ArticlePDF Available

Oral Aloe vera as a treatment for osteoarthritis: A summary

Authors:
  • RAE Solutions

Abstract

While pain relief is a basic tenet of health care, pain is under-treated in the UK (Davies and Mcvicar, 2000) and this issue remains unresolved. This paper suggests that oral Aloe vera could be used in the treatment of chronic non-cancer pain (CNCP), particularly that caused by osteoarthritis (OA). Despite being used as arthritis treatment for centuries (Yoo et al, 2008), evidence of effectiveness of Aloe vera is anecdotal or from small studies. The perceived benefits of prescribing Aloe vera for OA may be twofold: it has utility as an anti-inflammatory agent and also as a prophylactic against the gastrointestinal irritant effects of non-steroidal anti-inflammatory drugs (NSAIDs). Long-term, randomized, controlled studies are still needed to address the lack of evidence informing optimum prescribing of pain medication for people with OA (Cowan, 2007). There is no reason that so called 'nutraceutical' agents should not be subjected to the same rigorous randomized, controlled, double-blind trials as other 'mainstream' drugs. Therefore, it is appropriate to ask whether NSAID treatment and side effects can be improved by the addition of oral Aloe vera. Thus, we may then be in a more informed position to resolve the ongoing 'Pandemonium over Painkillers' (Cowan, 2007).
LONG-TERM CONDITIONS
British Journal of Community Nursing Vol 15, No 6 280
LONG-TERM CONDITIONS
280 British Journal of Community Nursing Vol 15, No 6
Oral Aloe vera as a treatment
for osteoarthritis: a summary
David Cowan
David Cowan, Reader in the Institute for Strategic Leadership and Service Improvement, Faculty of Health and Social Care,
London South Bank University Email: david.cowan@lsbu.ac.uk
ABSTRACT
While pain relief is a basic tenet of health care, pain is under-treated in
the UK (Davies and Mcvicar, 2000) and this issue remains unresolved.
This paper suggests that oral Aloe vera could be used in the treatment of
chronic non-cancer pain (CNCP), particularly that caused by osteoarthritis
(OA). Despite being used as arthritis treatment for centuries (Yoo et al, 2008),
evidence of effectiveness of Aloe vera is anecdotal or from small studies.
The perceived benefits of prescribing Aloe vera for OA may be twofold: it
has utility as an anti-inflammatory agent and also as a prophylactic against
the gastrointestinal irritant effects of non-steroidal anti-inflammatory
drugs (NSAIDs). Long-term, randomized, controlled studies are still needed
to address the lack of evidence informing optimum prescribing of pain
medication for people with OA (Cowan, 2007). There is no reason that so
called ‘nutraceutical’ agents should not be subjected to the same rigorous
randomized, controlled, double-blind trials as other ‘mainstream’ drugs.
Therefore, it is appropriate to ask whether NSAID treatment and side
effects can be improved by the addition of oral Aloe vera. Thus, we may
then be in a more informed position to resolve the ongoing ‘Pandemonium
over Painkillers’ (Cowan, 2007).
KEY WORDS
Pain w NSAIDs w Anti-inflammatory w Quality of life
As noted previously in this Journal, the provision
of pain relief is a basic tenet of health care which
should concern all relevant professionals, purchas-
ers and policy makers (Cowan, 2007). It was also noted
that pain is under-treated in the UK (Davies and McVicar,
2000) and that the economic burden of chronic non-can-
cer pain (CNCP) is high (Reginster, 2002). These disorders,
such as OA are associated with the poorest quality-of-life
issues, and the prevalence of OA is expected to increase as
this affects older people, who constitute an increasing pro-
portion of the population (Reginster, 2002). Pain among
older people is a significant problem and more evidence to
inform prescribing, particularly CNCP, is required (Cowan
2002). These issues remain unresolved.
Osteoarthritis pain
For some time, people have not been satisfied with
approaches to managing OA pain (Jay et al, 1997; Arthritis
News, 2000; Cowan, 2007; Arthritis Research Campaign
(ARC), 2009a). In addition, little evidence exists to inform
prescribing practices regarding the safety and efficacy of
non-steroidal anti-inflammatory drugs (NSAIDs) in older
people and indeed for the whole spectrum of age groups
(Cowan, 2002; 2007). NSAIDs are one of the most widely
used groups of drugs in England, particularly for OA
among older people (Department of Health (DH), 2001;
Jones et al, 2002). However, it has long been apparent that
traditional NSAIDs are not suitable for many people who
are affected by OA, ironically, older people in particular
(Cowan, 2002; 2007). In an age of evidence-based prac-
tice, we need information that will increase the overall
knowledge base regarding medicines that have long been
in common use, about which much is assumed, yet, about
which relatively little is still known (Cowan, 2007). While
previous papers in this Journal have focused on the need
for such research into the use of comparing NSAIDs with
opioid analgesics for CNCP (Cowan, 2002; 2007), this
paper focuses on the suggestion that Aloe vera could be
used in the treatment of such conditions, particularly pain
caused by OA.
