Presented by

Dr. Sudhakar Kokate

Director PPRC, India

About disease

∞ Inflammation of a joint characterised by pain,

swelling and limitation of a joint movement

∞ Osteo-arthritia (OA)

– Knee and hip…debilitating disease affected

– More in women than male

– Increases with ageing

PPRC/INDIA 01

About disease

∞ Rheumatoid arthritis (RA)

- Most common disease

- Affects 1% of world population

- Involves many joints

PPRC/INDIA 02

About disease

PPRC/INDIA 03

Drugs in Practice

∞ Non-steroidal anti-inflammatory drugs

(NSAIDS)

…. For symptomatic treatment of

OA and RA

Side effects risk in use

- many limitations

PPRC/INDIA 04

Side effects of NSAIDS drugs

∞ Propensity to cause stomach ulcers

- GI bleeding

- Perforations

∞ New cox – 2 drugs

- Long term use may increase the risk

of stroke and heart attack

PPRC/INDIA 05

∞ USFDA withdrawn from market

∞ Biologics drugs

(Anti-bodies for IL-1, IL-6, TNF-ɑ)

Benefits:

- Reduce inflammation

- Joint destruction

PPRC/INDIA 06

Side effects of NSAIDS drugs

Disadvantages

∞ Not effective universally

∞ Higher costs

∞ Severe side effects as life – threatening

infections

∞ Increases risk of malignances

PPRC/INDIA 07

Emerging CAM therapy

∞ CAM: Complementary and Alternative

Medicine

∞ Use of accu-puncture

∞ 60-90% of dissatisfied patients use this

therapy

PPRC/INDIA 08

Symptoms of Arthritis

∞ Caused due to the aggravation of vata

(air) dosha and accumulation of Ama

(toxins) gets deposited in the weak areas

of the body

∞ Weak digestion, constipation, overeating

and little physical activity

PPRC/INDIA 09

Osteoarthritis

∞ Most common joint disease

∞ Women >55 yrs age affected

∞ 12% incidences of Osteoarthritis in India

∞ Condition of synovial joints characterised

by cartilage loss with peri-articular

response

PPRC/INDIA 10

Emerging new trends

in

the development

of

PhytoDrugs

In

Arthritis PPRC/INDIA 11

Ashwagandha Withania somnifera

PPRC/INDIA 12

Withania somnifera

• The root contains traces of an essential oil

• It is effective in the treatment of rheumatic

infections

• The water soluble portion of the root extract

contains indefinite amorphous substances and a

quantity of sugar

PPRC/INDIA 13

Ajwain Trachyspermum ammi

PPRC/INDIA 14

Trachyspermum ammi

• The seeds are used as a household remedy for

indigestion, colic, diarrhoea, flatulence and asthma

• In arthritis it is quite effective

• Ref. The Ayurvedic Pharmacopoeia of India, New

Delhi Part I, Vol. I, II

• Waltis T.E. - Textbook of Pharmacogney PPRC/INDIA 15

Alfalfa Medicago sativa

PPRC/INDIA 16

Medicago sativa

• It contains 1-canavanine, an amino acid causes

curing properties against joint pain

PPRC/INDIA 17

Angelica Angelica archangelica

PPRC/INDIA 18

Angelica archangelica

• It is used in European folk medicine

• Western variety has 12 anti-inflammatory

constituents, 10 anti-spasmodic constituents and 5

anodyne ones

• Chinese species is sold in North America in the

name of dang guei or dang quai

PPRC/INDIA 19

Black cohosh Cimicifuga racemosa

