HERBAL TREATMENT AND RHEUMATOID ARTHRITIS: AN OVERVIEW

About Authors:
Prabhakar Sharma^*1, Prakash Pandey¹, Sunil Roshan¹, Ashish Garg2, Vikas Pandey³, Anil Pasi⁴
¹Department of Pharmacognosy, GRKIST (Pharmacy), Jabalpur, M.P.
²Department of Pharmaceutics, GRKIST (Pharmacy), Jabalpur, M.P.
³Department of chemistry, RDVV, Jabalpur, M.P.
⁴College of pharmacy, IPS academy, Indore, M.P.
*mr.pks19@gmail.com, pksmp11@gmail.com

Abstract
Sometimes Herbal medicines are referred as herbalism or natural medicine is the use of herbs for their therapeutic or medicinal value, an herb is a plant or plant part valued for its medicinal, aromatic or savory qualities. Herb plants produce and contain a variety of chemical substances that act upon the body herbalism has a long tradition of use outside of conventional medicine. It is becoming more main stream as improvements in analysis and quality control along with advances in clinical research show the value of herbal medicine in the treating and preventing disease. By definition, ‘traditional’ use of herbal medicines implies substantial historical use, and this is certainly true for many products that are available as ‘traditional herbal medicines’.

REFERENCE ID: PHARMATUTOR-ART-1793

Introduction
Sometimes Herbal medicines are referred as herbalism or natural medicine is the use of herbs for their therapeutic or medicinal value. The world health organization (WHO) has reported traditional medicine as including therapeutic practices that have been in preserverance, often for hundreds of years, before the progress and expansion of modern medicine and are still in use today [Gansser, 1964]. Herbal supplements have been employed for thousands of years in the east and have had a recent renewal in popularity among consumers in the west [Jahangir et al., 2009]. Every tradition on earth, through written or oral tradition, has build on the vast variety of healing plants for their therapeutic properties. The number of herbal products accessible today was commenced from the same traditional formulas or ingredients. Herbal medicine is still the backbone of about 75–80% of the world community, mainly in the advanced countries, for primary health care because of better liberal reliability, better compatibility with the human body and lesser side effects [Kamboj V. P. 2000]. Plants have the capacity to synthesize a wide variety of chemical compounds that are used to perform important biological functions, and to protect against attack from predators such as arthoprods, fungi and herbivorous mammals. Many of these phytochemicals have favourable effects on long-term health when spend by humans, and can be used to effectively treat human diseases. Plants had been used for medicinal purposes long before recorded past history. Ancient Chinese as well as Egyptian papyrus writings describe medicinal uses for plants as early as 3,000 BC Indigenous cultures (such as African and native American) used herbs in their healing practices, while others developed traditional medical systems (such as Ayurveda and traditional Chinese medicine) in which herbal therapies were used.

Rheumatoid Arthritis:-
Rheumatoid arthritis is a chronic inflammatory disease discriminate by joint swelling, joint tenderness, as well as destruction of synovial joints, well known to severe disability and immature mortality [Scott et al., 1987, Mitchell et al.1986, Pincus et al., 1984, Isomaki and Wolfe., 1992].

Classification: - There are several diseases where joint pain is primitive, and is considered the main character. Generally when a person has "arthritis" it is said that they have one of these diseases, which include many diseases such as Osteoarthritis, rheumatoid arthritis, gout as well as pseudo-gout, septic arthritis, ankylosing, and spondylitis, juvenile idiopathic arthritis, and still's disease.

Signs and Symptoms: -Certain signs and symptoms are normally seen to most types of arthritis. It's necessary to recognize early signs as well as symptoms of arthritis and to consult with a doctor for diagnosis and treatment.Jointpain, stiffness, swelling, and inflammation are among the dangerous signs and early symptoms of arthritis.