Aloe vera has been used for medicinal purposes by
humankind for centuries, including for the treatment of
burns, as an anti-viral, for inhibition of tumour cells and
not least, for treatment of arthritis (Yoo et al, 2008). Despite
this, generally, the evidence for the effectiveness of Aloe
vera is anecdotal or from relatively small studies. However,
this evidence warrants further investigation. Authors have
commented on Aloe vera’s anti-inflammatory properties
when both applied topically and ingested orally (Atherton
1997; Davis, 1997). Furthermore, the findings of pre-clini-
cal and animal studies also support the suggestion that Aloe
vera is an efficacious anti-inflammatory agent (Yagi and
Takeo, 2003; Yoo et al 2008). Yagi and Takeo (2003) found
in an in vitro study that the neutral polysacchar ides of the
Aloe species, aloemannan and acemannan demonstrated
anti-inflammatory, anti-tumour and immuno-suppressive
activities. When examining whether ethanol fractions of
Aloe vera demonstrated in vitro anti-inflammatory activi-
ties, Yoo et al (2008) found that they potently suppressed
the expression of cyclo-oxygenase (COX-2), which is
identical to an anti-inflammatory mechanism of NSAIDs.
Furthermore, in the in vivo arm of their study, Yoo et al
(2008) demonstrated a statistically significant improvement
in the analgesic effect among rats injected with Aloe vera
as compared to controls (n=20, <0.05).
Atherton (1997) found in an ‘n of 1’ study that a patient
British Journal of Community Nursing Vol 15, No 6 281
LONG-TERM CONDITIONS
suffering from juvenile rheumatoid arthr itis and who was
experiencing the abdominal side effects of ceiling NSAID
doses was able to reduce NSAID use by half within an 18-
month period of drinking Aloe vera gel.
In a small uncontrolled study by Blitz et al (1963)
12 patients (age range 24-84, male 70%), clinically diag-
nosed by x-ray as having evidence of duodenal lesions,
were treated with oral Aloe vera gel emulsion. Within
a year, repeat x-ray examination indicated evidence of
complete healing in 11 patients. The 84-year-old patient
unfortunately died, but without recurrence of any lesion.
Obviously, the above evidence needs to be augmented
with more robust investigation. In vitro and animal work
needs to be demonstrated and indeed replicated in statisti-
cally significant samples of humans that are representative
of the demographic profiles of those people who are most
likely to benefit from var ious types of Aloe vera treat-
ment. Thus, more rigorous, properly designed randomized,
controlled, large scale studies are now needed. However,
despite the apparent shortcomings of the current evidence,
the perceived benefits of prescribing Aloe vera for people
with OA can be seen as twofold: Aloe vera has utility as an
anti-inflammatory agent and also as a prophylactic against
the detrimental gastrointestinal irritant effects of NSAIDs.
Clearly, an agent that can provide additional analgesic
and anti-inflammatory effects for people with OA would
constitute a major breakthrough in the treatment of this
potentially debilitating disease. However, the additional
benefit of protection against gastrointestinal damage is also
of particular importance. NSAID-induced gastrointestinal
toxicity has long been among the most common drug-
related serious adverse events in industrialized nations
(Fries, 1991). NSAIDs kill some 16500 Americans each
year, making these drugs the fifteenth largest cause of
death in the USA (New Scientist, 2005). In the UK, an
estimated 12000 episodes of bleeding gastrointestinal ulcer
and 2600 deaths are caused annually by NSAIDs (Moore
and Phillips, 1999).
The implications are significant. Aloe vera could be used
as an anti-inflammatory agent either alone or in combina-
tion with other drugs, particularly NSAIDs. In the case of
the latter, any gastro-protective effect against the damage
caused by NSAIDs would be of considerable benefit, both
in terms of quality of life and cost effectiveness. However,
as previously noted, long-term, randomized, controlled
studies of pain medications are still needed to address the
problem of lack of available evidence to inform the opti-
mum prescribing of pain medication for people with OA
(Cowan, 2007). This applies equally to Aloe vera. There
has been a trend for some time in resorting to comple-
mentary medicines, with many people suffering with pain
caused by OA trying unproven supplements, with few of
these having been convincingly shown to work. Indeed,
a recent report by the Arthritis Research Campaign on
complementary medicines in the use of arthritis found no
randomized controlled trials involving the use of Aloe vera
(ARC, 2009b). There is no reason though that so-called
‘nutraceutical’ agents should not be subjected to the same
rigorous randomized, controlled, double-blind trials that
other ‘mainstream’ drugs are subjected to. For example,
research could be undertaken that focuses on comparing
treatment for OA comprising an oral NSAID against an
oral NSAID combined with an oral Aloe vera adjuvant. It
is possible that the quality of life of OA sufferers could be
improved by more effective analgesia and attenuation of
NSAID side effects afforded by the addition of Aloe vera.
