treatment with different curcumin concentrations resulted in
decreased Bcl-2 expression, while Bax expression increased in a concentration-
dependent manner. Park et al.’s (2007) study suggests that in curcumin-induced
apoptosis, an imbalance of Bax/Bcl-2 might be the upstream event in the mitochon-
drial pathway, and is followed by activation of caspase-9 and caspase-3, which lead to
apoptosis. Lastly, the same study also confirmed the role of curcumin in the inhibition
of COX-2 expression and reduction in The naturally occurring prostaglandin E2
(PGE2) production with increasing curcumin concentration, consistent with numer-
ous animal and in vitro studies.
624 J. Hall and R. Bravo-Clouzet

• Mathy-Hartet et al. (2009) provided a deeper insight into the metabolism of chon-
drocytes. They investigated the effects of curcumin for a longer period of time
(12 days) compared to other studies (12–48 h), and studied curcumin effects on
human chondrocytes. Human chondrocytes were cultured for 12 days in the absence
or in the presence of IL-1beta and with or without curcumin at concentrations of 5,
10, 15, and 20 mM. The results revealed that curcumin is an inhibitor of PGE2, nitric
oxide (NO), IL-6, IL-8, and MMP-3. The effect of curcumin was concentration-
dependent and at concentrations of 15 and 20 mM, curcumin significantly inhibited
Il-1betz-stimulated NO production (P < 0.001). Similar results were observed in cur-
cumin inhibition of PGE2 production and total basal MMP3 production. The study
demonstrated the efficacy of curcumin in the treatment of OA. Authors assert that
curcumin is a potent inhibitor of PGE2, NO, and pro-inflammatory cytokines such
as IL-6 and IL-8 in human chondrocytes. In addition, curcumin counteracts the
stimulating effect of IL-1 on MM-3 synthesis associated with cartilage matrix
degradation.
• Moon et al. (2010) demonstrated the efficacy of curcumin against both collagen-
induced arthritis (CIA) in mice and IL-1b-induced activation in fibroblast-like syno-
viocytes (FLs). Arthritic index was significantly suppressed at 5 days after booster
immunization in mice treated with curcumin whereas arthritic index in control mice
had gradually increased. In addition, the increase in paw thickness was significantly
less in mice treated with curcumin compared to control mice. Furthermore, to assess
the effect of curcumin in synovial fibroblasts, the cells were exposed to 10 ng/ml
IL-1b alone or treated with increasing concentrations of curcumin for 1 h before
stimulation with IL-1b for 24 h. Treatment with 20 mM curcumin significantly
reduced arthritic index as well as inhibited IL-1b-induced PGE2 production. Authors
support the view that curcumin can be used as a potential therapeutic agent for RA by
inhibiting pro-inflammatory mediators and regulating humoral and cellular immune
responses.

5.1.4.2 Clinical trials

• A crossover randomized control trial (RCT) examined the effect of turmeric extract
in combination with zinc complex and other botanicals – Withania somnifera and
Boswellia serrrata – that included 42 patients with OA. The patients received
100 mg of turmeric extract three times a day for 3 months and then switched to
another treatment for the next 3 months. Improvements in pain severity and disability
were observed, although the exact role of turmeric could not be confirmed due to
other botanicals and zinc in the compound treatment (Kulkarni et al., 1991).
• In a registry study, 50 OA patients were evaluated to determine if the special turmeric
formulation called Merivaw could provide more benefits than their standard
medical therapy. Merivaw is a special patented combination of curcumin with
 Anti-Inflammatory Herbs for Arthritis 625

soybean-derived phosphatidylcholine (1:2 ratio). The patients in the first group re-
ceived their standard medical therapy as determined by patients’ physicians, while pa-
tients in the second group received both Merivaw and their standard therapy. After
3 months, results were assessed by the Western Ontario and McMaster Universities
(WOMAC) score and the treadmill walking performance. The Merivaw group of OA
patients experienced a 58% decrease in their overall pain, stiffness, and physical func-
tionality. In addition, the Merivaw group experienced an increase of 300% of their
Social and Emotional Index (SEI) score. Blood tests revealed a 16-fold decrease of
C-reactor protein (CRP) in patients who had elevated levels of this protein and took
Merivaw in addition to their standard treatment. Lastly, the participants in the Mer-
ivaw group were able to reduce the amount of their painkillers by 63% compared to
patients on standard medical therapy alone (Belcaro et al., 2010a).
• In a subsequent registry study, 100 patients with OA, received either the ‘best avail-
able treatment (n ¼ 50)’ or the ‘best available treatment and Merivaw (n ¼ 50).’ This
study extended the end points of the previous study by including the assessment
of biochemical markers of inflammation. After 8 months of continuous use of
1 g/day Merivaw (200 mg of turmeric), in patients in the treatment group the
WOMAC score for OA symptoms decreased by more than 50% and a threefold
increase in walking distance was observed in the treatment group compared to the
control group. Furthermore, the Karnofsky Performance Scale Index significantly
increased (from 73.3 at inclusion to 92.2 at the completion of the study) while the
control group did not have significant improvement (from 74.2 to 81 at the comple-
tion). Major decrease of all biochemical end points was observed in the treatment
group (Belcaro et al., 2010b).