Causes of arthritis: -The causes of arthritis depend on the form of arthritis. Causes include injury (leading to osteoarthritis), metabolic abnormalities (such as gout and pseudogout), hereditary factors, the directs and indirect effect of infections (bacterial and viral), as well as a misdirected immune system along with autoimmunity (such as in rheumatoid arthritis and systemic lupus erythematosus) .

Diagnosis: -All types of arthritis probably features pain, which patterns may differ depending on the arthritis as well as the location. It (RA)is generally problematic in the morning and associated with stiffness; in the primary stages, patients do not show any symptoms after a morning shower. Osteoarthritis, on the other side, tends to be bad after exercise. In the old and young, pain might not be the more effective ; the aged patient simply not move more, the infantile patient do not use the affected limb.

Animal model for study of arthritic activity
Collagen induced arthritic rats: Collagen type-ii arthritis results when animal’s such as rats are immunized against homologous type ii collagen. The producing polyarthritis is characterized by marked cartilage destruction which is associated with immune complex deposition on articular surfaces, bone reabsorption and periosteal proliferation and moderate to marked synovitis and inflammation [Trentham DE et al.1977, Terato K et al1982]. The lesion induced is somewhat more analogous to those seen in human rheumatoid arthritis [Bendele AM., 2001]. CIA is done in female rats by immunization with native hetrologous or bovines type-ii collagen emulsified in incomplete fraunds adjuvant (IFA) emulsion (2 mg/ml) subcutaneously in the tail 2-3 cm from the body or over the back at three sites (250 μl) divided on day 0 and day 7 [Rosana DI Paola et al.2008,Mohammad KM et al2010].

Adjuvant induced arthritic rats: Rat adjuvant arthritis is widely used for evaluation of various anti-arthritic agents. The hallmarks of this model are reliable onset and progression of robust easily assessable, polyarticular inflammation, marked bone reabsorption and periosteal bone proliferation. In this model male lewis rats (160-200 grams 7/group) are generally used in studies of adjuvant arthritis. Induction of adjuvant arthritis is done with either frauds’ complete (FCA) supplemented with adjuvant n, ndioctylddecyl- n’,n-bis(2-hydroxyethyl) propanediamine (LA). Adjuvant can be injected at the base of the tail or in one of the foot pad. In case if the injection is into the footpad, it allows study of the acute inflammatory reaction in that local area as well as the immunological reaction that develops approximately 9 days later in the contra lateral paw and various organs. In the later stages of disease (day 12+), adjuvant arthritis rats are often relatively immobile due to severity of paw swelling and so require special care to insure that they have access to water and food. [Hemraj et al., 2012, Mohammad et al., 2010, Bendele et al.,2001].

Mechanism of action: Arthritis is a complex family of musculoskeletal disorders consisting of more than 100 different diseases or conditions that smash joints, bones,cartilage, muscles and other connective tissues, restrain or halting physical movement. Rheumatoid arthritis (RA) is a form of inflammatory arthritis and an autoimmune disease.

Current treatment: There is no cure for either rheumatoid or osteoarthritis. Treatment options vary depend’s on the type of arthritis and include physical therapy, lifestyle changes (including exercise and weight control),. Medications can help reduce inflammation in the joint which reduces pain. More often, by decreasing inflammation, the joint damage condition may be slowed. In general, studies have shown that physical exercise of the affected joint can have noticeable improvement in terms of long-term relief from pain. Furthermore, exercise of the arthritic joint is encouraged to maintain the health of the particular joint and the overall body of the person [Ettinger et al., 1997]. In arthritis the joints become stiff and the range of movement may be limited. Physical therapy for treatment has been shown to significantly improve function, reduce pain, and delay need for surgical intervention in advanced cases [Fransen et al., 2001]. Exercise often focuses on improving muscle strength, allowance and flexibility. In some cases, exercises and physical workout may be designed to train balance. Occupational therapy can furnish assistance with activities as well as equipment. There is no. of plants which are used for arthritis treatment such as ajuga bracteosa, alangium salvifolium, aipinia galangal, aniometes malabarica, aristolochia bracteata, bacopa moniera. Current approach for treatment are NSAIDS, corticosteroids, Methotrexate, Sulfasalazine, Tumor Necrosis Factor Inhibitors etanercept, adalimumab and infliximab, T-cell Costimulatory Blocking Agents abatacept, B cell Depleting Agents rituximab, Interleukin-1 (IL-1) Receptor Antagonist Therapy anakinra Intramuscular Gold Other Immunomodulatory and Cytotoxic agents .