Furthermore, it may be that in some cases, Aloe vera could
replace NSAIDs.
While OA affects several million people in the UK,
many of them older people, there is currently no cure for
this condition, so the emphasis has to be on effective treat-
ment. Current drug treatments to relieve pain caused by
OA are unsatisfactory with many people experiencing dif-
ficulty in finding an agent that affords adequate pain relief
contour99/iStockphoto
LONG-TERM CONDITIONS
282 British Journal of Community Nursing Vol 15, No 6
KEY POINTS
w Pain is a basic tenet of health care.
w Osteoarthritis pain is often undertreated.
w Non-steroidal anti-inflammatory drugs are not always
appropriate or safe.
w Aloe Vera has utility as an anti-inflammatory agent
and as a prophylactic against gastrointestinal irritant
effects.
with no side effects (Cowan, 2007). Data derived from
the proposed research would help to inform optimum
prescribing for people with OA. The growing acceptance
of alternative therapies and the acknowledged severity
of NSAID side effects make it appropriate to now ask
whether NSAID treatment and associated side effects can
be improved by the addition of Aloe vera or indeed, even
replaced by it. Thus, we may then be in a more informed
position to resolve the ongoing ‘Pandemonium over
Painkillers’ (Arthritis News, 2000; Cowan, 2007). BJCN
Addington-Hall J, Fakhoury W, McCarthy M (1998) Specialist palliative care in
non-malignant disease. Palliative Medicine 12: 417-27
Arthritis News (2000) Pandemonium over pain killers. Editorial 90: 4
Arthritis Research Campaign (2009a) Arthritis News. http://tinyurl.com/3ydbs5j
(Accessed13 May 2010)
Arthritis Research Campaign (2009b) Complementary and alternative medicines for
the treatment of rheumatoid arthritis, osteoarthritis and fibromyalgia.http://tinyurl.
com/32crvp4 (Accessed 26 May 2010)
Atherton P (1997) The Essential Aloe Vera. Mill Enterprises, Thornborough Mill,
Buckingham
Blitz JJ, Smith JW, Gerard JR (1963) Aloe Vera Gel in Peptic Ulcer Therapy:
Preliminary Report. Journal of the American Osteopathic Association 62: 731-35
Brandt KD (1993) Should non-steroidal anti-inflammatory drugs be used to
Cowan DT (2002) Chronic Non-Cancer Pain in Older People: Current
Evidence for Prescribing. Br J Community Nurs 7: 420-25
Cowan DT (2007) Pandemonium Over Painkillers Persists. Br J Community Nurs
12: 166-69
Davies J, McVicar A (2000) Issues in effective pain control 2: from assessment to
management. Int J Palliat Nurs 6: 162-69
Davis RH (1997) Aloe Vera: A Scientific Approach. Vantage Press, New York
Department of Health (2001) Prescription Pricing Authority. Prescription Analysis and
Cost. The Stationary Office, London
Fries JF (1991) NSAID Gastropathy: the second most deadly rheumatic disease?
Epidemiology and Risk Appraisal. J. Rheumatology 18(supp 28): 6-10
Jay L. Goldstein MD, Leanne R. (1997) Management of NSAID-Induced
Gastropathy: An economic decision analysis. Clin Ther 19(6):1496-1508
Jones AC, Coulson K, Muir K et al (2002) A nurse-delivered advice intervention
can reduce chronic non-steroidal anti-inflammatory drug use in general prac-
tice: a randomised controlled trial. Rheumatology 41: 14-21
Moore RA, Phillips CJ (1999) Cost of NSAID adverse effects to the UK National
Health Service. Journal of Medical Economics 2: 45-55
Szalavitz M (2005) Opioids could offer mass market pain relief. New Scientist
2484: 19
Yagi A, Kabash A, Mizuno K, Moustafa SM, Khalifa TI, Tsuji H (2003) Radical
scavenging glycoprotein inhibiting cyclooxygenase-2 and thromboxane A2
synthase from aloe vera gel. Planta Med Mar 69(3): 269-71
Yoo EA, Kim SD, Lee WM et al (2008) Evaluation of antioxidant, antinociceptive,
and anti-inflammatory activities of ethanol extracts from Aloe saponaria Haw.