PPRC/INDIA 20

Cimicifuga racemosa

• There are five species worldwide that have been

used to treat rheumatism

• It contains aspirin-like substances and the root of

the plant is very beneficial

• Other anti-inflammatory and anti-spasmodic

constituents

PPRC/INDIA 21

Celery Apium graveolens

PPRC/INDIA 22

Apium graveolens

• Eating raw or cooked celery seeds or large amount

of this plant to treat rheumatism arrived in North

America

• Celery is rich in minerals

• 1 cup of celery contains 350 mg of potassium

PPRC/INDIA 23

Chaparral Larrea tridentata

PPRC/INDIA 24

Larrea tridentata

• It is widely promoted in health food-stores as a

treatment for arthritis

• Externally as a wash or internally as a tea

PPRC/INDIA 25

Cat’s claw Uncaria tomentosa, Uncaria guianensis

PPRC/INDIA 26

Uncaria tomentosa, Uncaria guianensis

• This plant contains oxindole alkaloids tannis,

quinoxic acid glycosides, flavonoids and sterols

• Extract of this herb is effective in arthritis

PPRC/INDIA 27

Devdaru Cedrus deodara

PPRC/INDIA 28

Cedrus deodara

• It is acute and pungent in action

• This is one of the most useful drug

• It is used in combination with other anti-pyretics

PPRC/INDIA 29

Ginseng liquor Panax quinquefolius

PPRC/INDIA 30

Panax quinquefolius

• It contains ginsenosides which has a variety of

pharmacological actions

• It handles a wide variety of stresses effective in

rheumatism

PPRC/INDIA 31

Garlic Allium sativum

PPRC/INDIA 32

Allium sativum

• It possesses anti-inflammatory anti-arthritic, hypo-

lipidemic, anti-coagulant, hypo-proteomic, hypo-

cholesterolemic, anti-bacterial, anti-fungal, anti-

hypersensitive and hypo-glycaemic action

PPRC/INDIA 33

Gandhaprasarini Paederia foetida

PPRC/INDIA 34

Paederia foetida

• This plant exhibits disease modifying anti-

rheumatic activity

• It also helps in treating inflammatory disorders

PPRC/INDIA 35

Ginger Zingiber officinale

PPRC/INDIA 36

Zingiber officinale

• Chromatographic fraction results showed that most

of the fractions containing gingerols / gingerol

derivatives were excellent inhibitors of LPS-induced

PGE-2 production

• Ginger extract when administered daily for 4 weeks

caused significant reduction in PGE-2 levels in rats

PPRC/INDIA 37

Green tea Camellia sinensis

PPRC/INDIA 38

Camellia sinensis

• One of the most commonly consumed beverages in

the world with no side-effects

• Sufficient experimental proof on the effect of

Green tea’s anti-inflammatory and chondro-

protective properties at molecular level

PPRC/INDIA 39

Hop tea Humulus lupulus

PPRC/INDIA 40

Humulus lupulus

• It contains 32 constituents that have anti-

inflammatory activities

• 10 out of them may act as sedative

• It is popular remedy for rheumatism

PPRC/INDIA 41

Karpura Cinnamomum camphora

PPRC/INDIA 42

Cinnamomum camphora

• When applied on the affected area camphor may

redden the skin and produce a warm sensation

• When rubbed into painful, stiff joints, ligaments

and muscles, it provides soothing “camphor-ice”

