Devil's Claw ( Harpagophytum procumbens ) as a Treatment for Osteoarthritis: A Review of Efficacy and Safety

Complementary Medicine Research Unit, Primary Medical Care, University of Southampton, Aldermoor Health Centre, Southampton, Hampshire, United Kingdom.
The Journal of Alternative and Complementary Medicine (Impact Factor: 1.59). 01/2007; 12(10):981-93. DOI: 10.1089/acm.2006.12.981
Source: PubMed


Osteoarthritis (OA) is a highly prevalent musculoskeletal disorder. Conventional treatment (i.e., the use of nonsteroidal anti-inflammatory drugs-NSAIDs) is associated with well-documented adverse effects. Devil's Claw (Harpagophytum procumbens) a traditional South African herbal remedy used for rheumatic conditions, may be a safer treatment option. To date, 14 clinical trials have assessed its efficacy/ effectiveness in OA.
To address the two main questions of importance to clinicians: (1) Does Devil's Claw work for the treatment of OA, and (2) Is it safe?
A review of the literature on Devil's Claw and OA from 1966 to 2006 was performed using multiple search databases, monographs, and citation tracking. Relevant trials in all languages were identified and included. Both internal validity (i.e., adequacy of the dosage and period of treatment for this condition, reporting of randomization, rates of dropout, blinding, and statistical analysis) and external validity (i.e., inclusion/ exclusion criteria, baseline characteristics of the study populations, trial setting, and the appropriateness of the outcome measures of the trials) were assessed.
Fourteen studies were identified: eight observational studies; 2 comparator trials (1 open, the other randomized to assess clinical effectiveness); and 4 double-blinded, placebo-controlled, randomized controlled trials to assess efficacy. Many of the published trials lacked certain important methodological quality criteria. However, the data from the higher quality studies suggest that Devil's Claw appeared effective in the reduction of the main clinical symptom of pain. The assessment of safety is limited by the small populations generally evaluated in the clinical studies. From the current data, Devil's Claw appears to be associated with minor risk (relative to NSAIDs), but further long-term assessment is required.
The methodological quality of the existing clinical trials is generally poor, and although they provide some support, there are a considerable number of methodologic caveats that make further clinical investigations warranted. The clinical evidence to date cannot provide a definitive answer to the two questions posed: (1) Does it work? And (2) is it safe? A definitive high-quality trial that addresses the necessary methodologic improvements noted is needed to answer these important clinical questions.

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    • "Data from the high-quality study by Lecomte and Costa (1992) cited in Brien (2006) and also the study by Chantre et al (2000) indicated that Devil's Claw appears effective in the reduction of the main clinical symptom of pain. However, definitive high-quality trials to assess both effectiveness and efficacy are needed, taking into account the methodological improvements identified, to determine whether this remedy is beneficial for the treatment of OA (Brien 2006). "
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    DESCRIPTION: Traditional Western Herbal Medicine
    Full-text · Research · Sep 2015
    • "The EMA Committee on Herbal Medicinal Products (HMPC) has issued a draft monograph for discussion in which an indication for the treatment of mild articular pain and mild digestive disorders is proposed on the basis of traditional use (EMEA, 2008) . The efficacy of Hp-containing products in the treatment of lower back pain or osteoarthritis has been tested in several clinical trials and these have been reviewed (Brien et al., 2006; Denner, 2007; Gagnier et al., 2007; Loew and Rietbrock, 1996). There is good evidence of the efficacy and good tolerability, including equivalence with NSAIDs and superior tolerability (Chantre et al., 2000; Chrubasik et al., 1999, 2002, 2003, 2004; Gagnier et al., 2007; Wegener and Lupke, 2003). "
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    ABSTRACT: Harpagophytum procumbens (Hp) is often used in the supportive treatment of inflammatory and degenerative diseases of the skeletal system. Although the clinical efficacy in osteoarthritis has been demonstrated in clinical trials, the molecular target(s) of Hp are unclear. This study quantified the effects of the ethanol Hp extract (60% v/v ethanol, sole active ingredient of Pascoe®-Agil), on the expression and release of the major pro-inflammatory mediators in LPS-stimulated human monocytes and the intracellular signalling pathways involved in inflammation. The Hp extract dose-dependently inhibited the release of TNFα as well as that of interleukin (IL)-6, IL-1β and prostaglandin E₂ (PGE₂). The Hp prevented TNFα and IL-6 mRNA expression in human monocytes and cyclooxygenase-2 (COX-2) in RAW 264.7 cells. Furthermore, the Hp extract inhibited LPS-stimulated AP-1-mediated gene transcription activity and binding to the AP-1 response elements. The extract had no effect on the LPS-induced binding of nuclear factor-κB in RAW 264.7 cells, on LPS-induced degradation of IκBα or on LPS-induced activation of mitogen-activated protein kinases (MAPK), p38MAPK and JNK in human monocytes. The data indicate that a standardized ethanol Hp extract inhibits induction of pro-inflammatory gene expression, possibly by blocking the AP-1 pathway. This is novel evidence of a possible mechanism of action of this antiinflammatory drug.
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