Phytother Res 22(10): 1389-95
... It should be noted that high-quality randomized controlled trials (RCT's) are warranted to confirm this. Another study examined the use of Aloe vera, which has a possible pain-reducing effect due to its anti-inflammatory properties; however, positive results can only be withheld from anecdotal evidence [47]. Recently, marine oil, rather widely used, appeared to be a promising painkiller, although dependent of the type of arthritis: most pronounced in rheumatoid arthritis, but much less so in osteoarthritis [48]. ...
... Finally, it is also a likely possibility to use agonists of inhibitory receptors on the outside of the C-fiber plasma membranes, with taurine possibly being the most suitable, because it is almost entirely non-toxic, even when given in doses more than 1 g per day, and at the same time it is an important intracellular antioxidant both in skeletal muscle and the heart, and it is also antimutagenic [52]. This is in sharp contrast to the commonly used analgesic acetaminophen (paracetamol), which is very likely a mitochondrial mutagen in cell types expressing CYP2E1 or other paracetamoldegrading cytochrome P450s, which at least in nonhuman mammalian species includes cells in the hippocampus [46,47]. Taurine, a catabolite of the amino acid cysteine, in the dose range of 50-200 mg/kg/day can dampen inflammation, muscle soreness, and pain [21,126]. ...
Article
Many serious inflammatory disorders and nutrient deficiencies induce chronic pain, and anti-inflammatory diets have been applied successfully to modify the inflammatory symptoms causing chronic pain. Numerous scientific data and clinical investigations have demonstrated that long-term inflammation could lead to an inappropriate or exaggerated sensibility to pain. Also, some non-steroidal anti-inflammatory drugs (NSAID), which directly act on the many enzymes involved in pain and inflammation, including cyclooxygenases, are used to dampen the algesic signal to the central nervous system, reducing the responses of soft C-fibers to pain stimuli. On the other hand, there are a few reports from both health authorities and physicians, reporting that decreased transmission of pain signals can be achieved and improved, depending on the patient’s dietary habit. Many nutrients, as well as a suitable level of exercise (resistance training), is the best method for improving the total mitochondrial capacity in muscle cells, which can lead to a reduction in sensitivity to pain, particularly by lowering the inflammatory signaling to C-fibers. According to the current literature, it could be proposed that chronic pain results from the changed ratio of neuropeptides, hormones, and poor nutritional status, often related to an underlying inflammatory disorder. The current review also evaluates the effective role of nutrition-related interventions on the severity of chronic pain. This review pointed out that nutritional interventions can have a positive effect on pain experience through the indirect inhibitory effect on prostaglandin E2 and attenuation of mitochondrial dysfunction caused by ischemia/reperfusion in skeletal muscle, improving the intracellular antioxidant defense system. These data highlight the need for more nutrition studies where chronic pain is the primary outcome, using accurate interventions. To date, no nutritional recommendation for chronic pain has been officially proposed. Therefore, the goal of this article is to explore pain management and pain modulation, searching for a mode of nutrition efficient in reducing pain.
... The extract perhaps may have mimicked the mechanism of action of the conventional drugs or exert other mechanism to reduce the pain perception. Similar to this proposed mechanism of action exhibited by the extract, are the reports of Cowan (2007) and Shahraki et al. (2014) who gave submission that methanol and ethanol extracts from Aloe vera have been proven to have analgesic activity in vivo and in vitro respectively by suppressing the expression of cyclo-oxygenase enzymes. The dose-dependent relief of pain perception observed in this study correlates with the reports of Saptarini and Deswati, (2015), Ashfaq et al. (2016) and Anisuzzman et al. (2017) who also reported a dose-dependent analgesic activity using same model. ...
Article
Full-text available
A study to investigate the ethnobotanical use of Luffa cylindrica (L.) Roem leaf in pain and fever relief was carried out. Methanolic extract was obtained from leaves of Luffa cylindrica and was subjected to phytochemical screening using standard procedure of Trease and Evans (1989). Analgesic effect of the plant was carried out by inducing pain in mice in the form of abdominal constriction using glacial acetic acid. The antipyretic property of the plant was also investigated in rats by yeast-induced pyrexia. Phytochemical analysis of methanolic extract of L. cylindrica leaves revealed the presence of saponins, tannins, phenolics, alkaloids, triterpenes, flavonoids and cardiac glycosides in appreciable amounts. The extract showed a significant (p < 0.05) inhibition of abdominal constriction in mice induced with pain sensation in a dose-dependent manner. Antipyretic activity of the plant was evident by a significant reduction (p < 0.05) in rectal temperature at all investigated doses (100, 200 and 400 mg/kg body weight) and was time dependent. Methanolic extract of Luffa cylindrica leaves exhibited potent analgesic and antipyretic activities which therefore supports the ethnopharmacological use of the plant.