relief

PPRC/INDIA 43

Pepper Piper nigrum

PPRC/INDIA 44

Piper nigrum

• As an external application, it dilates the superficial

vessels and acts as a counter-irritant

• It is used as an analgesic liniment for myalgia and

rheumatic pains

PPRC/INDIA 45

Liquorice Glycyrrhiza glabra

PPRC/INDIA 46

Glycyrrhiza glabra

• It acts on the body without any harmful side-effects

• It has significant anti-inflammatory and anti-allergy

activity

• It has been historically in the treatment of

inflammation, allergy and asthma

PPRC/INDIA 47

Mustard plaster Brassica alba, Brassica juncea

PPRC/INDIA 48

Brassica alba, Brassica juncea

• Popular counter-irritant treatment for arthritis

• Active principle – allyl-isothiocyanate

• Crush the seeds in grinder, moisten the mixture

with vinegar and sprinkle the flour. Spread mixture

on cloth and place it on skin for > 20 mins. After

removal, wash the affected area

PPRC/INDIA 49

Pineapple Ananas comosus

PPRC/INDIA 50

Ananas comosus

• Active principle – “Bromelain” helps prevent

inflammation

• Athletic trainers recommend pineapple for athletes

to prevent and treat sports injury

• Bromelain help the body to get rid of immune

antigen complex compounds that are implicated in

arthritic conditions PPRC/INDIA 51

Rosemary Rosmarinus officinalis

PPRC/INDIA 52

Rosmarinus officinalis

• The leaves of this plant contain carnosal, oleanolic

acid rosmarinic acid and ursdic acid which acts as

an anti-inflammatory activity

PPRC/INDIA 53

Red pepper Capsicum sp.

PPRC/INDIA 54

Capsicum sp.

• It interferes with pain perception

• It contains capsaicin salicylates and others

• These help to relieve arthritis

PPRC/INDIA 55

Sesame seeds Sesamum indicum

PPRC/INDIA 56

Sesamum indicum

• Chinese folk medicine to eat seeds

• ½ ounce of the seeds contain 4 gm of essential

fatty acids, 175 mg of calcium, 64 mg of

magnesium, 0.73 mg of copper

• Increased copper intake may be important during

arthritis attacks

• A rind ½ ounce of seeds & sprinkle on food PPRC/INDIA 57

Stinging nettle Urtica dioica

PPRC/INDIA 58

Urtica dioica

• Official remedy for rheumatism in Germany

• Most important herb to consider for treating early

onset arthritis

• Contains anti-inflammatory component similar to

that of steroid drugs

• Dose: 1 tablespoon juice thrice a day, freeze the

juice if needed PPRC/INDIA 59

Thunder god vine Tripterygium wilfordii Hook f.

PPRC/INDIA 60

Tripterygium wilfordii Hook f.

• It is a perennial vine-like plant that grows in

Southern China and Taiwan

• Root extract is for treatment of various auto-

immune and inflammatory diseases including RA

PPRC/INDIA 61

Turmeric Curcuma longa

PPRC/INDIA 62

Curcuma longa

• Curcumin, the yellow pigment of Turmeric has

significant anti-inflammatory action

• Curcumin – effective as cortisone in inflammation

• Dosage: 400-600 mg thrice a day

• Non-toxic dietary pigment quite useful in arthritis

• It is effective in liver infections PPRC/INDIA 63

Wild cucumber bark

PPRC/INDIA 64

Wild cucumber bark

• Best plant for treating rheumatism and arthritis

• It is to be taken in drinking alcohol or tea

PPRC/INDIA 65

Wild yam Dioscorea villosa

PPRC/INDIA 66

Dioscorea villosa

• Contains “Diosgenin” a steroid constituent with

anti-inflammatory properties

• Wild yam tea popular folk remedy for muscular

rheumatism

• Dosage: 1 ounce of wild yam root + 1 ginger root

= fill jar with boiling water – mixture at room

temp. Drink 2 – 3 cups / day PPRC/INDIA 67

Willow Salix spp.

PPRC/INDIA 68

Salix spp.

• Active principle: “Salicin”

• Pain relieving and anti-inflammatory properties

PPRC/INDIA 69

Wintergreen Gaultheria procumbens

PPRC/INDIA 70

Gaultheria procumbens

• Chief active principle: Methylsalicylate

• Dried herb is used

PPRC/INDIA 71

Yucca Yucca filamentosa

PPRC/INDIA 72

Yucca filamentosa

• To reduce arthritic pain

• Saponin extract of Yucca showed positive

therapeutic effect

• It decreases bacterial endotoxin absorption thus

reducing inhibition of cartilage synthesis

PPRC/INDIA 73

Thank you !!