Conclusion
Rheumatoid arthritis (RA) is a chronic systemic disease, characterize by inflammation of multiple joints and in bones , muscles, the severity of the disease varies from one person to other person ranging from minor pain along with discomfort to severe inflammation, with joint damage and deformity. Arthritis is an most threatening disease worldwide. There are various plants are used for treatment of arthritis viz. Momordica charantia, Enicostema littorale, Eugenia jambolena, Azadirachta indica, Pterocapus marsupium, Trigonella foenum-graecum, Curucuma longa, Embica officinalis, Tinosfora cordifolia and Picrorrhiza kurrooa. The plants provide essential compounds with active principles, having minimal side effects, proven to be useful for arthritis control. This review makes an attempt to give scientific account of use of valuable medicinal plants extracts in arthritis.

References

Bendele AM. Animal models of rheumatoid arthritis. J Musculoskel Neuron Interact 2001; 377-385.
Gansser, A., Geology of the Himalayas, Interscience, New York, 1964, p. 289
Ettinger JR., W. H.; Burns, R.; Messier, S. P.; Applegate, W.; Rejeski, W. J.; Morgan, T.;
Shumaker, S.; Berry, M. J. (1997). the journal of the american medical association 277 (1): 25–31.
Fransen M, Crosbie J, Edmonds J (January 2001). "physical therapy is effective for patients with osteoarthritis of the knee: a randomized controlled clinical trial". J. Rheumatol. 28 (1): 156–64.
Hemraj Vashist et al, Animal models for arthritis-a review. International Journal of Recent
Advances in Pharmaceutical Research, 2012; 2(1): 20-25
Isomaki H. Long-term outcome of rheumatoid arthritis. J Rheumatol suppl 1992; 95:3–8.
Jahangir et al 2010; use of herbal products and potential interactions in patients with Cardiovascular diseases, J Am Coll Cardiol 9; 55(6): 515-525.
Kamboj V. P., Herbal Medicine, Current Science, 78(1), 10, 2000
Mitchell D.M., Spitz P.W.,et al. Survival, prognosis, and causes of death in rheumatoid arthritis. Arthritis Rheum 1986; 29:706–14.
Mohammad K.M.., Taeem R., Hamed S. 2010; Development of a new animal model-bioassay procedure for the evaluation of xanthin oxidase inhibitors. 5: 3750-3755.
Pincus T, Callahan LF, Sale WG, Brooks AL, Payne LE, Vaughn WK. 1984; Severe functional declines, work disability, and increased mortality in seventy-five rheumatoid arthritis patients studied over nine years. Arthritis Rheum 27: 864–72.
Rosana Di Paola, Salvatore Cuzzocrea. Autoimmunity of animal model of arthritis. Autoimmunity review.2008; 8:73-75.
Scott D.L., Symmons D.P., Coulton BL, Popert AJ. 1987, Long-term outcome of treating Rheumatoid arthritis: results after 20 years. Lancet 1:1108–11.
Trentham D.E., Townes A.S., Kang A.H. Autoimmunity to type ii collagen: an experimental model of arthritis. J Exp Med.1977; 146:857-868.
Terato K, Hashida R, Miyamoto K, Morimoto T, Katay, Kobayashi S, Tajima T, Otake S, Horni H, Nagai Y. Histological, immunological and biochemical studies on type ii collagen arthritis in rats. Biomed Res 1982; 3: 495-523.