... This increased consumer popularity is reflected by the shift in market availability of aloe juices from specialty outlets to mainstream groceries and drug stores [2] . Consumer interest in aloe beverages stems from the association of aloe juice with a variety of both anecdotal and experimental research-supported health benefits including the prevention or treatment of various tumors [3,4] and arthritis [5] , reduction in symptoms of diabetes [6] enhancement of immunity [7] and decreased cholesterol levels [8] . Present dietary scenario necessitates exploring the possibility of incorporating novel ingredients in commonly consumed foods rather than developing new food product [16] . ...
... The disease is mostly in the category of "sores" of traditional Chinese medicine, Local treatment combined with systemic therapy [14]. Oral ulcers are not only associated with these factors, but also with environmental factors, systemic diseases (gastric ulcer, duodenal ulcer, cirrhosis, biliary tract disease [15], etc.), psychological factors [16] (interpersonal sensitivity, depression, anxiety, etc.) related. Most of the existing models showed significant tenderness, ulcer around the mucosal congestion, ulcers were round or oval, surrounded by flush around; but the biochemical indicators failed to show it. ...
... This increased consumer popularity is reflected by the shift in market availability of aloe juices from specialty outlets to mainstream groceries and drug stores [2] . Consumer interest in aloe beverages stems from the association of aloe juice with a variety of both anecdotal and experimental research-supported health benefits including the prevention or treatment of various tumors [3,4] and arthritis [5] , reduction in symptoms of diabetes [6] enhancement of immunity [7] and decreased cholesterol levels [8] . Present dietary scenario necessitates exploring the possibility of incorporating novel ingredients in commonly consumed foods rather than developing new food product [16] . ...
... It has been proven through the in vitro study which shows that the extract, could potentially suppress the expression of cyclo-oxygenase (COX-2) (Shahraki et al., 2014), as one of the way the NSAID medicine works. It has also been proven through in vivo where ethanol and methanol could significantly increase the analgesic effect when it is injected to rats (Cowan, 2007). The analgesic activity is derived from the existence of carboxypeptidase and bradikinase enzyme which function is to lessen or to relieve the pain. ...
Conference Paper
Pain is one signal of tissue damage due to mechanical, chemical or physical stimulation. Analgesics are class of drugs used to treat pain. Generally analgesics side effect is peptic ulcer. Indonesian society, hereditary and traditionally, used natural products as a treatment. Plants produce secondary metabolites to overcome various diseases. Pharmacological effects on natural products are due to the synergism effect and polivalent activity. This paper aims to review the potential analgesic agents and action of mechanism of phytochemicals from Indonesia natural products for the further improvement of its utility in curing pain and maintaining good health. The review on this article using online and offline literature. Based on this, the pain can be overcome by using various natural products including Aloe Vera (Aloe vera), Papaya (Carica papaya), Noni (Morinda citrifolia), Ginger (Zingiber officinale), Bitter (Andrographis paniculata), Betel (Piper betle), and Turmeric (Curcuma domestica). In general, the mechanism of the plants to relieve the pain is by suppressing the expression of cyclo-oxygenase (COX-2).
... Despite being used as arthritis treatment for centuries, evidence of effectiveness of Aloe vera in anecdotal or from small studies on osteoarthritis (OA).The perceived benefits of prescribing Aloe vera for OA may be twofold: it has utility as an anti-inflammatory agent and also as a prophylactic against the gastrointestinal irritant effects of non-steroidal anti-inflammatory drugs [50] . ...
Article
Some of the phytochemicals present in Aloe vera can provide relief to rheumatoid arthritis (RA) patients through promoting wound healing as well as reducing inflammation and relieving pain, which are common symptoms of RA patients. Emodin in Aloe vera latex inhibited various inflammation kinases and signaling pathways in vitro and in vivo models of pancreatitis, arthritis and atherosclerosis. Novel molecular targets of emodin have been revealed in therapeutic uses based on animal studies, but only limited data related to the bioavailability, pharmacokinetics and metabolism of emodin are available till now. Western blot and quantitative PCR confirmed aloe emodin in Aloe vera latex up-regulating galectin-3 expression; recombinant galectin-3 augmented expression of antiviral genes IFN-β/r, PKR and 2’,5’-oligoadenylate synthase in infected cells, agreeing with expression pattern of those treated with aloe emodin. Galectin-3 which is a β-galactoside-binding animal protein, is evolutionarily highly conserved and it has been demonstrated in RA patients to advance the transformation of synovial fluid into fibrotic tissue, in addition to activating osteoclasts, producing severe debilitation in patients. More work of emodin and aloe emodin needs to done to fully translate the observed preclinical findings in RA and related complications. Aloe pectins obtained from Aloe vera inner leaf gel were distinguished by size: the room temperature extraction generated a high molecular weight (HMW), whereas extraction with heating produced a low molecular weight pectin. The HMW aloe pectin calcium gel is highly efficient encapsulating agent suitable for controlled release of pharmacological substance, such as protein, antibodies and vaccines. Inhibition of galectin-3 mediated cellular interaction by pectin from dietary sources, such as citrus pectin, was revealed through haemagglutination significantly. The up-regulation of galectin-3 expression by potential therapeutics, such as emodin, aloe emodin, aloe pectin was focused in present review. In addition, protein and/or lectin having anti-inflammatory, radical scavenging and anti-oxidant enzymes’ activity in Aloe vera gel were fully expected as putative prophylactic and biological response modifiers in the treatment of a broad range of inflammatory diseases such as RA.