5.2 Boswellia
5.2.1 Description
Boswellia is a genus of trees known for their fragrant resin. It grows on dry hilly areas
throughout India, North Africa, and the Middle East. Boswellia serrata is a medium to
large-sized branching tree of the boswellia genus. The oldest written document mention-
ing boswellia as a drug is the papyrus Ebers written around 1500 BC. Ayurvedic medicine
uses different parts of the boswellia tree for treatment of asthma, rheumatisms, dysentery,
skin ailments, ulcers, blood purification, etc. It was also used as a perfume and in religious
celebrations. The oil of boswellia is also known as Indian frankincense (Review of
Natural Products, 2011b).

5.2.2 Chemistry
The active forms of the boswellia resin are the boswellic acids, which make up 30% of the
resin. The boswellic acids are organic acids, consisting of a pentacyclic triterpene, a
carboxyl group, and at least one other functional group. Alpha-boswellic acid and
626 J. Hall and R. Bravo-Clouzet

beta-boswellic acid both have an additional hydroxyl group; they differ only in their tri-
terpene structure. Other boswellic acids include the keto-boswellic acids and their acetyl
counterparts. The typical used forms of boswellia are gum resin preparation or ethanol
extracts of the gum resin standardized to contain 10–15 mm/ml of 3-O-acetyl-11-keto-
beta-boswellic acid (Martinez et al., 1989).

5.2.3 Evidence of anti-inflammatory activity

5.2.3.1 In vitro studies
• Blain et al. (2010) found that high levels of Boswellia inhibited metalloproteinase
expression/activation and significantly reduced the production of nitrite, prostaglan-
dins, and COX. Cartilage degradation was induced in vitro with IL1a and treated
in the presence or absence of boswellia extract for 28 days. The study demonstrated that
boswellia prevents collagen degradation and inhibits pro-inflammatory mediators.
• Another study also demonstrated that the acetyl-11-keto-boswellic acid may have a
role in the inhibition of NF-kB and down-regulation of the pro-inflammatory
cascade (Takada et al., 2006).
• Boswellia extract also provides protection from IL-1b-induced death of human cul-
tured chondrocytes and improves their glycosaminoglycans production. There is also
an inhibitory potential on MMP-3 production (Sengupta et al., 2011).

5.2.3.2 Animal studies

• Boswellia extract showed a marked anti-inflammatory activity in induced edema in
rats and mice treated with different dosages of the boswellia extract compared to con-
trol groups (Singh and Atal, 1986).
• Serum from experimental animals supplemented with a boswellia extract was cocul-
tured with human chondrocytes. In this study, B. serrata extract significantly
improved anti-inflammatory efficacy on the chondrocytes in in vitro and in vivo
experiments (Sengupta et al., 2011).
• Moussaieff and Mechoulam (2009) reported that boswellia resins inhibit NF-kB
activation. In addition, an anti-inflammatory effect on the inflamed mouse paws
was observed.

5.2.3.3 Clinical studies

• Etzel evaluated the efficacy of boswellia extract in 210 RA patients. Compared to pla-
cebo, boswellia displayed a significant reduction in joint pain/swelling and morning
stiffness, and overall improvement of the patients’ health and well-being (Etzel, 1996).
• In Kimmatkar’s study, patients with OA were divided into two groups (n ¼ 30) for
treatment and placebo. After 8 weeks, significant improvement was observed in
the treatment group. Authors suggested the use of B. serrata extract for the treatment
of OA (Kimmatkar et al., 2003).
 Anti-Inflammatory Herbs for Arthritis 627

• A double-blind, randomized, placebo-controlled study (n ¼ 75) using 5-Loxinw

(B. Serrata extract) for 90 days demonstrated pain reduction and improvement of
physical functions in OA patients as well as safety of the extract. A significant reduc-
tion in the synovial fluid MMP-3 was also demonstrated (Sengupta et al., 2008).

5.3 Stinging Nettle

5.3.1 Description
Stinging nettle (Urtica dioica) is a perennial plant native to Europe; it is now found in abun-
dance throughout temperate North America. It grows well in nitrogen-rich soil, blooms
between June and September, and usually reaches 2–4 ft high. Stems are upright and rigid.
The leaves are dark green, heart-shaped, finely serrated, and tapered at the ends. They grow
opposite one another along the stalk and contain bristles that release stinging chemicals
when touched. Stinging nettle is dioecious, having both male and female flowers on
the same plant (Blumenthal et al., 2000; Review of Natural Products, 2011a,b,c).
Nettle has a long medicinal history. In medieval Europe, it was used as a diuretic and to
treat joint pain. In addition, it has been used for hundreds of years to treat anemia, eczema,
arthritis, and gout. Other folk medicine applications are wound healing and treatment of
scalp seborrhea. Modern clinical application of nettle is in the management of symptoms of
benign prostatic hyperplasia (BPH), cardiovascular symptoms, diabetes, arthritis, and aller-
gic rhinitis (Chrubasik, 2007; Review of Natural Products, 2011a,b,c). In Germany, sting-
ing nettle herb is used as a component of prepared medicine for the treatment of rheumatic
ailments. Pharmacopial-grade stinging nettle herb must be collected during the flowering
period and contain not less than 18% water-soluble extractives (ABC, 2011).