... Lee et al. (1995) reported that dichloromethane extracts of AG is with angiogenic activity. Gel of the species is also used for the treatment of osteoarthritis (Cowan 2010;Maia-Filho et al. 2010). Tomasin and Gomez-Marcondes (2011) reported that oral administration of A. vera and honey reduces Walker tumor growth by decreasing cell proliferation and increasing apoptosis in tumor tissue. ...
Article
Full-text available
Aloe vera (L.) Burm. f. is a succulent shrubby perennial of the family Asphodelaceae (commonly known as ‘Natural healer’, ‘Lily of the desert’, ‘Plant of immortality’, ‘Miracle plant’, ‘The Wand of Heaven’, etc.) with immense therapeutic uses not withstanding its potential significance in cosmetic and food industries. The plant is the source of two products, gel and latex (commercially aloe products are pills, jellies and creams, drinks, liquid, sprays, ointments and lotions) obtained from its fleshy leaves. This unique plant also belongs to a larger plant family, the ‘Xeroids’. Considering the pharmacological and other potential uses of A. vera, an updated overview has been conducted on the species involving all essential aspects to provide necessary information to researchers for effective utilization of the species in human welfare.
Article
Full-text available
Obesity is a significant health concern, as it causes a massive cascade of chronic inflammations and multiple morbidities. Rheumatoid arthritis and osteoarthritis are chronic inflammatory conditions and often manifest as comorbidities of obesity. Adipose tissues serve as a reservoir of energy as well as releasing several inflammatory cytokines (including IL-6, IFN-γ, and TNF-α) that stimulate low-grade chronic inflammatory conditions such as rheumatoid arthritis, osteoarthritis, diabetes, hypertension, cardiovascular disorders, fatty liver disease, oxidative stress, and chronic kidney diseases. Dietary intake, low physical activity, unhealthy lifestyle, smoking, alcohol consumption, and genetic and environmental factors can influence obesity and arthritis. Current arthritis management using modern medicines produces various adverse reactions. Medicinal plants have been a significant part of traditional medicine, and various plants and phytochemicals have shown effectiveness against arthritis and obesity; however, scientifically, this traditional plant-based treatment option needs validation through proper clinical trials and toxicity tests. In addition, essential oils obtained from aromatic plants are being widely used as for complementary therapy (e.g., aromatherapy, smelling, spicing, and consumption with food) against arthritis and obesity; scientific evidence is necessary to support their effectiveness. This review is an attempt to understand the pathophysiological connections between obesity and arthritis, and describes treatment options derived from medicinal, spice, and aromatic plants. (Full-text link: https://www.mdpi.com/2072-6643/14/5/985)
Article
Full-text available
Arthritis is an chronic, inflammatory, systemic autoimmune disease characterized by pain, swelling and stiffness. Allopathic medications have been prescribed to alleviate symptoms of this disease which results into associated side effects like gastrointestinal bleeding and bone loss (osteoporosis).The use of herbal medicine becoming popular due to toxicity and side effects of allopathic medicines. Medicinal plants play an important role in the development of potent therapeutic agents. In this review an attempt has been done to highlight the work on medicinal plants having Anti-arthritic potential. The present paper also involves various plant drugs along with their chemical constituents and pharmacological profile which focus on the dose administered, bioactive extract involved in anti-arthritic mechanism. This work stimulates the researchers for further research on the potential use of medicinal plants having anti- arthritic property.
Article
Full-text available
Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with gastrointestinal problems, notably dyspepsia and bleeding. These adverse effects are costly both in terms of acute hospital admissions and in co-prescribing of gastroprotective agents. The costs of these interventions has been estimated for the National Health Service (NHS) in the UK on the basis of a typical Primary Care Group (PCG) of 100,000 people, the whole population, and for the average patient prescribed an NSAID. The annual burden of NSAID-related gastrointestinal adverse effects to the NHS is large. The middle estimate for an average PCG was £435,000 (range £290,000 to £633,000). The middle estimate for the UK was £251 million (range £166 million to £367 million). The middle cost per patient prescribed an NSAID was £48 (range £32 to £70). As much as half of all acid-suppressing prescribing in the UK may be for NSAID-related gastrointestinal effects.
Article
Full-text available
The objective of this study was to investigate how many patients who die from causes other than cancer might benefit from specialist palliative care. This was achieved by secondary analysis of data from the Regional Study of Care for the Dying, a retrospective national population-based interview survey. The investigation involved 20 self-selected English health districts, nationally representative in terms of social deprivation and most aspects of health services provision. A total of 3696 patients were randomly selected from death registrations in the last quarter of 1990; an interview concerning the patient was completed 10 months after the death by bereaved family, friends or officials. The results show that a third (243/720) of cancer patients who were admitted to hospices or had domiciliary palliative care scored at or above the median on three measures of reported symptom experience in the last year of life. That is the number of symptoms (eight or more), the number of distressing symptoms (three or more) and the number of symptoms lasting more than six months (three or more). A total of 269 out of 1605 noncancer patients (16.8%) fulfilled these criteria. On this basis, it is estimated that 71 744 people who die from nonmalignant disease in England and Wales each year may require specialist palliative care. An increase of at least 79% in caseload would, therefore, be expected if specialist palliative care services were made fully available to noncancer patients. This is a conservative estimate, as non-cancer patients were matched to only one-third of cancer patients who had specialist palliative care. It is concluded that clinicians and patient groups caring for patients with advanced nonmalignant disease must work together with specialist palliative care services and with health commissioners to develop, fund and evaluate appropriate, cost-effective services which meet patient and family needs for symptom control and psychosocial support.
Article
Full-text available
To find out whether a nurse-delivered educational package can reduce chronic oral non-steroidal anti-inflammatory drug (NSAID) usage in general practice. A prospective randomized controlled trial with assessment of economic cost/benefits was carried out in five general practices in Nottinghamshire with computerized prescribing systems, representing a mix of rural/urban and fundholding/non-fundholding practices. Patients suffering from non-malignant, non-inflammatory musculoskeletal pain received repeat prescriptions for oral NSAIDs. Two hundred and twenty-two patients were randomized to a control group (simple advice regarding NSAID use) or an intervention group (asked to withdraw their NSAIDs and employ appropriate alternative drug and non-drug therapies). All advice was supported by patient literature and delivered by a nurse practitioner trained in musculoskeletal assessment. The primary outcome measure was change in NSAID use 6 months after the intervention. Secondary outcome measures were changes in health and quality of life (SF-36 and EQ-5D questionnaires) and drug, health service and patient costs. An extra 28% of patients in the intervention group either stopped taking oral NSAIDs or reduced dosage by > or =50% at 6 months compared with controls. There was no detrimental effect on health and well-being. Oral NSAID prescription costs were significantly lowered in the intervention group but not in the control group. A non-significant increase in total drug prescription costs occurred in both groups. Nurse-based intervention can reduce chronic NSAID usage and costs in primary care and would be cost-effective if maintained in the long term. This intervention package would be readily applicable in primary care.
Article
Aloe species are traditionally prescribed for hypertension, burning, and rheumatoid arthritis. To elucidate the mechanism of the antihypertensive and anti-inflammatory activities of this herb, the ethanol fraction from A. saponaria Haw. was evaluated for antioxidative activity using xanthine-xanthine oxidase (XO) assay, 2,2-Diphenyl-lpicrylhydrazyl radical (DPPH) assay, lipopolysaccharide (LPS)-induced nitric oxide (NO) production in RAW 264.7 cell, and antinociceptive activity using a tail-flick assay and hind paw pressure assay in cisplatin-treated hyperalgesic rats. The ethanol fraction displayed potent antioxidative activities in XO assay. In addition, ethanol fractions showed potent scavenging effects in DPPH assay. We next examined whether ethanol fractions showed anti-inflammatory activities. Ethanol fractions significantly suppressed NO production from LPS-activated RAW264.7 cells. As expected, ethanol fractions dose-dependently inhibited the messenger RNA expression of inducible NO synthase (iNOS). Moreover, ethanol fractions potently suppressed the expression of cycloxygenase (COX)-2 and granulocyte-macrophage colony-stimulating factor (GM-CSF), which are stimulated by LPS in RAW264.7 cells. In addition, ethanol fractions significantly blocked cisplatin-induced hyperalgesia using tail-flick assay and hind paw pressure test in rats. Taken altogether, ethanol extracts of aloe may be useful as a functional food or as a drug against reactive oxygen species (ROS) mediated diseases.