5.3.2 Chemistry
It has been suggested that the following nettle compounds may have clinical application:
nettle root lignans (including divanillyltetrahydrofuran), lectin U. dioica agglutinin,
9-hyroxy-10 trans-12-cis-octadecadienic acid, polysaccharides, caffeic acid, steroidal
compounds, and malic acids. Stinging nettle also contains vitamin K and B-group
vitamins. Its trichomes contain histamine, serotonin, and choline (Review of Natural
Products, 2011c).

5.3.3 Evidence of anti-inflammatory activity

5.3.3.1 In vitro/animal studies
• Several in vitro studies using human cell lines suggest that nettle extract has an effect
on COX enzymes, downregulates the inflammation cascade, may reduce primary
T-cell response, and inhibits NF-kB (Review of Natural Products, 2011c).
• A new stinging nettle leaf extract called Hox alpha has been shown to significantly
suppress MMP, which explains clinical efficacy of this extract in the treatment of
RA (Schulze-Tanzil et al., 2002).
628 J. Hall and R. Bravo-Clouzet

• Animal studies suggest that the extract of U. dioica has analgesic and antinociceptive
properties as well as the ability to reduce inflammation in induced paw edema
(Marrasini et al., 2010).

5.3.3.2 Clinical data

• In a pilot study (23 patients with OA), Rayburn et al. (2009) used a stinging nettle
extract cream and observed improved function and reduction of pain (mean reduc-
tion of 4.17 in WOMAC score).
• In a multicenter study, 152 patients with degenerative, rheumatic diseases were trea-
ted with 1.54 g nettle herb dry extract daily. After 3 weeks, 70% of patients reported
subjective improvement of symptoms (ABC, 2011).
• In a randomized study of 37 patients with acute arthritis, the effect of stewed stinging
nettle herb combined with a subtherapeutic dose of NSAIDs (Diclofenac) was com-
pared to a standard dose of Diclofenac. One group was given 50 g nettle and 50 g
Diclofenac and the other group took 200 mg of Diclofenac. The clinical end points
(verbal rating scale from 0 to 4, physician assessment for the pressure, pain, and stiff-
ness) were complemented by the evaluation of the CRP levels. In both groups,
median scores improved by almost 70% compared to the initial values. The authors
suggested that stinging nettle herb may enhance the NSAID antirheumatic effective-
ness and that further research is needed to evaluate the efficacy of stewed nettle (on its
own) to reduce/eliminate inflammation in acute attacks of arthritis (Chrubasik et al.,
1997).

6. CONCLUSIONS AND FUTURE DIRECTION

Arthritis is a serious public health threat and is the nation’s leading cause of disability. It
significantly reduces the quality of life, not only for the individuals with the disease, but
also for the whole family. The economic burden of arthritis is substantial with medical
and social cost of $128 billion annually. The aging US population and growing preva-
lence of obesity only exacerbate the problem. Current pharmacological therapies are lim-
ited in their efficacy, symptomatic, and frequently toxic. Therefore, the public health
approach to prevent or delay the onset of disease as well as to manage arthritis is essential.
OA can be prevented with weight control and precautions to avoid certain occupational
and sport injuries. Although there are currently no known means to prevent RA, elim-
ination/reduction of risk factors such as poor nutrition, smoking, and stress would be
beneficial. In addition, the pain and disability accompanying all types of arthritis can
be minimized through early diagnosis, weight control, physical activity, anti-
inflammatory diet, stress-management, and physical/occupational therapy. Research
has identified inflammation as a key contributory factor in the pathogenesis of RA
and OA and promising alternative botanical remedies which target the different
 Anti-Inflammatory Herbs for Arthritis 629

molecules/proteins responsible for inflammatory response. Curcumin, boswellia, and

stinging nettle, among others, are promising anti-inflammatory herbs. They have not
only anti-inflammatory, but also antioxidant, cardiovascular, and chemopreventive
properties. These synergistic effects cannot be undermined, and should be better utilized
in the chronic disease prevention and management.
Turmeric, boswellia, and stinging nettle have been evaluated mostly in preclinical
setups; future studies should be aimed to improve their efficacy and eventually establish
them as affordable, effective, and ‘no side effects causing’ arthritis therapy.

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