Article
Nonsteroidal antiinflammatory drug (NSAID) gastrointestinal (GI) pathology (gastropathy) accounts for over 70,000 hospitalizations and over 7,000 deaths annually in the United States. Not all patients, however, are at equal risk. Major risk factors for serious events (hospitalization or death) in patients with rheumatoid arthritis (RA) are age, level of disability, concurrent use of prednisone, prior NSAID side effects and NSAID dose. For the average patient with RA, the chance of hospitalization or death due to a GI event is about 1.3 to 1.6% over the course of 12 months and about 1 in 3 over the entire course of the disease. Subgroups of patients have risks ranging from nearly zero to as high as 4 or 5%/years. A simple scoring system based on multivariate analysis of risk factors permits the clinician to directly calculate the risk for the individual patient.
Article
The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with a 2% to 4% annual incidence of serious gastrointestinal complications. These adverse clinical outcomes, and the strategies used to prevent their occurrence, translate into a significant economic burden. A decision-analysis model was constructed to contrast the 6-month costs associated with various approaches to preventing and managing NSAID-induced gastropathy and to evaluate the economic impact of two treatment regimens using fixed-dose formulations of diclofenac/misoprostol. After incorporating expected medical out-comes and predicted practice patterns, 6-month per-patient costs were derived from the model for each of five treatment regimens: (1) NSAID alone; (2) NSAID with a histamine2-receptor antagonist; (3) NSAID with coprescribed misoprostol; (4) diclofenac/misoprostol 50 mg/200 micrograms TID/BID; and (5) diclofenac/misoprostol 75 mg/200 micrograms BID. The combined diclofenac/misoprostol regimens demonstrated an 18.6% per-patient cost advantage compared with the combined NSAID regimens. Based on a 6-month period, this cost savings translated into a $214.00 per-patient overall cost savings ($1153.00 per patient for NSAID regimens versus $939.00 for diclofenac/misoprostol regimens). The magnitude of this difference was verified by Monte Carlo simulation. Despite the considerable cost difference, sensitivity analyses revealed that our model was robust and that no single variation substantially influenced the results. Given the lack of long-term prospective, comparative clinical-outcomes studies in this area, this decision analysis provides guidance to clinicians in developing a rational and cost-effective approach to the treatment of patients requiring chronic NSAID therapy.
Article
In the first of these two articles, Davies and McVicar (2000) reviewed issues regarding pain assessment and examined the best means of providing the underpinning education. In the second article, pain management issues are considered while focusing on the factors that influence the translation of planned care into action. The literature identifies that inadequate pain control continues to be a problem and, assessment issues apart, suggests that a lack of knowledge of analgesic pharmacology, and resultant misconceptions among both health professionals and patients, are major factors. This article provides an overview of the rationale for the use of analgesics by considering their biological actions, how the drugs fit into the analgesic 'ladder' (World Health Organization (WHO), 1994), and how they relate to the principles of managing chronic pain. The most common misconceptions concern the use of morphine and arise as a consequence of a lack of understanding of this drug. Further issues relating to the multidimensional aspects of pain and the need for psychosocial care and sound re-evaluations of the continuing effectiveness of pain control are identified. Finally, some of the professional issues that affect the transference of assessment and knowledge are examined. Nurses have a pivotal role in pain assessment and it is suggested that education must play a role in the development of genuine interprofessional working which will allow nurses to have more influence in formulating the care strategy and subsequent action.
Article
Chronic pain is a serious problem for many older people, yet its management in this population is often less than satisfactory. The high incidence of toxicity and side effects with some medications and irrational fears of opioid dependence are significant barriers to effective pain management. In this article, the research evidence relating to these issues is examined, and their impact on nurse prescribing considered. More studies are needed to assess the veracity of opposing arguments, and to support effective assessment and prescribing by nurses.
Article
An acitve glycoprotein fraction containing 58 % protein was isolated from Aloe vera gel by precipitation with 55 % ammonium sulfate followed by gel permeation using DEAE-Sephacel A-25, Sepharose 6B and Sephadex G-50 columns in a yield of 3 × 10⁻³ %. The glycoprotein fraction showed a single band corresponding to a subunit of verectin at the same position when stained with both Coomassie brilliant blue and periodic acid-Schiff reagents on 18 % SDS-PAGE. The molecular weight (14 kDa) was confirmed by Sephadex G-50 column chromatography. The glycoprotein fraction showed a radical scavenging activity against superoxide anion generated by the xanthine-xanthine oxidase system as well as inhibition of cyclooxygenase-2 and reduction of thromboxane A2 synthase level in vitro. Abbreviations BPB:bromo phenol blue BSA:bovine serum albumin CBB:coomassie brilliant blue DMPO:5,5-dimethyl-1-pyrroline N-oxide EDTA:edetic acid GSH:glutathione NBT:nitro blue tetrazolium SDS-PAGE:sodium dodecylsulfate polyacrylamide gel electrophoresis XOD:xanthine oxidase